Cyclosporine - An eye opener in severe cutaneous adverse drug reactions

Severe cutaneous adverse drug reactions (sCADR) comprise the life-threatening Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Aim: The aim of this study was to assess the efficacy and safety of cyclosporine in treating sCADR. Materials and Methods: A retrospective study was done from data collected over a three year period at the department of dermato-venereo-leprology at a tertiary care centre in South India. Out of thirty-four in-patients with adverse drug reactions (ADRs), twenty who fulfilled the inclusion criteria (one DRESS, ten SJS and nine TEN patients) were taken for the study. Fixed drug eruption and TEN with multiorgan failure were excluded. Methodology: Patients were evaluated, screened for multiorgan involvement, offending drug/drugs were withheld, routine investigations done and the severity assessed based on SCORTEN. Treatment was initiated with injection dexamethasone 1mg/kg/day and supportives. In those with unsatisfactory response in three days, if not contra-indicated, oral cyclosporine was added at a dose of 100mg bid for 2 weeks, tapered by 50mg/week and stopped once the lesions healed. Efficacy of cyclosporine was assessed using the average number of stabilization days, the rate of cutaneous re-epithelialization and the duration of hospitalization. Results: For SJS, the mean duration of stabilization was 2 days, re-epithelialization 7.9 days and hospital-stay 18.1 days. For TEN, the mean duration of stabilization was 3.9 days, re-epithelialization 12.8 days and hospital-stay 29.2 days. Conclusion: With the use of cyclosporine, patients stabilized early, re-epithelialization occurred early; concomitant use with steroids helped in early tapering of steroid dose. Recovery time and duration of hospital stay were shortened. Cyclosporine was well tolerated, no significant toxicity was noted; there was no mortality.