CLINICAL SPECTRUM AND CAUSATIVE AGENTS OF ADVERSE CUTANEOUS DRUG REACTIONS:

A RETROSPECTIVE STUDY FROM BARAU DIKKO TEACHING HOSPITAL KADUNA, NIGERIA

Abstract

Background: Adverse cutaneous drug reactions (ACDRs) are significant causes of dermatological
morbidity, ranging from mild eruptions to severe life-threatening conditions. Their patterns and
implicated drugs vary across settings, and local data are essential to inform clinical practice and
pharmacovigilance.
Aim: To describe the clinical patterns of ACDRs, identify implicated drug classes, and assess
associations with patient demographics at a tertiary dermatology clinic in Kaduna, Nigeria.
Methods: Electronic Medical Records (EMRs) of patients diagnosed with ACDRs over a 10-year
period (2015–2024) were reviewed. Diagnosis was based on clinical evaluation documented by
dermatologists. Causality assessment was performed using standard clinical judgment, and
severity was classified into mild and severe forms (including Stevens–Johnson syndrome and toxic
epidermal necrolysis). Data extracted included socio-demographic characteristics, clinical
patterns, suspected causative drugs, and severity. Descriptive statistics were used, and associations
were tested using the chi-square test, with p < 0.05 considered statistically significant.
Results: Of 4,426 dermatology patients seen during the study period, 62 had ACDRs, giving a
proportion of 1.4%. The mean age was 28.0 ± 17.3 years, with a slight female predominance
(51.6%). Fixed drug eruption was the most common pattern (85.5%), while severe reactions
accounted for 14.5%. Sulfonamides (48.4%) and non-steroidal anti-inflammatory drugs,
particularly diclofenac (27.4%), were the most frequently implicated medications. Other
implicated drugs included antiepileptics and antifungals. Angiotensin-converting enzyme
inhibitors (ACEIs) were associated with angioedema. Two patients (3.2%) had suspected reactions
to the COVID-19 vaccine (generalized hypopigmentation and pityriasis rosea). No statistically
significant association was found between reaction type and age group or gender (chi-square test,
p > 0.05).
Conclusion: ACDRs in this setting are predominantly fixed drug eruptions, with sulfonamides and
NSAIDs as the leading implicated drug classes. These findings highlight the need for strengthened
pharmacovigilance and cautious use of high-risk medications