Patients with severe cutaneous adverse drug reactions have extremely high hair cortisol concentrations that do not correlate with presence of depression.

Background: Hair cortisol concentrations (HCC) +/- DHEA, a depression and stress biomarker has not been studied in severe cutaneous adverse drug reactions (SCAR). Objective: To determine DHEA/HCC correlation with SCAR-associated depression and compare the ratio with published values. Methods: Depression was assessed using M.I.N.I. and DHEA/HCC measured in epidermal necrolysis (EN) and DRESS patients at a South African tertiary hospital. PubMed search was conducted for publications documenting DHEA/HCC. Results: 22/37 participants enrolled were depressed, significantly higher in EN than DRESS. HCC, DHEA or DHEA/HCC were not different between SCAR; depressed versus non-depressed; and presence versus absence of suicidal ideation. DHEA/HCC was unaffected by HIV or TB status. HCC was high in all SCAR patients, regardless of gender. HCC in SCAR was extremely high compared to published healthy controls [309.33 (28.9 - 1835.7) vs. 46.1 (17.7 - 153.2), p = <0.01]; depressed subjects [1349.67 (SD 1935.59) vs. 7.26 (SD 0.47), p = <0.01] and depressed HIV positive males [1479.61 (SD 2313.74) vs. 18.02 (SD 9.37), p =0.0003]. Conclusions: HCC was high and sustained in SCAR irrespective of HIV, TB, or depression status. No association existed between DHEA/HCC ratio and depression. Sustained high cortisol levels potentially impact long-term SCAR-associated outcomes.

Grantor dc:publisher.institution

Department of Medicine

Year dc:date.issued

2024

Author dc:creator

• Zitha, Eddy

Advisors dc:contributor.advisor

• Lehloenya, Rannakoe
• Khumalo, Nala
• Peter, Jonny

• Dermatology

Handle dc:identifier.uri

http://hdl.handle.net/11427/41180

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/41180