Indian Dermatology Online Journal

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 12  |  Issue : 1  |  Page : 78--83

The role of frozen section in the rapid diagnosis of severe cutaneous adverse drug reactions


Rajam Nicholas1, Mandeep Singh Bindra2, Lydia Mathew1, Dharshini Sathishkumar1, Jeyaseelan Lakshmanan3, Renu George1 
1 Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Renu George
Department of Dermatology, Venerology and Leprosy, Christian Medical College, Vellore, Tamil Nadu
India

Context: Early diagnosis is the mainstay in the management of severe cutaneous adverse reactions (SCARs) to drugs. Aims: To study the role of frozen section in the rapid diagnosis of SCARs and the impact on outcome of the affected patients. Settings and Design: A single-blind, hospital-based study was conducted from December 2014-July 2016. Methods and Material: We biopsied 32 adults with SCARs diagnosed by clinical features and standard criteria. The histopathological features seen on frozen sections were compared to that of paraffin blocks. The impact of rapid diagnosis on the clinical outcome was studied in toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug rash with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Statistical Analysis: Z test was used to compare two proportions. Kappa statistic, sensitivity, specificity, positive predictive value, and negative predictive value of the frozen section diagnosis were calculated in TEN/SJS and DRESS using MedCalc software. Results: Frozen and paraffin sections were done in TEN/SJS spectrum (13), DRESS (17), and AGEP (2). The sensitivity, specificity and kappa values for frozen section diagnosis in SJS/TEN and DRESS were 91.7%, 95%, 0.867 and 94.4%, 100%, 0.937 respectively. The concordance between frozen and paraffin section diagnosis was 100% in TEN, SJS, DRESS and AGEP. All the 6 patients with TEN and 2 with AGEP survived. Taking the worst-case scenario, the mortality in SJS was 28.6%. The mortality among patients with DRESS was 11.8%. Conclusions: Frozen section helps in the rapid diagnosis and early treatment of SCARs and differentiates it from diseases that mimic it.


How to cite this article:
Nicholas R, Bindra MS, Mathew L, Sathishkumar D, Lakshmanan J, George R. The role of frozen section in the rapid diagnosis of severe cutaneous adverse drug reactions.Indian Dermatol Online J 2021;12:78-83


How to cite this URL:
Nicholas R, Bindra MS, Mathew L, Sathishkumar D, Lakshmanan J, George R. The role of frozen section in the rapid diagnosis of severe cutaneous adverse drug reactions. Indian Dermatol Online J [serial online] 2021 [cited 2021 Apr 15 ];12:78-83
Available from: https://www.idoj.in/article.asp?issn=2229-5178;year=2021;volume=12;issue=1;spage=78;epage=83;aulast=Nicholas;type=0