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Kwan J, Ahmed H, Ponsetto MK, Succar T, Chodosh J, Saeed HN. Relationship between Atopic Disease and Acute Ocular and Systemic Outcomes in Patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Ocul Immunol Inflamm 2023; 31:900-904. [PMID: 35486647 PMCID: PMC10012391 DOI: 10.1080/09273948.2022.2061520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To describe the relationship between history of atopic disease on systemic and ocular manifestations of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN). METHODS Retrospective chart review of patients with SJS/TEN patients. Those with and without prior atopic diagnosis were compared. RESULTS In total, 200 patients with SJS/TEN were identified. A total of 23 patients also had an atopic diagnosis. Four, 10, and 18 had atopic dermatitis, allergic rhinitis, and asthma respectively. Acute ocular severity was significantly worse in the atopic cohort. No significant differences in overall systemic severity of SJS or mortality were found between the atopic and non-atopic cohorts. Compared to our hospital system's general population, prevalence of an atopic diagnosis was significantly higher in those with SJS/TEN. CONCLUSION Patients with a history of an atopic diagnosis appear to have more significant acute ocular involvement during their SJS/TEN hospitalization. Atopic conditions appear to occur more frequently in the SJS/TEN population compared to the general population.
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Affiliation(s)
- James Kwan
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Harris Ahmed
- Loma Linda University Medical Center, Department of Ophthalmology, Loma Linda, CA
| | | | - Tony Succar
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Hajirah N. Saeed
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA
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Kaide CG, San Miguel CE. Stevens Johnson Syndrome – “Steven Who? And Why I Should Care About His Johnson?”. CASE STUDIES IN EMERGENCY MEDICINE 2020. [PMCID: PMC7122494 DOI: 10.1007/978-3-030-22445-5_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diagnosing rashes in the emergency department can be challenging. If the rash is extensive and targetoid, include Stevens-Johnson Syndrome (SJS) on your differential and be sure to obtain a thorough history to identify possible offending agents. Additionally, prioritize supportive care and obtaining a dermatology/burn consult to coordinate appropriate care.
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Affiliation(s)
- Colin G. Kaide
- Wexner Medical Center, Ohio State University, Columbus, OH USA
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Abstract
Toxic epidermal necrolysis (TEN) is a serious, life-threatening skin reaction characterized by severe exfoliation and destruction of the epidermis of the skin. In most TEN cases, drugs are believed to be the causative agent; antipsychotics, antiepileptics, and other medications such as sulfonamides are among the most common causes of drug-induced TEN. Phenytoin, a commonly prescribed medication for seizure, was found to cause TEN. Evidence-based treatment guidelines are lacking, so the best strategy is to identify and avoid potential risk factors and to provide intensive supportive care. The aim of this literature review is to focus on phenytoin-induced TEN, to explore the risk factors, and to highlight the possible treatment options once phenytoin-induced TEN is confirmed.
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Affiliation(s)
- Osama M Al-Quteimat
- Department of Pharmacy Services, Clevevland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Manzini TC, Gosnell BI, John MAA, Moosa MYS. Efavirenz challenge in patients with nevirapine induced Stevens-Johnson Syndrome. S Afr J Infect Dis 2015. [DOI: 10.1080/23120053.2016.1156874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Law EH, Leung M. Corticosteroids in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Ann Pharmacother 2014; 49:335-42. [DOI: 10.1177/1060028014560012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To review the evidence for the use of steroids in adults presenting with Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), or overlap. Data Sources: EMBASE (1974 to April 2014), MEDLINE (1946 to April 2014), Cochrane Database of Systematic Reviews, and International Pharmaceutical Abstracts (1970 to January 2014) were searched using the terms: prednisone, methylprednisolone, dexamethasone, prednisolone, steroids, glucocorticoids, corticosteroids, Stevens-Johnson Syndrome, toxic epidermal necrolysis, and SJS/TEN overlap. Study Selection and Data Extraction: English-language, full reports of experimental and observational studies were included. Bibliographies from pertinent publications were reviewed for additional references. Prespecified outcomes included survival, survival to discharge, hospitalization without intensive care, length of intensive care stay, duration of hospitalization, ophthalmological complications, infection rates, and adverse events. Data Synthesis: Six studies that used steroids for SJS, TEN, and/or overlap were included. All studies were retrospective cohort studies with no case-control or cross-sectional studies; 5 studies reported on steroid doses, and 2 studies reported time from disease onset to steroid use (2-4 days). Only 1 of 6 studies reported a statistically significant impact on mortality with steroids use (odds ratio = 0.4; 95% CI = 0.2-0.9). Adverse event rates were not reported in any of the studies. Conclusions: A review of the current evidence reveals a need for prospective, randomized controlled studies to provide more definitive conclusions on steroid use in patients with SJS, TEN, and/or overlap.
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Affiliation(s)
| | - May Leung
- Surrey Memorial Hospital, Surrey, BC, Canada
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Clinical Evaluation Comparing the Efficacy of Aquacel Ag with Vaseline Gauze versus 1% Silver Sulfadiazine Cream in Toxic Epidermal Necrolysis. Adv Skin Wound Care 2014; 27:210-5. [DOI: 10.1097/01.asw.0000445919.06416.32] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hafermann MJ, Barber GR, Dreskin SC, Lindberg GK. Fatal case of cephalexin-induced toxic epidermal necrolysis. SAGE Open Med Case Rep 2014; 2:2050313X14532250. [PMID: 27489646 PMCID: PMC4857339 DOI: 10.1177/2050313x14532250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To describe a case of toxic epidermal necrolysis likely caused by cephalexin with a review of the literature. Case: An 80-year-old male with a known allergy to cephalosporins, residing at a long-term acute care hospital, received cephalexin for a urinary tract infection. And 1 day after starting therapy, the patient developed an extensive erythematous rash accompanied by skin sloughing; 4 days after receiving cephalexin, the patient was directly admitted to the burn intensive care unit and was diagnosed with toxic epidermal necrolysis involving 56% of the total body surface area. Progressive deterioration to multisystem organ failure ensued, and the patient died 5 days following his admission to the burn intensive care unit. At the time of death, ulcerations were noted over approximately 80% of his body. Summary: The temporal association of the patient’s ingestion of cephalexin for a urinary tract infection to his onset of toxic epidermal necrolysis suggests that this 80-year-old man developed toxic epidermal necrolysis following the administration of cephalexin for a urinary tract infection.
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Affiliation(s)
| | - Gerard R Barber
- Department of Pharmacy Services, University of Colorado Hospital, Aurora, CO, USA
- School of Pharmacy, University of Colorado, Aurora, CO, USA
| | - Stephen C Dreskin
- Allergy, Asthma, and Immunology Practice, University of Colorado Hospital
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Gordon K Lindberg
- University of Colorado Hospital, Aurora, CO, USA
- Surgery–GI Tumor and Endocrine Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
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Management of Ocular Conditions in the Burn Unit: Thermal and Chemical Burns and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. J Burn Care Res 2011; 32:547-60. [DOI: 10.1097/bcr.0b013e31822b0f29] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Pompholyx is a vesicobullous disorder of the palms and soles. The condition is hard to treat because of the peculiarities of the affected skin, namely the thick horny layer and richness of the sweat glands. In this article, we review the available therapies, and score the treatments according to the level of evidence. The cornerstones of topical therapy are corticosteroids, although calcineurin inhibitors also seem to be effective. Topical photochemotherapy with methoxsalen (8-methoxypsoralen) is as effective as systemic photochemotherapy or high-dose UVA-1 irradiation. Systemic therapy is often necessary in bullous pompholyx. Corticosteroids are commonly used although no controlled study has been published to date. For recalcitrant cases, corticosteroids are combined with immunosuppressants. Alitretinoin has efficacy in chronic hand dermatitis including pompholyx. Another evolving treatment seems to be the intradermal injection of botulinum toxin. Radiotherapy might be an option for selected patients not responding to conventional treatment. In practice, patients benefit most from a combination of treatments.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden Friedrichstadt, Germany.
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Garcia JBS, Ferro LSG, Carvalho AB, da Rocha RM, de Souza LML. Severe Carbamazepine-Induced Cutaneous Reaction in the Treatment of Post-herpetic Neuralgia. Case Report. Rev Bras Anestesiol 2010; 60:429-37. [DOI: 10.1016/s0034-7094(10)70053-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 03/18/2010] [Indexed: 11/28/2022] Open
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Heparin-Induced Thrombocytopenia in a Nonthrombocytopenic Patient With Toxic Epidermal Necrolysis Causing Fatal Outcome: Is HIT Still a HIT? J Burn Care Res 2009; 30:747-51. [DOI: 10.1097/bcr.0b013e3181ac05bf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abou-Elhamd KEA. Two cases of Stevens–Johnson syndrome following intake of klavox with review of literature. Eur Arch Otorhinolaryngol 2008; 266:1327-30. [DOI: 10.1007/s00405-008-0785-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 07/23/2008] [Indexed: 11/30/2022]
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Borras-Blasco J, Navarro-Ruiz A, Borras C, Castera E. Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection. J Antimicrob Chemother 2008; 62:879-88. [DOI: 10.1093/jac/dkn292] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Toxic epidermal necrolysis with a rare long-term oral complication requiring surgical intervention. ACTA ACUST UNITED AC 2008; 105:e29-33. [DOI: 10.1016/j.tripleo.2007.12.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Accepted: 12/14/2007] [Indexed: 11/20/2022]
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