phenytion, carbamazepine, sodium valproate and lamotrigine induced cutaneous reactions

Adverse effects of antiepileptic drugs including cutaneous reactions may not only affect the result of treatment and quality of life, but can also be fatal if severe. Skin rash is more likely to occur during the first few months of treatment. The objective of this study was description of skin rashes in users of four antiepileptic drugs. We identified skin rashes of phenytoin, carbamazepine, sodium valproate and lamotrigine in a prospective descriptive cross sectional study in 1086 cases. Patients suffering from skin diseases, systemic illness with cutaneous presentations, radiation or drug–induced rash from non antiepileptic drugs and patients unwilling to be examined monthly were excluded. All the cases were followed for 6 months. Skin rashes occurred in 2.1% (23/1086) of patients. Twelve patients were male and the remaining 11 were female. The age of patients ranged from 8 to 71 (mean 24) years. Maculopapular rash and Stevens Johnson’s syndrome formed 56.5% (13/23) and 30.4% (7/23) of symptomatic cases, respectively. Toxic epidermal necrolysis, erythema multiform and psoriatic dermatitis each were detected in 4.3% (1/23) of patients. The interval between the beginning of antiepileptic as monotherapy or an add-on drug and skin rash presentation was from 3 to 45 (mean 13)days. Combination therapy was found to increase the incidence of rash, but dosage of drug did not show such effect. Special attention to skin rash in the first month of therapy and monotherapy instead of polytherapy is recommended.