One of the most important tasks of contemporary pharmacy is the search for new drugs characterised by high activity and being safe to use. Unfortunately, the majority of drugs show some adverse drug reaction (ADR) or toxic effects, usually related to intake of an overdose, taking a drug for a too long time or hypersensitivity to a given drug components. Side effects can be often minimised by administering another pharmaceutical form of drug or an alternative drug from another chemical group. This solution is particularly important in treatment of the elderly whose enzymatic efficiency is reduced. An important element of correct hospitalisation is to report and register all unwanted side effects of a given drug, which would eventually lead to a shortening of the treatment, reduction of its cost and help avoid the undesired effects in other patients. Each report on the undesired side effect of a given drug or on the frequency and conditions of its occurrence contributes to the knowledge on a given drug and permits optimisation of the pharmacotherapy. The character and intensity of the adverse drug reaction differ from very mild to highly serious. The widest range of side effects has been observed to accompany the use of cytostatics, antibiotics and antiinflammatory drugs. The most often developing ADR include dysfunctions of the alimentary track, allergic reactions and skin changes. The undesired side effects can be caused the mechanism of the drug activity (cough after of inhibitors ACE), the chemical structure (skin changes after application of coxibes, stomach dysfunctions after acetylcysteine) or by a combination of these two factors (stomach ulcers after administration of non-steroid antiinflammation drugs).

In the years 2000-2004 at the Department of Dermatology a project was undertaken to monitor patients who developed skin changes as a result of ADR of the drugs administered. In the five years 57 patients, including 30 men and 27 women were observed. The majority of the patients developed macular - papular rash (16), urticaria medicamentosa and Quincke's oedema (16) and erythema multiforme (15). The other cases included erythroderma (5), anaphylactic shock (2), lichenoid dermatosis (1), vesicular eruption (1) and Hoigne's syndrome (1). The most probable factors producing these changes were concluded to be antibiotics (45%), non-steroid antiinflammation drugs (33%) and the other drugs responsible were from different pharmacological and chemical groups (carbamazepine, diltiazem, hydrocortisone, methotrexate and herbs). The frequency of occurrence of skin changes of particular type in age groups were also analysed. The greatest number of skin changes in response to drug therapy was in the age group 41 - 60, while for the age group > 60 ADR revealed the greatest diversity in the clinical picture. The most probable explanation of these findings are the polypragmasy applied in the elderly patients and the interdrug interaction as well as decreased efficiency of the organic clearances.

The conclusion is that although the cases of drug rashes made a small percent of those in hospitalised patients of the Department of Dermatology, the fact of their occurrence as a result of adverse drug reaction should be taken into consideration in planning pharmacological treatment.

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1. DELAYED TYPE HYPERSENSITIVITY TO PENICILLIN IN A PATIENT WITH MORPHEA - CASE REPORT