51
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Understanding Epidermal Necrolysis after the Initial Hospitalization. J Invest Dermatol 2021; 141:1139-1140. [PMID: 33888216 DOI: 10.1016/j.jid.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 11/22/2022]
Abstract
In-hospital mortality for epidermal necrolysis (EN) has been well-characterized, but less is known about the long-term complications. Marxer et al. (2020) report mortality rates of 7.4% during the initial hospitalization, 4.8% within 90 days, and 7.6% after 91 days. Compared with that of matched controls, long-term mortality was not increased, highlighting the importance of understanding the long-term sequelae of EN survivors.
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52
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Lian SB, Oh CC, Yeo YW, Lee HY. Spectrum of Nail Sequelae in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. JAMA Dermatol 2021; 157:117-119. [PMID: 33295942 DOI: 10.1001/jamadermatol.2020.4664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Yi Wei Yeo
- Department of Dermatology, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore
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53
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Abstract
Systemic diseases often manifest with cutaneous findings. Many pediatric conditions with prominent skin findings also have significant pulmonary manifestations. These conditions include both inherited multisystem genetic disorders such as yellow-nail syndrome, neurofibromatosis type 1, tuberous sclerosis complex, hereditary hemorrhagic telangiectasia, Klippel-Trénaunay-Weber syndrome, cutis laxa, Ehlers-Danlos syndrome, dyskeratosis congenita, reactive processes such as mastocytosis, and aquagenic wrinkling of the palms. This overview discusses the pulmonary manifestations of skin disorders.
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Affiliation(s)
- Bernard A Cohen
- Division of Pediatric Dermatology, Johns Hopkins Medical Institutions, 200 N. Wolfe Street, Baltimore, MD 21287, USA.
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54
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Shanbhag SS, Koduri MA, Kannabiran C, Donthineni PR, Singh V, Basu S. Genetic Markers for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in the Asian Indian Population: Implications on Prevention. Front Genet 2021; 11:607532. [PMID: 33510770 PMCID: PMC7837290 DOI: 10.3389/fgene.2020.607532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
This review attempts to collate all the studies performed in India or comprising a population originating from India and to find out if there is an association between the HLA (human leucocyte antigen) type of individual and development of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) subsequent to medication use. The authors performed a PubMed search of all articles published in English from 2009 to 2019 for articles that studied HLA type in patients who developed SJS/TEN after intake of a specific drug in the Asian Indian population or in individuals of Asian Indian origin. The selection criteria were satisfied by a total of 11 studies that reported HLA associations with specific drugs, which induced SJS/TEN, mainly anti-epileptic drugs, and cold medicine/non-steroidal anti-inflammatory drugs. These studies involved a small number of patients, and hence, there is limited evidence to conclude if these associations can be extrapolated to a larger population of the same ethnicity. Similar multi-center studies need to be conducted with a larger sample size to confirm these associations. This would have implications in policy making and for understanding the potential of using genetic markers as a screening tool before prescribing a drug to a patient, which might make them susceptible to developing a potentially life-threatening disease such as SJS/TEN. This is possibly the only mode of primary prevention for this potentially fatal severe cutaneous adverse drug reaction.
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Affiliation(s)
| | - Madhuri A Koduri
- Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Manipal Academy of Higher Education, Manipal, India
| | - Chitra Kannabiran
- Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Kallam Anji Reddy Molecular Genetics Laboratory, L.V. Prasad Eye Institute, Hyderabad, India
| | | | - Vivek Singh
- Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Center for Ocular Regeneration (CORE), L.V. Prasad Eye Institute, Hyderabad, India
| | - Sayan Basu
- The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India.,Brien Holden Eye Research Centre (BHERC), L.V. Prasad Eye Institute, Hyderabad, India.,Center for Ocular Regeneration (CORE), L.V. Prasad Eye Institute, Hyderabad, India
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55
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Wei KC, Fang YH, Chen WC. Disseminated eruption of ectopic sebaceous glands after toxic epidermal necrolysis with good treatment response to oral isotretinoin. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_50_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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56
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Jongkhajornpong P, Ueta M, Lekhanont K, Puangsricharern V, Prabhasawat P, Chantaren P, Pisuchpen P, Kinoshita S. Association of HLA polymorphisms and acetaminophen-related Steven-Johnson syndrome with severe ocular complications in Thai population. Br J Ophthalmol 2020; 106:884-888. [DOI: 10.1136/bjophthalmol-2020-317315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 01/23/2023]
Abstract
Background/aimsTo investigate the association of genetic polymorphisms of human leucocyte antigens (HLA) class I and II genes with acetaminophen-related Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) who developed severe ocular complications (SOC) in the Thai population.MethodsA prospective case–control study including 20 unrelated Thai acetaminophen-related SJS/TEN patients with SOC and 60 Thai healthy volunteers, recruited at three university hospitals in Bangkok, Thailand, from September 2014 to August 2019. HLA genes were analysed using PCR amplification followed by hybridisation with sequence-specific oligonucleotide (SSO) probes with bead-based typing kits. The carrier and gene frequencies of individual HLA alleles in patients were compared with those in control volunteers based on dominant assumption using Fisher’s exact test.ResultsAmong HLA class I polymorphisms, HLA-A*33:03, HLA-B*44:03 and HLA-C*07:01 were significantly associated with acetaminophen-related SJS/TEN and SOC with high ORs (95% CI, corrected p value; Pc) in carrier frequency of 5.4 (1.8 to 16.3, Pc=0.0274), 9.0 (95% CI 2.7 to 30.4, Pc=0.0034), and 9.3 (2.8 to 30.2, Pc=0.0022), respectively. There were no significant HLA class II associations with the disease after corrected for a total number of alleles tested.ConclusionHLA-B*44:03 was strongly associated with acetaminophen-related SJS/TEN patients who developed SOC in Thai population. In addition, we also found moderate to strong associations with HLA-A*33:03 and HLA-C*07:01 suggesting their potential roles in the pathogenesis of SOC in acetaminophen-related SJS/TEN.
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57
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Shanbhag SS, Shah S, Singh M, Bahuguna C, Donthineni PR, Basu S. Lid-Related Keratopathy in Stevens-Johnson Syndrome: Natural Course and Impact of Therapeutic Interventions in Children and Adults. Am J Ophthalmol 2020; 219:357-365. [PMID: 32681905 DOI: 10.1016/j.ajo.2020.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/23/2020] [Accepted: 07/08/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare the long-term visual outcomes of different management strategies in children and adults with Stevens-Johnson Syndrome (SJS)-induced chronic lid-related keratopathy. DESIGN Retrospective comparative case series. METHODS This study included 705 eyes of 401 patients (81 children and 320 adults) with SJS who presented with chronic lid-related keratopathy between 1990 and 2015. Affected eyes received either conservative therapy [topical medications (n = 363)] or definitive management (n = 342) that included mucous membrane grafting (MMG), prosthetic replacement of the ocular surface ecosystem (PROSE) contact lenses, or both. The primary outcome measure was change in best corrected visual acuity (BCVA) over time. The secondary outcome measure was the odds of developing corneal ulceration or perforation in the first year. RESULTS The treatment subgroups were comparable at baseline in terms of BCVA and previous management (P > .10). Over 10 years, children and adults who received conservative therapy lost at least 5 lines of median BCVA and carried a 3 times higher risk of developing corneal ulceration in the first year. Conversely, definitive therapy provided significant benefit by improving median BCVA (P < .0001). In children, MMG was more effective than PROSE (P = .009), whereas PROSE was more effective than MMG in adults (P = .028). However, the combination of MMG followed by PROSE provided the best results in both children and adults (P < .036). CONCLUSIONS Both MMG and PROSE changed the natural course and helped in preserving and improving vision in eyes with SJS-induced lid-related keratopathy. Regardless of age, those who received both MMG and PROSE had the best long-term visual outcomes.
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58
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Kume M, Nakagawa Y, Kiyohara E, Arase N, Wataya-Kaneda M, Yaga M, Yanagawa M, Fujimoto M. A case of zonisamide-induced toxic epidermal necrolysis with acute respiratory failure. Allergol Int 2020; 69:642-644. [PMID: 32439282 DOI: 10.1016/j.alit.2020.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Miki Kume
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukinobu Nakagawa
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Eiji Kiyohara
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriko Arase
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mari Wataya-Kaneda
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Moto Yaga
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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59
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The nationwide epidemiological survey of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan, 2016-2018. J Dermatol Sci 2020; 100:175-182. [PMID: 33046331 DOI: 10.1016/j.jdermsci.2020.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening severe cutaneous adverse reactions (SCARs). The first national epidemiological survey of SJS/TEN was carried out in 2008. We conducted a new survey to identify changes from the previous survey. OBJECTIVE The present survey aimed to estimate the number of SJS/TEN patients in Japan between 2016 and 2018 (primary survey) and to clarify clinical epidemiological profiles (secondary survey). METHODS A primary survey asking for numbers of SJS/TEN patients during the study period was sent to 1205 institutions nationwide. A secondary survey was sent to institutions reporting SJS/TEN patients, seeking detailed information. RESULTS Yearly prevalence per million was 2.5 for SJS and 1 for TEN. The secondary survey allowed analysis of 315 SJS cases and 174 TEN cases from 160 institutions. Mean age was 53.9 years in SJS, and 61.8 years in TEN. Mortality rate was 4.1 % for SJS and 29.9 % for TEN. In TEN, mean age and mortality rates had increased from the previous survey. The ratio of expected to observed mortality calculated by SCORTEN score was lowest with high-dose steroid therapy (0.40), followed by steroid pulse therapy (0.52). CONCLUSION The present findings suggest that the mortality rate of TEN has increased because of increases in mean ages of patients and patients with malignant neoplasm as underlying disease. When comparing the ratio of expected mortality to actual mortality, high-dose steroid therapy achieved the greatest reduction in mortality.
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60
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O'Reilly P, Whelan B, Ramsay B, Kennedy C, Meskell P, Coffey A, Wilson DM, Fortune DG, Ryan S. Patients', family members' and healthcare practitioners' experiences of Stevens-Johnson syndrome and toxic epidermal necrolysis: a qualitative descriptive study using emotional touchpoints. J Eur Acad Dermatol Venereol 2020; 35:e232-e234. [PMID: 32977354 PMCID: PMC7984232 DOI: 10.1111/jdv.16958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022]
Affiliation(s)
- P O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - B Whelan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - B Ramsay
- Charles Centre for Dermatology, University Hospital Limerick, ULHG, Limerick, Ireland
| | - C Kennedy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,School of Nursing and Midwifery, Robert Gordon University, Aberdeen, UK
| | - P Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - A Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - D M Wilson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - D G Fortune
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Psychology, University of Limerick, Limerick, Ireland
| | - S Ryan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Charles Centre for Dermatology, University Hospital Limerick, ULHG, Limerick, Ireland
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61
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Asgarpour JMS, Lam LM, Vogel TK, Goez HR, Fiorillo L. Human Leukocyte Antigen Gene Testing and Carbamazepine-Induced Toxic Epidermal Necrolysis: A Study of Pediatric Practice. J Cutan Med Surg 2020; 25:25-29. [PMID: 32909461 DOI: 10.1177/1203475420952422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening drug-induced dermatologic conditions. SJS/TEN occurs in 1-10 per 10 000 patients taking carbamazepine (CBZ) (Pratt VM, McLeod HL, Rubinstein WS et al. Medical Genetics Summaries. National Center for Biotechnology Information US; 2018: 1-527). The development of SJS/TEN is associated with variable drug metabolism and presence of an at-risk HLA haplotype. HLA-B*15:02 and HLA-A*31:01 haplotypes can produce a hyperimmune response in the setting of CBZ use in patients of Asian and European descent, respectively (Schneider JA, Cohen PR. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A concise review with a comprehensive summary of therapeutic interventions emphasizing supportive measures. Adv Ther. 2017; 34:1235-1244). OBJECTIVE The US Food and Drug Administration (FDA) and the Canadian pharmacogenomics Network for Drug Safety (CPNDS) recommend that patients with high-risk ethnic backgrounds should be genetic tested before initiating CBZ (Sukasem C, Chaichan C, Nakkrut T et al. Association between HLA-B Alleles and Carbamazepine-induced maculopapular exanthema and severe cutaneous reactions in Thai patients. Journal of Immunology Research. 2018; 1-11).We sought out to assess the awareness of this in prescribing practitioners and their standard of practice. METHODS We created a 15-question survey and distributed to pediatric neurologists and pediatricians at the University of Alberta. We hypothesized that there was a discordance between the standard of practice and the recommendation by the FDA and CPNDS. RESULTS The survey results indicated a lack of awareness of the at-risk ethnicities for CBZ-induced SJS/TEN. HLA gene testing was rarely done prior to initiation of CBZ in high-risk patients. In addition, there was a lack of awareness for standard of care for genetic testing in Canada and worldwide. CONCLUSIONS Our results demonstrate an evident gap between current prescriber practices and existing FDA and CPNDS recommendations to screen for HLA genotypes. We hope that this study captures the realistic potential to improve patient outcomes.
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Affiliation(s)
- Jessica M S Asgarpour
- 12357 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren M Lam
- 12357 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Tina K Vogel
- 12357 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Helly R Goez
- 3158 Department of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Loretta Fiorillo
- 12357 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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62
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Kuijper E, French L, Tensen C, Vermeer M, Bouwes Bavinck J. Clinical and pathogenic aspects of the severe cutaneous adverse reaction epidermal necrolysis (EN). J Eur Acad Dermatol Venereol 2020; 34:1957-1971. [PMID: 32415695 PMCID: PMC7496676 DOI: 10.1111/jdv.16339] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022]
Abstract
The severe cutaneous adverse reaction epidermal necrolysis (EN) which includes toxic epidermal necrolysis and the milder Stevens-Johnson syndrome is characterized by epidermal loss due to massive keratinocyte apoptosis and/or necroptosis. EN is often caused by a drug mediating a specific TCR-HLA interaction via the (pro)hapten, pharmacological interaction or altered peptide loading mechanism involving a self-peptide presented by keratinocytes. (Memory) CD8 + T cells are activated and exhibit cytotoxicity against keratinocytes via the perforin/granzyme B and granulysin pathway and Fas/FasL interaction. Alternatively drug-induced annexin release by CD14 + monocytes can induce formyl peptide receptor 1 death of keratinocytes by necroptosis. Subsequent keratinocyte death stimulates local inflammation, activating other immune cells producing pro-inflammatory molecules and downregulating regulatory T cells. Widespread epidermal necrolysis and inflammation can induce life-threatening systemic effects, leading to high mortality rates. Research into genetic susceptibility aims to identify risk factors for eventual prevention of EN. Specific HLA class I alleles show the strongest association with EN, but risk variants have also been identified in genes involved in drug metabolism, cellular drug uptake, peptide presentation and function of CD8 + T cells and other immune cells involved in cytotoxic responses. After the acute phase of EN, long-term symptoms can remain or arise mainly affecting the skin and eyes. Mucosal sequelae are characterized by occlusions and strictures due to adherence of denuded surfaces and fibrosis following mucosal inflammation. In addition, systemic pathology can cause acute and chronic hepatic and renal symptoms. EN has a large psychological impact and strongly affects health-related quality of life among EN survivors.
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Affiliation(s)
- E.C. Kuijper
- Department of DermatologyLeiden University Medical CentreLeidenThe Netherlands
| | - L.E. French
- Department of Dermatology and AllergyUniversity HospitalLMU MunichMunichGermany
| | - C.P. Tensen
- Department of DermatologyLeiden University Medical CentreLeidenThe Netherlands
| | - M.H. Vermeer
- Department of DermatologyLeiden University Medical CentreLeidenThe Netherlands
| | - J.N. Bouwes Bavinck
- Department of DermatologyLeiden University Medical CentreLeidenThe Netherlands
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63
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Thompson LL, Chen ST, Lawton A, Charrow A. Palliative care in dermatology: A clinical primer, review of the literature, and needs assessment. J Am Acad Dermatol 2020; 85:708-717. [PMID: 32800870 DOI: 10.1016/j.jaad.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/25/2022]
Abstract
Palliative care has been shown to improve quality of life, symptoms, and caregiver burden for a range of life-limiting diseases. Palliative care use among patients with severe dermatologic disease remains relatively unexplored, but the limited available data suggest significant unmet care needs and low rates of palliative care use. This review summarizes current palliative care patterns in dermatology, identifying areas for improvement and future investigation.
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Affiliation(s)
- Leah L Thompson
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Steven T Chen
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Andrew Lawton
- Harvard Medical School, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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64
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Noguchi Y, Takaoka M, Hayashi T, Tachi T, Teramachi H. Antiepileptic combination therapy with Stevens-Johnson syndrome and toxic epidermal necrolysis: Analysis of a Japanese pharmacovigilance database. Epilepsia 2020; 61:1979-1989. [PMID: 32761907 DOI: 10.1111/epi.16626] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-mediated diseases characterized by an extensive loss of the epidermal skin layer, often resulting in death. SJS and TEN are often triggered by certain drugs, including antiepileptic drugs (AEDs). Epilepsy is very difficult to treat and often involves the combination of two or more AEDs. In this study, we quantified not only the risk of SJS or TEN associated with single-AED therapy but also the risk related to concomitant AED treatment using reporting-derived signals. METHODS An analysis of the Japanese Adverse Drug Event Report (JADER) database was performed from the first quarter of 2004 to the fourth quarter of 2018. The single-AED signals were evaluated using the proportional reporting ratio (PRR), and the combination therapy signals were evaluated using Ω shrinkage measure and combination risk ratio (CRR). RESULTS SJS signals were associated with 11 AEDs, and TEN signals were related to 12 AEDs. Moreover, the following AED combinations were associated with SJS signals: carbamazepine-lorazepam (Ω025 : 0.33, CRR: 2.18) and fosphenytoin-lorazepam (Ω025 : 0.99, CRR: 39.20). The TEN signals were related to the following combinations: clobazam-gabapentin (Ω025 : 0.35, CRR: 3.14), phenytoin-gabapentin (Ω025 : 0.03, CRR: 2.18), valproic acid-gabapentin (Ω025 : 0.15, CRR: 2.25), clobazam-clonazepam (Ω025 : 0.03, CRR: 2.93), clobazam-valproic acid (Ω025 : 0.29, CRR: 1.55), fosphenytoin-lamotrigine (Ω025 : 0.05, CRR: 7.37), and lacosamide-levetiracetam (Ω025 : 0.74, CRR: 1.85). SIGNIFICANCE This study identified two AED combinations that increased the SJS signals and seven combinations that increased the TEN signals. Although AED monotherapies require attention for SJS and TEN, some AED combinations require extra caution.
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Affiliation(s)
- Yoshihiro Noguchi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Mirai Takaoka
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Tsuyoshi Hayashi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Tomoya Tachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Hitomi Teramachi
- Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan.,Laboratory of Community Health Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
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65
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Pruis SL, Jeon YK, Pearce F, Thong BYH, Aziz MIA. Cost-effectiveness of sequential urate lowering therapies for the management of gout in Singapore. J Med Econ 2020; 23:838-847. [PMID: 32301360 DOI: 10.1080/13696998.2020.1757456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims: Allopurinol is the most common urate lowering therapy (ULT) used to treat gout but may cause life-threatening severe cutaneous adverse reactions (SCAR) in a small number of patients. Risk of SCAR is increased for patients with the HLA-B*58:01 genotype. When alternative ULT is required, febuxostat or probenecid are recommended. The aim of this study was to conduct a cost-utility analysis of sequential ULT treatment strategies for gout, including strategies with and without HLA-B*58:01 genotyping prior to treatment initiation, with a view to inform optimal gout management in Singapore.Materials and methods: A Markov model was developed from the Singapore healthcare payer perspective. Reflecting local practice, 12 different treatment strategies containing at least one ULT (allopurinol, febuxostat, probenecid) were evaluated in adults with gout. Response rates (SUA < 6mg/dL) were derived from an in-house network meta-analysis and from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated over a 30-year time horizon, with costs and benefits discounted at 3% per annum. Sensitivity analyses were conducted to explore uncertainties.Results: Sequential treatment of allopurinol 300 mg/day-allopurinol 600 mg/day-probenecid ("standard of care") was cost-effective compared to no ULT, with an ICER of SGD1,584/QALY. Allopurinol300-allopurinol600-probenecid-febuxostat sequence compared to allopurinol300-allopurinol600-probenecid had an ICER of SGD11,400/QALY. All other treatment strategies were dominated by preceding strategies. Treatment strategies incorporating HLA-B*58:01 genotyping before ULT use were dominated by the corresponding non-genotyping strategy.Conclusions: Current standard of care (allopurinol300-allopurinol 600-probenecid) for gout is cost-effective compared with no ULT in the local context. Febuxostat is unlikely to be cost-effective in Singapore at current prices unless it is used last-line.
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Affiliation(s)
- Sil-Ling Pruis
- Agency for Care Effectiveness, Ministry of Health Singapore, Singapore, Singapore
| | - Yunjoo Karris Jeon
- Agency for Care Effectiveness, Ministry of Health Singapore, Singapore, Singapore
| | - Fiona Pearce
- Agency for Care Effectiveness, Ministry of Health Singapore, Singapore, Singapore
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
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Torres‐Navarro I, Briz‐Redón Á, Botella‐Estrada R. Systemic therapies for Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: a SCORTEN‐based systematic review and meta‐analysis. J Eur Acad Dermatol Venereol 2020; 35:159-171. [DOI: 10.1111/jdv.16685] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Affiliation(s)
- I. Torres‐Navarro
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
| | - Á. Briz‐Redón
- Department of Statistics and Operations Research Universitat de València València Spain
| | - R. Botella‐Estrada
- Dermatology Department Hospital Universitario y Politécnico la Fe València Spain
- Department of Medicine Universitat de València València Spain
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67
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Kaneko Y, Seko Y, Sotozono C, Ueta M, Sato S, Shimamoto T, Iwasaku M, Yamada T, Uchino J, Hizawa N, Takayama K. Respiratory complications of Stevens-Johnson syndrome (SJS): 3 cases of SJS-induced obstructive bronchiolitis. Allergol Int 2020; 69:465-467. [PMID: 32067932 DOI: 10.1016/j.alit.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Yoshiko Kaneko
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Yurie Seko
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mayumi Ueta
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Sato
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan
| | - Takayuki Shimamoto
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Iwasaku
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuyuki Hizawa
- Department of Pulmonary Medicine, Tsukuba University, Ibaraki, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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68
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Gao X, Tang X, Ai L, Gao Q, Liao Q, Chen M, Chen X, Zhou H, Ye Y, Li M, Han J, Wang F. Acute pancreatic injuries: A complication of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with cytotoxic immunocell activation. J Am Acad Dermatol 2020; 84:644-653. [PMID: 32561372 PMCID: PMC7297678 DOI: 10.1016/j.jaad.2020.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Complications involving internal organs are usually present in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, pancreatic complications are rarely reported and studied. OBJECTIVE To summarize clinical characteristics of SJS/TEN-associated acute pancreatic injuries and to investigate underlying inflammatory mechanisms. METHODS Clinical records of 124 inpatients with SJS/TEN were reviewed. Serum levels of tumor necrosis factor α, interleukin (IL) 6, IL-18, IL-15, IL-12p70, and soluble CD56 were determined in 18 healthy donors and 17 patients with SJS/TEN, including 3 with acute pancreatic injuries. RESULTS Acute pancreatic injury was diagnosed in 7.3% of patients (9/124) in the SJS/TEN cohort. Elevation of serum transaminase level and hypoalbuminemia occurred more frequently in patients with acute pancreatic injuries compared with those without pancreatic symptoms (P = .004 and <.001, respectively). Although acute pancreatic injury did not alter mortality rate of SJS/TEN, it was associated with longer hospitalization stays (P = .008). Within the serum cytokines whose levels were elevated in SJS/TEN, only IL-18 was found to be selectively increased in patients with acute pancreatic injuries compared with those without them (P = .03). LIMITATIONS Cohort was small. CONCLUSION Acute pancreatic injury is a gastrointestinal complication of SJS/TEN in which hepatotoxicity is more likely to occur. Overexpression of IL-18 might be involved in this unique entity.
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Affiliation(s)
- Xuemei Gao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Lu Ai
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Qian Gao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Qiman Liao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Mukai Chen
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Xiaohong Chen
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Hui Zhou
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Yanting Ye
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Minyi Li
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong
| | - Jiande Han
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong.
| | - Fang Wang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong.
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Shanbhag SS, Chodosh J, Fathy C, Goverman J, Mitchell C, Saeed HN. Multidisciplinary care in Stevens-Johnson syndrome. Ther Adv Chronic Dis 2020; 11:2040622319894469. [PMID: 32523661 PMCID: PMC7236394 DOI: 10.1177/2040622319894469] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/12/2019] [Indexed: 12/17/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.
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Affiliation(s)
- Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Cherie Fathy
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Sumner Redstone Burn Center, Boston, MA, USA
| | - Caroline Mitchell
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA
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70
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Ishikawa H, Watanabe Y, Takamura N, Watanabe T, Yamaguchi Y, Aihara M. A case of toxic epidermal necrolysis with refractory acute respiratory distress syndrome. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2020. [DOI: 10.1002/cia2.12101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Hideyuki Ishikawa
- Department of Environmental Immuno‐Dermatology Yokohama City University School of Medicine Yokohama Japan
| | - Yuko Watanabe
- Department of Environmental Immuno‐Dermatology Yokohama City University School of Medicine Yokohama Japan
| | - Naoko Takamura
- Department of Environmental Immuno‐Dermatology Yokohama City University School of Medicine Yokohama Japan
| | - Tomoya Watanabe
- Department of Environmental Immuno‐Dermatology Yokohama City University School of Medicine Yokohama Japan
| | - Yukie Yamaguchi
- Department of Environmental Immuno‐Dermatology Yokohama City University School of Medicine Yokohama Japan
| | - Michiko Aihara
- Department of Environmental Immuno‐Dermatology Yokohama City University School of Medicine Yokohama Japan
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71
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Shanbhag SS, Hall L, Chodosh J, Saeed HN. Long-term outcomes of amniotic membrane treatment in acute Stevens-Johnson syndrome/toxic epidermal necrolysis. Ocul Surf 2020; 18:517-522. [PMID: 32200005 DOI: 10.1016/j.jtos.2020.03.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/21/2020] [Accepted: 03/11/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To report the long-term outcomes of amniotic membrane (AM) use in the form of transplantation (AMT) and self-retained amniotic membrane (ProKera® device, PD) in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). METHODS Electronic records of all patients with a diagnosis of SJS/TEN at Massachusetts Eye and Ear between January 2008 and January 2018 were reviewed. Patients who received AM in acute SJS/TEN were selected. Only patients with follow-up ≥ 3 months after discharge were included. RESULTS Data of 55 eyes of 29 patients were analyzed. All 55 eyes received the first AM at a median interval of 5 days (inter-quartile range (IQR): 3-7 days) after onset of skin rash. Fifty-six percent of eyes (31/55) received AMT while 44% (24/55) received PD. Forty percent of eyes (22/55) required a repeat AMT or PD. Median follow-up after initial AM was 2.5 years (IQR: 1.2-3.6 years). At last follow-up, the best-corrected visual acuity was ≥20/40 in 87% of eyes (48/55). The most common complications in the chronic phase were meibomian gland disease and dry eye, seen in 78% of eyes (43/55) and 58% of eyes (32/55) respectively. CONCLUSIONS Long-term results show that early use of AM in the acute phase of SJS/TEN may be effective in mitigating severe vision loss after SJS/TEN. However, eyelid-related complications and dry eye remain a common problem even with the use of AM.
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Affiliation(s)
- Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA; The Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Leangelo Hall
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye & Ear, Boston, MA, USA.
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72
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Teng GG, Tan-Koi WC, Dong D, Sung C. Is HLA-B*58:01 genotyping cost effective in guiding allopurinol use in gout patients with chronic kidney disease? Pharmacogenomics 2020; 21:279-291. [PMID: 32180492 DOI: 10.2217/pgs-2019-0160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: Concerns for fatal severe cutaneous adverse reactions (SCARs) hamper allopurinol use. Methods and material: We adopted a health system perspective to evaluate the cost-effectiveness of HLA-B*58:01 genotyping before allopurinol initiation. A decision tree compared three treatment strategies in gout patients with chronic kidney disease who have higher risk for SCAR. They were standard allopurinol treatment followed by febuxostat in nonresponders, test-positive patients receive febuxostat while test-negative receive allopurinol and universal use of febuxostat. Results: The first strategy was the most cost effective. Genotyping dominated universal febuxostat use. Time horizon and SCAR incidence were the most influential factors on the incremental cost-effectiveness ratio. Conclusion: HLA-B*58:01 genotyping compared with standard allopurinol-febuxostat sequential treatment does not provide good value for money in gout with chronic kidney disease.
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Affiliation(s)
- Gim Gee Teng
- Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore, 119228.,Chronic Program, Alexandra Hospital, National University Health System, Singapore, 159964
| | - Wei-Chuen Tan-Koi
- Vigilance & Compliance Branch, Health Sciences Authority, Singapore, 138667
| | - Di Dong
- Global Health Research Center, Duke Kunshan University, China, 215316
| | - Cynthia Sung
- Vigilance & Compliance Branch, Health Sciences Authority, Singapore, 138667.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, 169857
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Seminario-Vidal L, Kroshinsky D, Malachowski SJ, Sun J, Markova A, Beachkofsky TM, Kaffenberger BH, Ergen EN, Mauskar M, Bridges A, Calhoun C, Cardones AR, Chen ST, Chodosh J, Cotliar J, Davis MDP, DeNiro KL, Dominguez AR, Eljure-Téllez J, Femia A, Fox LP, Guda A, Mitchell C, Mostaghimi A, Ortega-Loayza AG, Owen C, Pasieka H, Rahnama-Moghadam S, Saeed HN, Saunderson RB, Shanbhag S, Sharon VR, Strowd L, Venkatesh S, Wanat KA, Wetter DA, Worswick S, Micheletti RG. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. J Am Acad Dermatol 2020; 82:1553-1567. [PMID: 32151629 DOI: 10.1016/j.jaad.2020.02.066] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.
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Affiliation(s)
- Lucia Seminario-Vidal
- Department of Dermatology, University of South Florida, Morsani College of Medicine, Tampa, Florida; Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida.
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Malachowski
- Department of Internal Medicine, Medical College of Wisconsin Affiliated Hospitals, St. Joseph's Hospital, Milwaukee, Wisconsin
| | - James Sun
- Cutaneous Oncology Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Alina Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Elizabeth N Ergen
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melissa Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alina Bridges
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Cody Calhoun
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Adela R Cardones
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Cotliar
- Division of Dermatology, Harbor-University of California, Los Angeles Medical Center, Los Angeles, California
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juliana Eljure-Téllez
- Department of Dermatology, "Dr. Manuel Gea González" General Hospital, Mexico City, Mexico
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, New York University Langone Health, New York, New York
| | - Lindy P Fox
- Department of Dermatology, University of California, San Francisco, California
| | - Anisha Guda
- University of Texas Health San Antonio Long School of Medicine, San Antonio, Texas
| | - Caroline Mitchell
- Vincent Center for Reproductive Biology, Department of Obstetrics, Gynecology & Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | - Cindy Owen
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Helena Pasieka
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC
| | | | - Hajirah N Saeed
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Rebecca B Saunderson
- Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Swapna Shanbhag
- Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Victoria R Sharon
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Lindsay Strowd
- Department of Dermatology, Wake Forest University School of Medicine, Wake Forest, North Carolina
| | - Samantha Venkatesh
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karolyn A Wanat
- Department of Dermatology, University of Southern California, Los Angeles, California
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Scott Worswick
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert G Micheletti
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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Cabañas Weisz LM, Miguel Escuredo I, Ayestarán Soto JB, García Gutiérrez JJ. Toxic epidermal necrolysis (TEN): Acute complications and long-term sequelae management in a multidisciplinary follow-up. J Plast Reconstr Aesthet Surg 2020; 73:319-327. [DOI: 10.1016/j.bjps.2019.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/24/2019] [Accepted: 07/27/2019] [Indexed: 01/28/2023]
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O'Reilly P, Kennedy C, Meskell P, Coffey A, Delaunois I, Dore L, Howard S, Ramsay B, Scanlon C, Wilson DM, Whelan B, Ryan S. The psychological impact of Stevens-Johnson syndrome and toxic epidermal necrolysis on patients' lives: a Critically Appraised Topic. Br J Dermatol 2020; 183:452-461. [PMID: 31792924 PMCID: PMC7687230 DOI: 10.1111/bjd.18746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
CLINICAL SCENARIO A 65-year-old man presented with a 12-h history of deteriorating rash. Two weeks previously he had completed a course of neoadjuvant chemotherapy for ductal carcinoma of the breast. On examination there were bullae, widespread atypical targetoid lesions and 15% epidermal detachment. There was no mucosal involvement on presentation, but subsequently it did evolve. Skin biopsy showed subepidermal blistering with epidermal necrosis. This confirmed our clinical diagnosis of overlap Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). On transfer to intensive care he was anxious and fearful. MANAGEMENT QUESTION What are the psychological impacts of SJS/TEN on this man's life? BACKGROUND SJS and TEN have devastating outcomes for those affected. OBJECTIVES To conduct a Critically Appraised Topic to (i) analyse existing research related to the psychological impact of SJS and TEN and (ii) apply the results to the clinical scenario. METHODS Seven electronic databases were searched for publications focusing on the psychological impact of SJS/TEN on adults over 18 years of age. RESULTS Six studies met the inclusion criteria. Healthcare practitioners' (HCPs') lack of information around the disorder was highlighted. Patients experienced undue stress and fear. Some patients had symptoms aligned to post-traumatic stress disorder (PTSD), anxiety and depression. DISCUSSION AND RECOMMENDATION The evidence suggests that SJS and TEN impact psychologically on patients' lives. Education of HCPs, to address their lack of awareness and information on SJS/TEN, should facilitate their capacity to provide information and support to patients, thereby reducing patient anxiety. On discharge, a follow-up appointment with relevant HCPs to reduce the possibility of PTSD occurring should be considered.
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Affiliation(s)
- P O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - C Kennedy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,School of Nursing and Midwifery, Robert Gordon University, Aberdeen, U.K
| | - P Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - A Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - I Delaunois
- Regional Medical Library, University Hospital Limerick, Limerick, Ireland
| | - L Dore
- Glucksman Library, University of Limerick, Limerick, Ireland
| | - S Howard
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Psychology, University of Limerick, Limerick, Ireland
| | - B Ramsay
- Charles Centre for Dermatology, University Hospital Limerick, Limerick, Ireland
| | | | - D M Wilson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - B Whelan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - S Ryan
- Charles Centre for Dermatology, University Hospital Limerick, Limerick, Ireland
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76
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Capule F, Tragulpiankit P, Mahasirimongkol S, Jittikoon J, Wichukchinda N, Theresa Alentajan-Aleta L, James Barit JV, Casanova-Gutierrez J, Cabral-Lim L, Baltazar Reyes JP, Roa F, Salonga R, San Gabriel KF, Lynn Silao C. Association of carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis with the HLA-B75 serotype or HLA-B*15:21 allele in Filipino patients. THE PHARMACOGENOMICS JOURNAL 2020; 20:533-541. [PMID: 31896765 DOI: 10.1038/s41397-019-0143-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 12/02/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
A case-control study was conducted to investigate the association of HLA-A alleles, HLA-B alleles including HLA-B*15:02 and HLA-B75 serotype with carbamazepine-induced SJS/TEN in Filipino patients. A retrospective review of medical records was performed. Pertinent clinical data were collected. Eight (8) carbamazepine-induced SJS/TEN cases and 32 tolerant controls were recruited. Genomic DNA was extracted from the saliva samples and genotyping was performed by employing allele-specific polymerase chain reaction. Data were analyzed using the Fisher's exact test, Mann-Whitney U test, univariate logistic regression, and multivariate logistic regression. Single allele association analysis was done. The strength of association was expressed as odds ratio with 95% confidence interval. Positive predictive value, negative predictive value, sensitivity, and specificity were computed. Of all the alleles tested, the HLA-B75 serotype (p = 0.007, OR = 23.25, 95% CI = 2.33-232.21) and HLA-B*15:21 (p = 0.026, OR = 7.53, 95% CI = 1.27-44.79) were significantly associated with carbamazepine-induced SJS/TEN. The HLA-B75 serotype or HLA-B*15:21 allele may be used as a genetic risk assessment prior to prescription for prevention of carbamazepine-induced SJS/TEN in Filipino patients.
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Affiliation(s)
- Francis Capule
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | | | | | - Jiraphun Jittikoon
- Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | | | - Lara Theresa Alentajan-Aleta
- Section of Allergy and Immunology, Department of Medicine, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Jay-V James Barit
- Section of Dermatology, Department of Medicine, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Josephine Casanova-Gutierrez
- Section of Adult Neurology, Department of Neurosciences, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Leonor Cabral-Lim
- Section of Adult Neurology, Department of Neurosciences, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Jose Paciano Baltazar Reyes
- Section of Adult Neurology, Department of Neurosciences, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Francisca Roa
- Section of Dermatology, Department of Medicine, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Raymark Salonga
- Graduate School, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | - Katrina Faith San Gabriel
- Section of Allergy and Immunology, Department of Medicine, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Catherine Lynn Silao
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.,Department of Pediatrics, Philippine General Hospital and College of Medicine, University of the Philippines Manila, Manila, Philippines
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77
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McGetrick M, Siebenaler MK. Case 1: Fever, Conjunctivitis, Rash, and Genital Lesions in a 17-year-old Boy. Pediatr Rev 2020; 41:27-30. [PMID: 31894071 DOI: 10.1542/pir.2018-0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Molly McGetrick
- Department of Pediatrics, University of Florida, Gainesville, FL.,Division of Critical Care, Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Mary Katherine Siebenaler
- Department of Pediatrics, University of Florida, Gainesville, FL.,Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, IL
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78
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Lee HY, Creamer D. Stevens-Johnson syndrome/toxic epidermal necrolysis: a chronic condition? Br J Dermatol 2019; 182:826-827. [PMID: 31853947 DOI: 10.1111/bjd.18726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- H Y Lee
- Department of Dermatology, Singapore General Hospital, Singapore
| | - D Creamer
- Department of Dermatology, King's College Hospital, London, U.K
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79
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Shanbhag SS, Rashad R, Chodosh J, Saeed HN. Long-Term Effect of a Treatment Protocol for Acute Ocular Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Am J Ophthalmol 2019; 208:331-341. [PMID: 31326519 PMCID: PMC7935472 DOI: 10.1016/j.ajo.2019.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/16/2019] [Accepted: 07/12/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To describe the long-term effect of a treatment protocol for ocular involvement in acute Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), including focused ocular examination and pathology-appropriate use of lubrication, topical corticosteroids, topical antibiotics, and amniotic membrane transplantation (AMT). DESIGN Retrospective, comparative case series. METHODS A total of 48 patients (96 eyes) were included in this study. Nine of 48 patients (18 eyes) had acute SJS/TEN from 2000 to 2007 and did not receive protocol care (Group I). Thirty-nine of 48 patients (78 eyes) had acute SJS/TEN from 2008 to 2017 and received protocol care (Group II). The main outcome measures were best-corrected visual acuity (BCVA) at final follow-up visit and incidence of complications in the chronic phase. RESULTS No eyes in Group I received AMT for SJS/TEN, compared to 87% of qualifying eyes in Group II (P < .0001) There was a significant difference in the proportion of eyes with BCVA ≥20/40 at last follow-up between Group I and Group II (33% vs 92%, P < .001). The proportion of eyes with vision-threatening complications in the chronic phase was significantly higher in Group I versus Group II (67% vs 17%, P = .002), with most complications occurring in the first 2 years after disease onset in both groups. CONCLUSIONS A specific protocol for acute ocular care in SJS/TEN, including aggressive use of AMT, was highly successful in reducing corneal blindness and severe vision-threatening complications of the disorder.
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Affiliation(s)
- Swapna S Shanbhag
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Tej Kohli Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Ramy Rashad
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
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80
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Guvenir H, Arikoglu T, Vezir E, Misirlioglu ED. Clinical Phenotypes of Severe Cutaneous Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3840-3854. [PMID: 31696807 DOI: 10.2174/1381612825666191107162921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
Abstract
Drug hypersensitivity reactions are clinically heterogenous ranging from mild to severe. Most drug hypersensitivity reactions are accompanied by cutaneous manifestations. Fever, mucous membrane involvement, large blisters, facial oedema, pustulosis and visceral involvement are clinical features that lead to suspicion of severe adverse drug reactions. Severe cutaneous adverse drug reactions (SCARs) include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis. Serum sickness like reactions, drug induced vasculitis and generalized bullous fixed drug eruptions are less severe clinical entities. SCARs are uncommon but associated with significant morbidity and mortality. Physician should be aware of specific red flags and danger signs to immediately identify these reactions. Immediate drug withdrawal is mandatory. Early diagnosis and appropriate treatment significantly affect the prognosis of the disease. The purpose of our review is to discuss clinical phenotypes of severe cutaneous drug hypersensitivity reactions.
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Affiliation(s)
- Hakan Guvenir
- Department of Pediatric Allergy and Immunology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Tugba Arikoglu
- Department of Pediatric Allergy and Immunology, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Emine Vezir
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Emine Dibek Misirlioglu
- Department of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey
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81
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Wang F, Gao X, Chen X, Tang X, Chen H, Han J. Successful treatment of interstitial lung disease related to Stevens–Johnson syndrome/toxic epidermal necrolysis overlap with etanercept: A case report and published work review. J Dermatol 2019; 46:1035-1038. [PMID: 31436331 DOI: 10.1111/1346-8138.15058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Fang Wang
- Department of Dermatology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Xuemei Gao
- Department of Dermatology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Xiaohong Chen
- Department of Dermatology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Xuhua Tang
- Department of Dermatology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Haihong Chen
- Department of Respiratory Medicine The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
| | - Jiande Han
- Department of Dermatology The First Affiliated Hospital Sun Yat‐sen University Guangzhou China
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82
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Ingen-Housz-Oro S, Alves A, Colin A, Ouedraogo R, Layese R, Canoui-Poitrine F, Chosidow O, Mekontso-Dessap A, Wolkenstein P, de Prost N. Health-related quality of life and long-term sequelae in survivors of epidermal necrolysis: an observational study of 57 patients. Br J Dermatol 2019; 182:916-926. [PMID: 31385287 DOI: 10.1111/bjd.18387] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Few studies have investigated the global burden of sequelae and health-related quality of life (HRQoL) for survivors of epidermal necrolysis (EN). OBJECTIVES To investigate the long-term HRQoL for survivors of EN using validated instruments. METHODS We conducted a single-centre study that enrolled patients who were admitted for EN between 2010 and 2017. HRQoL was assessed via phone interview using the Short Form (SF)-36 questionnaire, Hospital Anxiety and Depression (HAD) scale, Impact of Event Scale-Revised, and general quality-of-life outcomes, including EN-specific sequelae. The primary outcome measure was the physical component summary (PCS) score of the SF-36. RESULTS In total, 57 survivors of EN [19 (33%) with intensive care unit (ICU) admission] were interviewed via telephone at a median of 3·6 years (1·9-6·1) after hospital discharge. The median PCS score was 0·44 SDs below that of the age- and sex-matched reference population and was significantly lower for survivors of EN who were admitted to the ICU vs. those who were not [43·7 (28·7-49·3) vs. 51·2 (39·4-56·5), P = 0·042]. The proportion of patients with EN who had HAD-anxiety score ≥ 8 or HAD-depression score ≥ 5 was 54% and 21%, respectively. Physical and mental outcomes did not differ between patients with EN who were admitted to the ICU and survivors of septic shock. Reported EN-specific sequelae were cutaneous (77%), ocular (70%), psychological (60%), dental/oral (49%), genital (30%) and respiratory (18%), with median intensity on a visual analogue scale. CONCLUSIONS Our study confirms the major burden and long-term impact of EN on quality of life for survivors and emphasizes the need for prolonged close follow-up after the acute phase. What's already known about this topic? Long-term sequelae have been reported in 90% of survivors of epidermal necrolysis (EN). Few studies have investigated the global burden of sequelae and health-related quality of life (HRQoL) in survivors of EN. What does this study add? Survivors of EN, particularly those admitted to the intensive care unit, had poorer physical HRQoL than the French reference population but had comparable HRQoL to survivors of septic shock. Survivors of EN exhibited symptoms of anxiety, depression and post-traumatic stress syndrome. The most frequent sequelae were cutaneous, ocular and psychological, with visual analogue scale scores of 5/10 and 6/10. These results confirm the burden of EN on quality of life.
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Affiliation(s)
- S Ingen-Housz-Oro
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France.,EA7379 EpidermE, UPEC, Créteil, France
| | - A Alves
- Service de Réanimation Médicale, Créteil, France
| | - A Colin
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - R Ouedraogo
- Service de Réanimation Médicale, Créteil, France
| | - R Layese
- Service de Santé Publique, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Clinical Epidemiology And Ageing Unit, DHU A-TVB, IMRB-EA 7376 CEpiA, Université Paris-Est UPEC, Créteil, France
| | - F Canoui-Poitrine
- Service de Santé Publique, Hôpital Henri Mondor, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Clinical Epidemiology And Ageing Unit, DHU A-TVB, IMRB-EA 7376 CEpiA, Université Paris-Est UPEC, Créteil, France
| | - O Chosidow
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - A Mekontso-Dessap
- Service de Réanimation Médicale, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France
| | - P Wolkenstein
- Service de Dermatologie, Créteil, France.,Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France
| | - N de Prost
- Centre National de Référence des Dermatoses Bulleuses Toxiques, Créteil, France.,Service de Réanimation Médicale, Créteil, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, IMRB, Créteil, France
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83
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O'Brien KF, Bradley SE, Mitchell CM, Cardis MA, Mauskar MM, Pasieka HB. Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment. J Am Acad Dermatol 2019; 85:523-528. [PMID: 31437544 DOI: 10.1016/j.jaad.2019.08.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/06/2019] [Accepted: 08/10/2019] [Indexed: 11/29/2022]
Abstract
The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.
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Affiliation(s)
| | - Sarah E Bradley
- Department of Obstetrics, MedStar Washington Hospital Center, Washington, DC; Department of Gynecology, MedStar Washington Hospital Center, Washington, DC
| | - Caroline M Mitchell
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael A Cardis
- Department of Dermatology, MedStar Washington Hospital Center, Washington, DC
| | - Melissa M Mauskar
- Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, Texas
| | - Helena B Pasieka
- Georgetown University School of Medicine, Washington, DC; Department of Dermatology, MedStar Washington Hospital Center, Washington, DC.
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84
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Trommel N, Hofland HW, van Komen RS, Dokter J, van Baar ME. Nursing problems in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome in a Dutch burn centre: A 30-year retrospective study. Burns 2019; 45:1625-1633. [PMID: 31387802 DOI: 10.1016/j.burns.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/12/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Multiple studies have been published on toxic epidermal necrolysis (TEN) and Stevens-Johnsen syndrome (SJS). Nursing care is an important part of the treatment of TEN patients. Unfortunately, limited information on nursing in TEN/SJS patients has been published in the current literature. Nursing research is needed to improve the complex nursing care required for these rare patients. Therefore, the objective was to assess nursing problems in TEN patients in a burn centre setting over a 30-year period. METHODS The data for this study were gathered retrospectively from nursing records of all patients with TEN/SJS admitted to Burn Centre Rotterdam between January 1987 and December 2016. Dutch burn centres were recently accepted as expertise centres for TEN patients. Nursing problems were classified using the classification of nursing problems of the Dutch Nursing Society. RESULTS A total of 69 patients were admitted with SJS/TEN. Fifty-nine patient files were available. The most frequently reported nursing problems (>20% of the patients) were wounds, threatened or disrupted vital functions, dehydration or fluid imbalance, pain, secretion problems and fever. Furthermore, TEN-specific nursing problems were documented, including oral mucosal lesions and ocular problems. The highest number of concomitant nursing problems occurred during the period between days three and 20 after onset of the disease and varied by nursing problem. CONCLUSIONS The most frequently reported nursing problems involved physical functions, especially on days three to 20 after onset of the disease. With this knowledge, we can start nursing interventions early in the treatment, address problems at the first sign and inform patients and their families or relatives of these issues early in the disease process. A next step to improve nursing care for TEN patients is to acquire knowledge on the optimal interventions for nursing problems.
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Affiliation(s)
- N Trommel
- Burn Centre, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands.
| | - H W Hofland
- Burn Centre, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands; Association of Dutch Burn Centres, P.O. Box 1015, 1940 EA Beverwijk, The Netherlands.
| | - R S van Komen
- Burn Centre, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands.
| | - J Dokter
- Burn Centre, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands.
| | - M E van Baar
- Burn Centre, Maasstad Hospital, P.O. Box 9100, 3007 AC Rotterdam, The Netherlands; Association of Dutch Burn Centres, P.O. Box 1015, 1940 EA Beverwijk, The Netherlands.
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85
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86
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Lee H. How different is Stevens–Johnson syndrome/toxic epidermal necrolysis in children? Br J Dermatol 2019; 181:10-11. [DOI: 10.1111/bjd.18036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H.Y. Lee
- Department of Dermatology/Allergy Centre Singapore General Hospital, DUKE‐NUS Medical School Singapore
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87
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McPherson T, Exton LS, Biswas S, Creamer D, Dziewulski P, Newell L, Tabor KL, Wali GN, Walker G, Walker R, Walker S, Young AE, Mohd Mustapa MF, Murphy R. British Association of Dermatologists' guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018. Br J Dermatol 2019; 181:37-54. [PMID: 30829411 DOI: 10.1111/bjd.17841] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 12/12/2022]
Affiliation(s)
- T McPherson
- Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - S Biswas
- Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, U.K
| | - D Creamer
- Department of Dermatology, King's Hospital NHS Foundation Trust, London, SE5 9RS, U.K
| | - P Dziewulski
- St Andrews Centre for Plastic Surgery and Burns, Mid Essex Hospital Services NHS Trust, Chelmsford, CM1 7ET, U.K
| | - L Newell
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8BJ, U.K
| | - K L Tabor
- Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, U.K
| | - G N Wali
- Oxford University Hospitals NHS Foundation Trust, Old Road, Headington, Oxford, OX3 7LE, U.K
| | | | | | | | - A E Young
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8BJ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - R Murphy
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, U.K.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, U.K.,University of Nottingham, University Park, Nottingham, NG7 2RD, U.K
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88
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Choi SH, Kim MK, Oh JY. Corneal Limbal Stem Cell Deficiency in Children with Stevens-Johnson Syndrome. Am J Ophthalmol 2019; 199:1-8. [PMID: 30347185 DOI: 10.1016/j.ajo.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/23/2018] [Accepted: 10/13/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine the incidence of corneal limbal stem cell deficiency (LSCD) as chronic ocular sequelae in children with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) and analyze the factors associated with LSCD development. DESIGN Retrospective case series. METHODS Medical records were reviewed of pediatric patients who had been admitted to Seoul National University Hospital with SJS/TEN and who were diagnosed as having acute ocular involvement. For each record, the following data were collected: demographic information, underlying diseases, causative agents, acute systemic and ocular manifestations, systemic and ocular treatments, chronic ocular complications including LSCD, and visual acuities. RESULTS Of 19 children with SJS/TEN, LSCD developed in 6 (32%) patients at a mean of 12.3 ± 21.3 months after the onset of SJS/TEN (median 3.5 months). Severity of acute systemic involvement including elevation of liver enzyme levels and serum C-reactive protein levels was significantly correlated with the development of LSCD (P = .0038) and chronic ocular complications (P = .0044). The presence of corneal epithelial defect necessitating the use of therapeutic contact lenses in the acute phase was also associated significantly with LSCD development. Combined penetrating keratoplasty and limbal allograft were performed in 3 of 6 LSCD patients, and grafts failed in 2 (67%) patients because of infection. At the last follow-up, visual acuities were significantly poorer in patients with LSCD compared with those without LSCD (P = .0055). CONCLUSIONS Corneal LSCD occurred in 32% of pediatric patients with SJS/TEN, leading to poor visual outcome. Severity of acute systemic involvement was significantly associated with the development of LSCD and chronic ocular complications.
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89
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Zhang S, Tang S, Li S, Pan Y, Ding Y. Biologic TNF-alpha inhibitors in the treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis: a systemic review. J DERMATOL TREAT 2019; 31:66-73. [PMID: 30702955 DOI: 10.1080/09546634.2019.1577548] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) is one of severe cutaneous adverse reactions with low morbidity but high mortality. Different systemic immunomodulating treatments are proposed but still remain controversial. Tumor necrosis factor (TNF)-alpha is long thought to be a vital mediator of epithelial cell death in SJS-TEN, indicating a potential target for therapy.Objective: The aim of this systemic review is to evaluate the efficacy and safety of biologic TNF-alpha inhibitors in the treatment of SJS-TEN.Methods: We reviewed the published literature by searching from PubMed, EMBASE, Web of Science and ClinicalTrial.gov. A total of 27 articles fulfilling our inclusion criteria were found and analyzed.Results: There were 21 case reports, four case series and two randomized controlled trials (RCTs) on the biologic TNF-alpha inhibitors for SJS-TEN therapy, comprising 91 patients. TNF-alpha inhibitors were used as monotherapy, second-line therapy or combination therapy. Among them, 79 patients (86.8%) responded well and discharged with few side effects and complications.Conclusions: Biologic TNF-alpha inhibitors are a safe and effective treatment for SJS-TEN. But further, larger RCTs need to be conducted to provide more evidence for clinical application.
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Affiliation(s)
- Shan Zhang
- Department of Dermatology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shunli Tang
- Department of Dermatology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Li
- Department of Dermatology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yunlei Pan
- Department of Dermatology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yingguo Ding
- Department of Dermatology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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90
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Flora TB, Alves CAXDM, Barucci FDMP, Mattos CB. Toxic epidermal necrolysis after yellow fever vaccination. An Bras Dermatol 2019; 93:942-943. [PMID: 30484555 PMCID: PMC6256206 DOI: 10.1590/abd1806-4841.20188237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Thaís Bologna Flora
- Medical Residency Program in Dermatology, Faculdade de Medicina de
Jundiaí, Jundiaí (SP), Brazil
| | | | | | - Camila Bonati Mattos
- Medical Residency Program in Dermatology, Faculdade de Medicina de
Jundiaí, Jundiaí (SP), Brazil
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91
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Ocular and Mucocutaneous Sequelae among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Togo. Dermatol Res Pract 2019; 2019:4917024. [PMID: 30838038 PMCID: PMC6374872 DOI: 10.1155/2019/4917024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/31/2018] [Accepted: 01/09/2019] [Indexed: 01/23/2023] Open
Abstract
Aim The aim of this study was to assess ocular and mucocutaneous sequelae among SJS/TEN survivors and identify risk factors of ocular sequelae. Patients and Method Late complications among SJS/TEN survivors were assessed using 2 methods: a retrospective assessment of medical records only or a retrospective assessment of medical records and physical examination of survivors who were contacted by phone. Results Between January 1995 and December 2017, 177 cases of SJS/TEN (138 cases of SJS, 29 cases of TEN, and 10 cases SJS/TEN overlap) were admitted into two university hospitals of Lomé (Togo). There were 113 women and 64 men, with an average age of 31.7±13.0 years (range: 5 to 80 years). The most used drugs were antibacterial sulfonamides (35.6%) and nevirapine (24.3%). HIV serology was positive in 68 (59.1%) of the 115 patients tested. Sixty-four (52,5%) of the 122 patients, who had been examined by an ophthalmologist during the acute stage, had acute ocular involvement, which was mild in 27.9% of patients, moderate in 13.1%, and severe in 11.5%. We recorded 17 deaths (i.e., three cases of SJS, 12 of TEN, and two of SJS/TEN overlap), including 11 cases of HIV infected patients. Of the 160 SJS/TEN survivors, only 71 patients were assessed 6 months after hospital discharge. Among them, forty-three (60.6%) patients had sequelae. Concerning mucocutaneous sequelae, the main lesions were diffuse dyschromic macules (38.0% of patients) and ocular sequelae were dominated by decreased visual acuity (14.1% of patients). In multivariate analysis, exposure to sulfadoxine (odds adjusted ratio = 5.95; 95%CI= [1.36-31.35]) and moderate (adjusted odds ratio = 5.85; 95%CI = [1.23-31.81]) or severe (adjusted odds ratio = 48.30; 95%CI = [6.25-1063.66]) ocular involvement at acute stage were associated with ocular sequelae. Conclusion Ocular and mucocutaneous sequelae are common in SJS/TEN survivors. Exposure to sulfadoxine and severity of acute ocular involvement are risk factors of ocular sequelae.
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92
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Xiong H, Wang L, Jiang M, Chen S, Yang F, Zhu H, Zhu Q, Tang C, Qin S, Xing Q, Luo X. Comprehensive assessment of T cell receptor β repertoire in Stevens-Johnson syndrome/toxic epidermal necrolysis patients using high-throughput sequencing. Mol Immunol 2019; 106:170-177. [PMID: 30623817 DOI: 10.1016/j.molimm.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/01/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
Stevens-Johnson syndrome (SJS) /toxic epidermal necrolysis (TEN) are life-threatening severe cutaneous adverse drug reactions characterized by widespread epidermal necrosis. Recent studies have indicated that SJS/TEN is a specific immune reaction regulated by T cells. Certain drug serves as foreign antigens that are presented by major histocompatibility complex (MHC) and recognized by T cell receptors (TCRs), inducing adaptive immune responses. However, few studies have performed detailed characterization of TCR repertoire in SJS/TEN, and it remains unclear whether the particular types of TCRs expanded clonally are drug-specific, which would provide a potential underlying mechanism of SJS/TEN. In this study, using high-throughput sequencing, we comprehensively assessed the diversity, composition and molecular characteristics of the TCRβ repertoires in 17 SJS/TEN patients associated with three different causative drugs including methazolamide (MZ), carbamazepine (CBZ) and allopurinol (ALP). Systematic analysis of the TCRβ sequences revealed that SJS/TEN patients had more highly expanded clones and less TCR repertoire diversity, and the TCR repertoire diversity of these patients showed certain associations with the clinical severity of disease. Similar predominant clonotypes, shared-usage TRBV/TRBJ subtypes and combinations thereof were observed among different subjects with the same causative agent. Our observations provide enhanced understanding of the role of T lymphocytes in the pathogenesis of SJS/TEN and enumerate potential therapeutic targets.
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Affiliation(s)
- Hao Xiong
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lanting Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Menglin Jiang
- Children's Hospital & Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Shengan Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Fanping Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Huizhong Zhu
- Children's Hospital & Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Qinyuan Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Chenling Tang
- BGI-Shenzhen, Shenzhen, 518083, China; China National GeneBank, BGI-Shenzhen, Shenzhen, 518120, China
| | - Shengying Qin
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Qinghe Xing
- Children's Hospital & Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
| | - Xiaoqun Luo
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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93
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Hefez L, Zaghbib K, Sbidian E, Valeyrie‐Allanore L, Allain M, Duong T, Colin A, Bellivier F, Romano H, de Prost N, Chazelas K, Chosidow O, Wolkenstein P, Ingen‐Housz‐Oro S. Post‐traumatic stress disorder in Stevens–Johnson syndrome and toxic epidermal necrolysis: prevalence and risk factors. A prospective study of 31 patients. Br J Dermatol 2018; 180:1206-1213. [DOI: 10.1111/bjd.17267] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 12/29/2022]
Affiliation(s)
- L. Hefez
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - K. Zaghbib
- Department of Psychiatry AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - E. Sbidian
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- EA 7379 EpidermE Université Paris‐Est Créteil Val de Marne (UPEC) Créteil F‐94010France
- Inserm Centre d'Investigation Clinique 1430 Créteil F‐94010France
| | - L. Valeyrie‐Allanore
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - M. Allain
- Clinical Research Unit AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - T.A. Duong
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - A. Colin
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - F. Bellivier
- Department of Psychiatry and Addiction AP‐HP GH Lariboisière ‐ F. Widal ParisFrance
| | - H. Romano
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - N. de Prost
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Intensive Care Unit AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- CARMAS Research Group Université Paris‐Est Créteil Val de Marne (UPEC) Créteil F‐94010 France
| | - K. Chazelas
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
| | - O. Chosidow
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- EA 7379 EpidermE Université Paris‐Est Créteil Val de Marne (UPEC) Créteil F‐94010France
- Inserm Centre d'Investigation Clinique 1430 Créteil F‐94010France
| | - P. Wolkenstein
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- EA 7379 EpidermE Université Paris‐Est Créteil Val de Marne (UPEC) Créteil F‐94010France
| | - S. Ingen‐Housz‐Oro
- Department of Dermatology AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- Reference Center for Toxic Bullous Diseases AP‐HP Hôpitaux Universitaires Henri Mondor 51 avenue du Maréchal de Lattre de Tassigny Créteil F‐94010France
- EA 7379 EpidermE Université Paris‐Est Créteil Val de Marne (UPEC) Créteil F‐94010France
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94
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Borrelli EP, Lee EY, Descoteaux AM, Kogut SJ, Caffrey AR. Stevens-Johnson syndrome and toxic epidermal necrolysis with antiepileptic drugs: An analysis of the US Food and Drug Administration Adverse Event Reporting System. Epilepsia 2018; 59:2318-2324. [PMID: 30395352 DOI: 10.1111/epi.14591] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially fatal adverse skin reactions that are most commonly triggered by certain medications. One class of medications that has been highly associated with SJS/TEN reactions is antiepileptic drugs (AEDs). We sought to quantify the risk of SJS/TEN associated with AEDs as a class, as well as individual AEDs, in the United States. METHODS An analysis was performed of the US Food and Drug Administration Adverse Event Reporting System (FAERS) from July 2014 through December 2017. Rates of SJS/TEN were calculated for each AED compared with all other non-AEDs. Reporting odds ratios (RORs), proportional reporting ratios (PRRs), and 95% confidence intervals (CIs) were calculated using OpenEpi. RESULTS With 198 reports, AEDs had more reports of SJS/TEN than any other medication class. AEDs as a class had an ROR of 8.7 (95% CI 7.5-10.2) and a PRR of 8.7 (95% CI 7.5-10.2) compared with all other non-AEDs. The AEDs with the highest risk estimates were zonisamide (ROR 70.2, 95% CI 33.1-148.7; PRR 68.7, 95% CI 32.9-143.5), rufinamide (ROR 60.0, 95% CI 8.3-433.5; PRR 58.9, 95% CI 8.4-411.5), clorazepate (ROR 56.0, 95% CI 7.8-404.1; PRR 55.1, 95% CI 7.8-385.0), lamotrigine (ROR 53.0, 95% CI 43.2-64.9; PRR 52.2, 95% CI 42.7-63.7), phenytoin (ROR 26.3, 95% CI 15.5-44.7; PRR 26.1, 95% CI 15.4-44.2), and carbamazepine (ROR 24.5, 95% CI 16.0-37.5; PRR 24.3, 95% CI 16.0-37.1). SIGNIFICANCE Although AEDs as a class were associated with 9 times the risk of SJS/TEN compared with non-AEDs, there were 6 AEDs with risk estimates greater than 20. Increased awareness of this risk among both prescribers and patients, particularly variations in risk among different AEDs, along with education on early recognition of SJS/TEN signs/symptoms, may help mitigate the number and severity of these adverse events.
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Affiliation(s)
- Eric P Borrelli
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island
| | - Erica Y Lee
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island
| | | | - Stephen J Kogut
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island
| | - Aisling R Caffrey
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island.,Veterans Affairs Medical Center, Infectious Diseases Research Program, Center of Innovation in Long Term Services and Supports, Providence, Rhode Island.,Brown University School of Public Health, Providence, Rhode Island
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95
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Cherukuri P, Bartenstein DW, Hawryluk EB. Pediatric Inpatient Dermatology: New Insights on Severe Eruptions and Cutaneous Adverse Reactions. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0242-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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96
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Tanaka R, Yonemori K, Hirakawa A, Kinoshita F, Kobayashi Y, Yamazaki N, Fujimoto M, Tamura K, Fujiwara Y. Anticancer Agent-Induced Life-Threatening Skin Toxicities: A Database Study of Spontaneous Reporting Data. Oncologist 2018; 24:266-272. [PMID: 30254188 DOI: 10.1634/theoncologist.2017-0511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/12/2018] [Indexed: 02/04/2023] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life-threatening cutaneous and mucosal adverse reactions to drugs. Nevertheless, the connection to anticancer agents remains unclear. To provide insight into the association of such adverse reactions with anticancer agents, we analyzed the profile of anticancer agent-induced SJS and TEN in the Japanese population. Of the 9,738 SJS/TEN events recorded in a database of spontaneous reporting data, 485 (5%, further categorized as SJS, 384 events, 79%; TEN, 101 events, 21%) were identified as anticancer agent-induced, and 53 of these (11%) were fatal. Multivariate logistic regression analyses indicated that, compared with patients using other drugs, those using anticancer drugs had lower incident risk of death (hazard ratio [HR], 0.592; p = .0006), longer median time to onset of SJS/TEN (18 vs. 11 days; p < .0001; multivariate Cox regression: HR, 0.66; p < .0001), and a higher likelihood of developing SJS/TEN later than 70 days after initiation of the suspected causal agent (15% vs. 7%; p < .0001), highlighting the need for vigilance and continuous monitoring for SJS/TEN in patients treated with anticancer agents. IMPLICATIONS FOR PRACTICE: Life-threatening skin toxicities induced by anti-cancer agents indicated significantly lower incident risk of death and longer time to onset of symptoms than for those induced by other drugs.
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Affiliation(s)
- Ryota Tanaka
- Divisions of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
- Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
| | - Kan Yonemori
- Divisions of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fumie Kinoshita
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yumiko Kobayashi
- Biostatistics and Bioinformatics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Naoya Yamazaki
- Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, University of Tsukuba, Tsukuba, Japan
| | - Kenji Tamura
- Divisions of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Fujiwara
- Divisions of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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97
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Lee HY. Wound management strategies in Stevens-Johnson syndrome/toxic epidermal necrolysis: An unmet need. J Am Acad Dermatol 2018; 79:e87-e88. [PMID: 29913262 DOI: 10.1016/j.jaad.2018.05.1258] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore.
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98
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Ingen-Housz-Oro S, Duong TA, de Prost N, Colin A, Fardet L, Lebrun-Vignes B, Barbaud A, Chosidow O, Wolkenstein P. Traitement des toxidermies graves. Ann Dermatol Venereol 2018; 145:454-464. [DOI: 10.1016/j.annder.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/13/2018] [Accepted: 02/14/2018] [Indexed: 12/17/2022]
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99
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Alvarado SA, Muñoz-Mendoza D, Bahna SL. High-risk drug rashes. Ann Allergy Asthma Immunol 2018; 121:552-560. [PMID: 29803714 DOI: 10.1016/j.anai.2018.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/14/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To provide a brief overview of the clinical presentation, common offending agents, management, prognosis, and mortality of 6 selected high-risk drug rashes, namely, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, multiple drug hypersensitivity (MDH) syndrome, acute generalized exanthematous pustulosis (AGEP), and drug-induced bullous pemphigoid (DIBP). DATA SOURCES A review of the published literature was performed with PubMed and supplemented with our clinical experience. STUDY SELECTIONS The most recent clinically relevant studies and older seminal works were selected. RESULTS Most of the published data on these uncommon rashes were based on small observational series or case reports. SJS and TEN have specific genotypes association with certain drugs, have high morbidity and mortality, and require aggressive management by a team of multiple specialists. DRESS syndrome is a severe, prolonged multiorgan reaction, yet it has a better prognosis than TEN. MDH is a syndrome of repeated reactions to unrelated drugs that often imposes diagnostic and management difficulties. AGEP consists of generalized sterile small pustules, usually mistaken for infection with subsequent inappropriate treatment. Bullous pemphigoid presents with tense pruritic bullae and characteristic linear basement membrane deposition of IgG and C3. DIBP has much better prognosis than the autoimmune variety. CONCLUSION In such high-risk drug rashes, early recognition, immediate withdrawal of the suspected drug(s), prompt individualized management, and monitoring of vital organs function are mandatory for reducing morbidity and mortality. The lack of reliable tests for identification of the causative agent imposes difficulty, particularly in patients receiving multiple medications.
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Affiliation(s)
- Sasha A Alvarado
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Diana Muñoz-Mendoza
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Sami L Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
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100
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Chaby G, Valeyrie-Allanore L, Duong TA, Lebrun-Vignes B, Milpied B, Sassolas B, Tetart F, Wolkenstein P, Chosidow O, Fardet L. Severe cutaneous adverse reactions due to inappropriate medication use. Br J Dermatol 2018; 179:329-336. [PMID: 29352771 DOI: 10.1111/bjd.16365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown. OBJECTIVES To estimate the proportion of SCARs related to inappropriate medication use. METHODS We carried out a retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected of inducing SCARs (i.e. not just the drug regarded as 'the most probable') were considered with regard to (i) prescription for an inappropriate indication, (ii) unintentional rechallenge despite a previous allergy to the drug or (iii) self-medication with prescription medicines. RESULTS In total, 602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered to have been appropriately used for 417 of the 602 individuals included in the study population [69·3%, 95% confidence interval (CI) 65·6-73·0] and inappropriately used for 144 individuals (23·9%, 95% CI 20·5-27·3). These inappropriate uses were due mainly to prescriptions for an inappropriate indication (65·8%, 95% CI 58·4-73·2) or unintentional rechallenge (20·9%, 95% CI 14·6-27·2). Allopurinol and co-trimoxazole were the drugs most frequently involved in inappropriate indications. Antibiotics were the largest group involved in unintentional rechallenge. Nonsteroidal anti-inflammatory drugs, available on prescription, were most frequently involved in inappropriate self-medication. CONCLUSIONS Our results underline the need for respecting the appropriate indication for drugs in order to reduce the incidence of SCARs. Reducing unintentional rechallenge also seems to be a necessary preventive measure.
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Affiliation(s)
- G Chaby
- EA 7379 EpiDermE, Université Paris Est Créteil, Créteil, France.,Department of Dermatology, Hôpital Nord, Amiens, France
| | | | - T A Duong
- Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - B Lebrun-Vignes
- EA 7379 EpiDermE, Université Paris Est Créteil, Créteil, France.,Department of Pharmacovigilance, Hôpital Pitié-Salpétrière, AP-HP, Paris, France
| | - B Milpied
- Department of Dermatology, Hôpital Saint André, Bordeaux, France
| | - B Sassolas
- Department of Internal Medicine and Pneumology, Hôpital Cavale Blanche, Brest, France
| | - F Tetart
- Deparment of Dermatology, Hôpital Charles Nicole, Rouen, France
| | - P Wolkenstein
- EA 7379 EpiDermE, Université Paris Est Créteil, Créteil, France.,Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - O Chosidow
- EA 7379 EpiDermE, Université Paris Est Créteil, Créteil, France.,Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France.,INSERM, Centre d'Investigation Clinique 1430, Créteil, France
| | - L Fardet
- EA 7379 EpiDermE, Université Paris Est Créteil, Créteil, France.,Department of Dermatology, Hôpital Henri-Mondor, AP-HP, Créteil, France
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