30%), followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (21.90%) and anti-epileptics (13.20%) [Figure 2]. Other drugs presenting with CADRs included ramipril (n = 1, 1.09%), enalapril (n = 1, 1.09%), amlodipine kinase inhibitor Nilotinib (n = 1, 1.09%), steroids (n = 2, 2.19%), lithium (n = 2, 2.19%), oral contraceptives (n = 1, 1.09%), folic acid (n = 1, 1.09%), benzoylperoxide (n = 1, 1.09%), and chlorpromazine (n = 1, 1.09%). Fixed drug combinations causing cutaneous manifestations included tetracycline and ibuprofen (n = 1, 1.09%), diclofenac and allopurinol (n = 1, 1.09%), rifampicin and isoniazid (n = 1, 1.09%), and dapsone and clofazimine (n = 1, 1.09%). One fatal CADR, toxic epidermal necrolysis (TEN), was seen with ciprofloxacin which was prescribed for a case of suspected enteric fever.

Figure 2 Drug groups causing CADRs Maculopapular rash was the most common CADR (n = 39, 42.85%), followed by fixed drug eruption (FDE) (n = 19, 20.87%), urticaria (n = 11, 12.08%) and photosensitivity (n = 4, 4.39%). Bullous eruption, erythema multiforme, lichenoid eruption, and TEN were seen in 1 (1.09%) patient each. Other CADRs accounted for 14 (15.38%) cases [Tables [Tables11 and and22]. Table 1 Incidence of different CADRs Table 2 Incidence of different CADRs with commonly used drugs The lag period between starting the drug and appearance of cutaneous reactions varied between 2 and 14 days in maximum number of cases (n = 73, 80.2%), within 2 days in 2 (2.19%) and between 15 and 30 days in 16 (17.58%) cases. Of all the 91 cases, 3.29% were classified as definite (n = 3), 76.

98% as probable (n = 70) and 19.78% as possible (n = 18). Outcome of CADR showed 65 (71.42%) patients cured, 25 (27.47%) improved and 1 (1.11%) expired. DISCUSSION Cutaneous reactions are the most common manifestations of ADRs.[7] A wide spectrum of cutaneous manifestations ranging from maculopapular rashes to TEN can be produced by different classes of drugs. Reactions include pruritis, maculopapular and morbilliform rashes, erythema multiforme, exfoliative dermatitis and others. Some severe CADRs may Brefeldin_A result in serious morbidity and even death.[8] Most drug-induced skin eruptions can be described as erythematous, morbilliform or maculopapular in nature.[9] In the present study, a total of 91 CADRs were reported. This number may not represent the true prevalence of CADRs during this period as patients with incomplete history and doubtful diagnosis were not included. Moreover, the exclusion of many minor cutaneous reactions which do not require hospitalization and underreporting by patients might have contributed to the decreased prevalence of CADRs in this study. Mild predominance of CADRs was seen in females as compared to males in concordance with other studies.