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Mentesidou L, Bachou T, Koidou A, Zarafonitis G, Delis D, Mavrikou M. Child With Stevens-Johnson Syndrome Associated With PCR-Confirmed Adenovirus Infection. Clin Pediatr (Phila) 2024; 63:738-742. [PMID: 37496372 DOI: 10.1177/00099228231189644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Lida Mentesidou
- 1st Department of Pediatrics, "Panagiotis and Aglaia Kyriakou" Children Hospital, Athens, Greece
| | - Theodora Bachou
- 1st Department of Pediatrics, "Panagiotis and Aglaia Kyriakou" Children Hospital, Athens, Greece
| | - Afroditi Koidou
- Department of Ophthalmology, "Panagiotis and Aglaia Kyriakou" Children's Hospital, Athens, Greece
| | | | - Dimitrios Delis
- 1st Department of Pediatrics, "Panagiotis and Aglaia Kyriakou" Children Hospital, Athens, Greece
| | - Mersyni Mavrikou
- 1st Department of Pediatrics, "Panagiotis and Aglaia Kyriakou" Children Hospital, Athens, Greece
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2
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Guzmán Tena P, Rodríguez Ramos M, Lloret Ruiz C, Vázquez Álvarez ML. Reactive Infectious Mucocutaneous Eruption (RIME): Expanding the Spectrum of Mucocutaneous Exanthems. ACTAS DERMO-SIFILIOGRAFICAS 2023:S0001-7310(23)00937-7. [PMID: 38061456 DOI: 10.1016/j.ad.2023.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
- P Guzmán Tena
- Servicio de Pediatría, Hospital Comarcal de Vinaròs, Vinaròs, Castellón, España.
| | - M Rodríguez Ramos
- Servicio de Pediatría, Hospital Comarcal de Vinaròs, Vinaròs, Castellón, España
| | - C Lloret Ruiz
- Servicio de Dermatología, Hospital Comarcal de Vinaròs, Vinaròs, Castellón, España
| | - M L Vázquez Álvarez
- Servicio de Pediatría, Hospital Comarcal de Vinaròs, Vinaròs, Castellón, España
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3
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Miller AE, Zhang D, Shields BE, Borghesi A, Benincaso AR, Bernardo L, Ramien M, Lara-Corrales I, Kirkorian AY, Maguiness S, Drolet B. COVID-19 associated severe mucocutaneous blistering eruptions: A case series. Pediatr Dermatol 2023; 40:990-995. [PMID: 37526023 DOI: 10.1111/pde.15407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023]
Abstract
Mucocutaneous eruptions are associated with numerous infectious processes and can present as erythema multiforme (EM), reactive infectious mucocutaneous eruption (RIME), Stevens Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN). Limited reports have detailed the association of these eruptions with SARS-CoV-2 infection. We present a series of eight cases of severe mucocutaneous blistering eruptions associated with SARS-CoV-2 infection. A retrospective case series was performed at six tertiary medical centers from March 1, 2020 to August 1, 2022. Inclusion criteria were met with a clinical diagnosis of EM, RIME, SJS, or TEN and a positive SARS-CoV-2 test (rapid antigen or polymerase chain reaction) less than 4 weeks prior to onset of dermatologic manifestation. Data was collected at time of each patient encounter. Eight patients met criteria with six pediatric patients (<18 years of age) having a median age of 15 years and two adult patients (>18 years of age) having a median age of 36 years. Patients were found to have a clinical diagnosis of RIME in 85.7% of cases. Oral mucosal involvement was the most common clinical finding (100%), followed by ocular (50.0%), urogenital (50.0%), and skin (37.5%) involvement. Evaluation did not reveal any additional infectious triggers in four patients. Evidence of possible concurrent or previous infectious triggers were identified in four patients. This case series highlights the development of severe mucocutaneous eruptions in association with COVID-19 infection, as well as the potential contributing role of concurrent or prior infections.
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Affiliation(s)
- Allison E Miller
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Donglin Zhang
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - Luca Bernardo
- ASST Fatebenefratelli Sacco, Pediatric Unit, Milan, Italy
| | - Michele Ramien
- Department of Pediatrics, Department of Medicine, University of Calgary, Calgary, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Sheilagh Maguiness
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Beth Drolet
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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4
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Fabi M, Dondi A, Andreozzi L, Frazzoni L, Biserni GB, Ghiazza F, Dajti E, Zagari RM, Lanari M. Kawasaki disease, multisystem inflammatory syndrome in children, and adenoviral infection: a scoring system to guide differential diagnosis. Eur J Pediatr 2023; 182:4889-4895. [PMID: 37597046 PMCID: PMC10640425 DOI: 10.1007/s00431-023-05142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
Children with Kawasaki disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C), and Adenovirus infections (AI) of the upper respiratory tract show overlapping features. This study aims to develop a scoring system based on clinical or laboratory parameters to differentiate KD or MIS-C from AI patients. Ninety pediatric patients diagnosed with KD (n = 30), MIS-C (n = 26), and AI (n = 34) admitted to the Pediatric Emergency Unit of S.Orsola University Hospital in Bologna, Italy, from April 2018 to December 2021 were enrolled. Demographic, clinical, and laboratory data were recorded. A multivariable logistic regression analysis was performed, and a scoring system was subsequently developed. A simple model (clinical score), including five clinical parameters, and a complex model (clinic-lab score), resulting from the addition of one laboratory parameter, were developed and yielded 100% sensitivity and 80% specificity with a score ≥2 and 98.3% sensitivity and 83.3% specificity with a score ≥3, respectively, for MIS-C and KD diagnosis, as compared to AI. CONCLUSION This scoring system, intended for both outpatients and inpatients, might limit overtesting, contribute to a more effective use of resources, and help the clinician not underestimate the true risk of KD or MIS-C among patients with an incidental Adenovirus detection. WHAT IS KNOWN • Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and adenoviral infections share overlapping clinical presentation in persistently febrile children, making differential diagnosis challenging. • Scoring systems have been developed to identify high-risk KD patients and discriminate KD from MIS-C patients. WHAT IS NEW • This is the first scoring model based on clinical criteria to distinguish adenoviral infection from KD and MIS-C. • The score might be used by general pediatricians before referring febrile children to the emergency department.
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Affiliation(s)
- Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy.
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Laura Andreozzi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - Leonardo Frazzoni
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Elton Dajti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Rocco Maurizio Zagari
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Massarenti 9, 40138, Bologna, Italy
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5
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Haseeb A, Elhusseiny AM, ElSheikh RH, Tahboub MA, Kwan JT, Saeed HN. Ocular involvement in Mycoplasma induced rash and mucositis: A systematic review of the literature. Ocul Surf 2023; 28:1-10. [PMID: 36396020 DOI: 10.1016/j.jtos.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a relatively newly identified clinical entity which is characterized by mucocutaneous manifestations in the setting of Mycoplasma infection. Though a clinically distinct disease, MIRM exists on a diagnostic continuum with entities including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, and the recently described reactive infectious mucocutaneous eruption (RIME). In this systematic review, we discuss published findings on the epidemiology, clinical manifestations, diagnosis, and management of MIRM, with an emphasis on ocular disease. Lastly, we discuss some of the most recent developments and challenges in characterizing MIRM with respect to the related diagnosis of RIME.
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Affiliation(s)
- Abid Haseeb
- Department of Ophthalmology, Nazareth Hospital, Philadelphia, PA, USA; Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Reem H ElSheikh
- Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mohammad A Tahboub
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - James T Kwan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA.
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6
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Shields BE, Wanat KA, Chiu YE. Undiagnosed and Rare Diseases in Critical Care. Crit Care Clin 2022; 38:243-269. [DOI: 10.1016/j.ccc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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7
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Tonkin R, Ladha M, Johnson N, Astle WF, Britton A, Shear NH, Murguía-Favela L, Ramien M. Reactive infectious mucocutaneous eruption – repeat etanercept after intravenous immunoglobulin: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221117887. [PMID: 36003890 PMCID: PMC9393491 DOI: 10.1177/2050313x221117887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Reactive infectious mucocutaneous eruption is a recently distinguished mucosal-predominant blistering eruption triggered by respiratory infections. We describe a previously healthy 11-year-old Black female with rapidly progressive mucocutaneous blistering after prodromal respiratory infection symptoms. Reactive infectious mucocutaneous eruption was suspected and treated with systemic corticosteroids followed by etanercept. Twenty-four hours after etanercept, the diagnosis of multisystem inflammatory syndrome in children was raised and intravenous immunoglobulin was given. Rapidly worsening mucocutaneous disease ensued but was controlled by a second dose of etanercept. Our case highlights the following: (1) the novel observation of possible interaction/neutralization of etanercept by intravenous immunoglobulin, (2) the challenging differential diagnosis of multisystem inflammatory syndrome in children for reactive infectious mucocutaneous eruption patients in the Coronavirus disease 2019 (COVID-19) pandemic, and (3) the role of early treatment to prevent dyspigmentation.
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Affiliation(s)
- Rochelle Tonkin
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Malika Ladha
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicole Johnson
- Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - William F Astle
- Pediatric Ophthalmology, Vision Clinic, Alberta Children’s Hospital, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ami Britton
- Wound Care/Surgery Clinic Nurse, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Neil H Shear
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Luis Murguía-Favela
- Section of Hematology and Immunology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Michele Ramien
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Community Pediatrics (Dermatology), Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
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8
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Vassallo C, Ruffo Di Calabria V, Isoletta E, Biscarini S, Di Filippo A, Brazzelli V. Clinical and microbiological characteristics of reactive infectious mucocutaneous eruption: A case series of 5 patients. JAAD Case Rep 2021; 17:152-156. [PMID: 34754894 PMCID: PMC8556596 DOI: 10.1016/j.jdcr.2021.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Camilla Vassallo
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Valentina Ruffo Di Calabria
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Eugenio Isoletta
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Simona Biscarini
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Institute of Infectious Diseases, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Di Filippo
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Institute of Infectious Diseases, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Valeria Brazzelli
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, Institute of Dermatology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, University of Pavia, Pavia, Italy
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9
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Valle J, Nasrollahi F, Eilbert W. Mycoplasma pneumoniae-induced rash and mucositis: A case report. Am J Emerg Med 2021; 54:324.e5-324.e7. [PMID: 34642080 DOI: 10.1016/j.ajem.2021.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a recently defined clinical entity characterized by pneumonia caused by M. pneumoniae with associated mucositis and frequent cutaneous lesions of a characteristic pattern. Although often similar in presentation, MIRM has distinct clinical and histologic features that are different from erythema multiforme and Stevens-Johnson syndrome/toxic epidermal necrolysis. We report a case of MIRM in a nine-year-old boy.
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Affiliation(s)
- Johan Valle
- Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, Room 469 CME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
| | - Farrah Nasrollahi
- Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, Room 469 CME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, Room 469 CME, 1819 West Polk Street, Chicago, IL 60612, United States of America.
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10
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Song A, Nicholson C, Maguiness S. Recurrent reactive infectious mucocutaneous eruption (RIME) in two adolescents triggered by several distinct pathogens including SARS-CoV-2 and influenza A. Pediatr Dermatol 2021; 38:1222-1225. [PMID: 34515364 PMCID: PMC8646723 DOI: 10.1111/pde.14780] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Reactive infectious mucocutaneous eruption (RIME) was proposed as new terminology to encompass postinfectious mucocutaneous eruptions. The term includes all postinfectious mucocutaneous eruptions such as the widely reported Mycoplasma pneumoniae-induced rash and mucositis (MIRM). Very few reports in the literature regarding recurrent RIME are found. We present two adolescent cases of recurrent RIME that involve SARS-CoV-2 and influenza A where the latter is a newly reported infectious trigger; in both patients, the initial episode was likely triggered by Mycoplasma pneumoniae (MP) infection.
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Affiliation(s)
- Amy Song
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Cynthia Nicholson
- University of Minnesota Department of Dermatology, Minneapolis, MN, USA
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Frantz R, Huang S, Are A, Motaparthi K. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:895. [PMID: 34577817 PMCID: PMC8472007 DOI: 10.3390/medicina57090895] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare diseases that are characterized by widespread epidermal necrosis and sloughing of skin. They are associated with significant morbidity and mortality, and early diagnosis and treatment is critical in achieving favorable outcomes for patients. In this scoping review, Excerpta Medica dataBASE and PubMed were searched for publications that addressed recent advances in the diagnosis and management of the disease. Multiple proteins (galectin 7 and RIP3) were identified that are promising potential biomarkers for SJS/TEN, although both are still in early phases of research. Regarding treatment, cyclosporine is the most effective therapy for the treatment of SJS, and a combination of intravenous immunoglobulin (IVIg) and corticosteroids is most effective for SJS/TEN overlap and TEN. Due to the rare nature of the disease, there is a lack of prospective, randomized controlled trials and conducting these in the future would provide valuable insights into the management of this disease.
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Affiliation(s)
- Robert Frantz
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (R.F.); (A.A.)
| | - Simo Huang
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA;
| | - Abhirup Are
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (R.F.); (A.A.)
| | - Kiran Motaparthi
- College of Medicine, University of Florida, Gainesville, FL 32606, USA; (R.F.); (A.A.)
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL 32606, USA
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