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Background <p>Phenytoin continues to be widely used in a number of countries as an antiseizure medication despite the introduction of newer agents. However, cutaneous adverse drug reactions (CADRs) associated with phenytoin remain a significant clinical concern, with manifestations ranging from mild maculopapular rashes to severe, life-threatening dermatological conditions.</p> Objective <p>This study aimed to evaluate clinical risk factors and develop a clinical prediction score for phenytoin-induced CADRs in hospitalized patients.</p> Methods <p>A retrospective cohort study included 447 patients aged ≥ 15 years who received phenytoin for the first time and were followed for at least 12 weeks. Data on demographics, clinical characteristics, comorbidities, concomitant drugs, and CADR occurrence were collected. Logistic regression identified independent risk factors, and a clinical prediction score was developed and evaluated using the area under the receiver operating characteristic curve (AuROC).</p> Results <p>Forty-seven (10.5%) patients developed CADRs. Multivariable analysis identified malignancy (adjusted OR = 6.27), HIV infection (adjusted OR = 47.1), alcohol dependence (adjusted OR = 37.14), concomitant diazepam use (adjusted OR = 11.07), and concomitant carbapenem use (adjusted OR = 9.88) as independent risk factors. The prediction score exhibited good discrimination with an AuROC of 0.856 (95% CI: 0.790–0.922). Internal validation yielded a consistent AuROC of 0.896 (95% CI: 0.836–0.955).</p> Conclusion <p>This study developed a clinical prediction score for phenytoin-induced CADRs in hospitalized patients, demonstrating good predictive ability using readily available clinical factors. This tool may help clinicians identify high-risk individuals for closer monitoring. External validation through prospective studies is needed to confirm its clinical utility.</p>

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Risk factors and predictive score for phenytoin-induced cutaneous reactions

  • 期刊论文

  • 发表日期：

    2025年12月29日

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  • Chumpol Anamnart,
  • Ram Kitjarak

摘要

Background

Phenytoin continues to be widely used in a number of countries as an antiseizure medication despite the introduction of newer agents. However, cutaneous adverse drug reactions (CADRs) associated with phenytoin remain a significant clinical concern, with manifestations ranging from mild maculopapular rashes to severe, life-threatening dermatological conditions.

Objective

This study aimed to evaluate clinical risk factors and develop a clinical prediction score for phenytoin-induced CADRs in hospitalized patients.

Methods

A retrospective cohort study included 447 patients aged ≥ 15 years who received phenytoin for the first time and were followed for at least 12 weeks. Data on demographics, clinical characteristics, comorbidities, concomitant drugs, and CADR occurrence were collected. Logistic regression identified independent risk factors, and a clinical prediction score was developed and evaluated using the area under the receiver operating characteristic curve (AuROC).

Results

Forty-seven (10.5%) patients developed CADRs. Multivariable analysis identified malignancy (adjusted OR = 6.27), HIV infection (adjusted OR = 47.1), alcohol dependence (adjusted OR = 37.14), concomitant diazepam use (adjusted OR = 11.07), and concomitant carbapenem use (adjusted OR = 9.88) as independent risk factors. The prediction score exhibited good discrimination with an AuROC of 0.856 (95% CI: 0.790–0.922). Internal validation yielded a consistent AuROC of 0.896 (95% CI: 0.836–0.955).

Conclusion

This study developed a clinical prediction score for phenytoin-induced CADRs in hospitalized patients, demonstrating good predictive ability using readily available clinical factors. This tool may help clinicians identify high-risk individuals for closer monitoring. External validation through prospective studies is needed to confirm its clinical utility.