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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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Kaimal S, Lobo C, Narayan G, Augustine M. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Fresh Look at an Old Foe. Indian J Dermatol 2023; 68:34-40. [PMID: 37151259 PMCID: PMC10162751 DOI: 10.4103/ijd.ijd_726_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are some of the less common cutaneous adverse drug reactions with significant mortality. Objectives This study was undertaken with the objective of studying the demographics and clinical profile of SJS/TEN and identifying parameters associated with mortality. Materials and Methods All patients with SJS/TEN over 10 years (2010-2020) were included in the study. Data obtained from in-patient and out-patient records were analysed. Results A total of 82 patients with SJS/TEN were admitted to our centre over a period of 10 years. Patients with SJS were significantly younger than those with TEN, with a male: female ratio >1 in SJS and <1 in TEN. The most commonly implicated drugs were antiepileptics (n = 29, 35.4%), antibiotics (n = 20, 24.4%). and Non-steroidal antiinflammatory drugs (NSAIDs) (n = 7, 8.5%). The mortality rate in the TEN group was 16% (n = 8). Certain factors such as cutaneous lesions preceding mucosal lesions at onset, high mean Body surface area (BSA) of denudation and a transfer to intensive care unit (ICU) more than 7 days after admission were significantly associated with higher mortality. There was no difference between survivors and deaths in terms of delay in hospitalisation, total disease duration, implicated drug, delay in initiation of therapy, the onset of re-epithelialisation, Severity-of-illness score for TEN (SCORTEN) and total duration of hospital stay. Conclusion Factors significantly associated with increased mortality in TEN were cutaneous onset of lesions, mean BSA of involvement and transfer to the intensive care unit (ICU) beyond day 7 of admission.
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Affiliation(s)
- Sowmya Kaimal
- From the Department of Dermatology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Carol Lobo
- From the Department of Dermatology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Girish Narayan
- Department of Emergency Medicine, St. John's Medical College, Bengaluru, Karnataka, India
| | - Mary Augustine
- From the Department of Dermatology, St. John's Medical College, Bengaluru, Karnataka, India
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Hamich S, Sqalli Houssaini A, Meziane M, Ismaili N, Benzekri L, Senouci K. Syndrome De Lyell Et Syndrome De Stevens-Johnson: Étude Rétrospective De 30 Cas. ANNALS OF BURNS AND FIRE DISASTERS 2022; 35:116-124. [PMID: 36381342 PMCID: PMC9416682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/15/2021] [Indexed: 06/16/2023]
Abstract
Stevens-Johnson syndrome and Lyell syndrome are severe bullous drug reactions that can be life-threatening. The aim of this study is to describe the epidemiological, etiological, clinical, therapeutic and evolutionary data of patients hospitalized in our Dermatology Department. This is a retrospective descriptive study over a period of 10 years. All records of patients admitted to the Dermatology Department for these cutaneous adverse drug reactions were included. A total of 30 patients were recorded, with a male predominance. There were 18 cases of Lyell syndrome, 8 cases of Stevens-Johnson syndrome and 4 cases of overlap syndrome. The mean time to onset after drug administration was 7.5 days. The average skin area detached was 48%. Visceral involvement was frequently observed: pulmonary involvement, renal involvement, hepatic cytolysis and hematological involvement. The notion of medication was found in all our patients, with self-medication in 23% of cases. The reason for prescription was dominated by post-surgical anticonvulsant prophylaxis. All our patients received symptomatic treatment, and corticosteroid therapy was administered in only one patient for macrophagic activation syndrome. The mortality rate was of 17%. Skin area involved, presence of renal failure or respiratory distress were the main prognostic factors.
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Affiliation(s)
- S. Hamich
- Service de Dermatologie et de Vénéréologie, CHU Ibn Sina, Université Mohamed V, 10100 Rabat, Maroc
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Babu T, Panachiyil GM, Vasudev PH, Ravi MD. A Rare Pediatric Case of Cefixime Induced Toxic Epidermal Necrolysis. Hosp Pharm 2022; 57:237-240. [PMID: 35601719 PMCID: PMC9117772 DOI: 10.1177/00185787211016332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cefixime is a third-generation cephalosporin that has been used for the treatment of a wide range of infections in children and adults. The incidence of cefixime induced toxic epidermal necrolysis (TEN) is less than 2% in adults, but it is infrequent among pediatric patients. We report a rare case of cefixime induced TEN in a 7-year-old boy. In this case, the child presented with symptoms of TEN after 2 days of administration of cefixime. This case highlights the need to select structurally different antibiotics in case of antibiotic-induced severe cutaneous adverse reaction (SCAR) to avoid recurrence of SCAR. Furthermore, concluded that irrational use of antibiotics could be disastrous as it can result in TEN as the incidence of antibiotics induced TEN ranges from 29% to 42%.
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Affiliation(s)
- Tirin Babu
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - George Mathew Panachiyil
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Prajwala Hassan Vasudev
- Department of Pediatrics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
| | - Mandyam Dhati Ravi
- Department of Pediatrics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru, Karnataka, India
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Thakur V, Vinay K, Kumar S, Choudhary R, Kumar A, Parsad D, Kumaran MS. Factors Predicting the Outcome of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A 5-Year Retrospective Study. Indian Dermatol Online J 2021; 12:258-265. [PMID: 33959522 PMCID: PMC8088174 DOI: 10.4103/idoj.idoj_437_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/11/2020] [Accepted: 09/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Clinicodemographic and laboratory parameters predicting the outcome of Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) may vary among populations owing to genotypic and environmental variations. There is a scarcity of studies evaluating these parameters in Indian population. Aims: To analyze clinicodemographic and laboratory parameters predicting disease outcome in patients of SJS/TEN. Materials and Methods: Clinical records of patients admitted with a diagnosis of SJS/TEN from January 2014 to December 2018 were reviewed retrospectively with respect to data pertaining to clinicodemographic details, laboratory parameters, and disease outcome. Results: Of 51 patients included in the study, 24 (47.06%) were females. Anticonvulsants [phenytoin (19.6%), carbamazepine (13.7%), others (5.88%)] were the most commonly implicated drugs followed by NSAIDs (19.6%). The overall mortality was 21.6% [SJS (0%), SJS-TEN overlap (18.8%), and TEN (28.6%)]. The mean detached body surface area (BSA) (35.4% ± 10.4% vs. 25.7% ± 11.8%; P = 0.02) was significantly higher among patients with mortality. Blood urea nitrogen, serum HCO3− levels, and random blood sugar were significantly associated with mortality. Presence of sepsis during the disease course was associated with higher mortality (9/12 vs. 2/39; P = 0.001). Other components of SCORTEN like age and heart rate were not significantly associated with poor outcome in our study. None of our patients had associated malignancy. Conclusion: A higher detached BSA, presence of sepsis, higher blood urea nitrogen and random blood sugar, and lower serum HCO3− levels were associated with mortality. Refinement of scoring systems predicting the outcome of SJS-TEN is needed for better disease prognostication.
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Affiliation(s)
- Vishal Thakur
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajat Choudhary
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ciddhavaduta DL, Kalaiselvan V, Midde ML, Baloju D. Analysis of severity and preventability in patients of-Toxic epidermal necrolysis-A case series. Clin Case Rep 2020; 8:2452-2456. [PMID: 33363758 PMCID: PMC7752467 DOI: 10.1002/ccr3.3145] [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: 06/02/2020] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
SJS-TEN is life-threatening autoimmune disorder triggered due to drugs such as analgesics, antibiotics, anticonvulsants, and antipsychotics. This report provides awareness to the Clinicians regarding prescription of drugs which cause SJS-TEN. Among young females of 20-40 years, screening for previous history, issuing drug alert cards, and preventing OTC prescriptions decreases mortality.
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Affiliation(s)
| | | | - Madhavi Latha Midde
- Department of DermatologySanthiram Medical College and General HospitalNandyalIndia
| | - Deepika Baloju
- ADR Monitoring CenterBhaskar Medical CollegeMoinabadIndia
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Oshikoya KA, Ogunyinka IA, Ogar CK, Abiola A, Ibrahim A, Oreagba IA. Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017. Ther Adv Drug Saf 2020; 11:2042098620905998. [PMID: 32110375 PMCID: PMC7016315 DOI: 10.1177/2042098620905998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCARs). There is scant literature on the characteristics and causes of these conditions among the Nigerian population. Here, we describe the epidemiology, associated morbidity and mortality, and culpable drugs in SJS and TEN cases using the National Pharmacovigilance (NPC) database in Nigeria. Methods: A retrospective review of the NPC database was done to analyze SJS and TEN cases reported over a period of 14 years. Annual reports, age and sex of patients, type of reporter, suspects and concomitant drugs, time to onset (TTO) of the reactions, and outcome of SJS and TEN were evaluated. Results: The NPC received a total of 24,015 adverse drug reaction (ADR) reports. SJS and TEN accounted for 284 (0.1%) of the total reports, of which 254 (89.4%) were SJS and the remainder were TEN. Females (n = 184, 64.8%) and individuals aged 19–40 years (n = 181, 63.7%) were the most affected by SJS and TEN. Antiretrovirals, followed by antibiotics, were the most common drug classes reported to cause SJS and TEN, with nevirapine (n = 174, 40.7%) and co-trimoxazole (n = 143, 33.5%) being the most widely implicated drugs. Among patients with reported outcomes, 73 (28.7%) SJS and 3 (10.0%) TEN cases recovered without sequelae, at the time of reporting. Severity of the SCAR was reported for only 171 (69.0%) cases, of which 12 (4.7%) and 8 (26.7%) resulted in death (Grade 5) among SJS and TEN cases, respectively. Conclusions: Antiretroviral and antibiotics were the commonly reported offending group of drugs for SJS and TEN cases. Nevirapine and co-trimoxazole were the commonly reported suspect drugs. SJS and TEN were reported most frequently in females and in patients aged 19–40 years, indicating that drug surveillance and counseling in these groups of patients may be beneficial.
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Affiliation(s)
- Kazeem Adeola Oshikoya
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, 1-5, Oba Akinjobi Street, Ikeja, Lagos 234, Nigeria
| | | | - Comfort Kunak Ogar
- National Pharmacovigilance Center, National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, FCT, Nigeria
| | - Abiodun Abiola
- National Pharmacovigilance Center, National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, FCT, Nigeria
| | - Ali Ibrahim
- National Pharmacovigilance Center, National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, FCT, Nigeria
| | - Ibrahim Adekunle Oreagba
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, University of Lagos, Idiaraba, Lagos, Nigeria
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Jha N, Alexander E, Kanish B, Badyal DK. A Study of Cutaneous Adverse Drug Reactions in a Tertiary Care Center in Punjab. Indian Dermatol Online J 2018; 9:299-303. [PMID: 30258795 PMCID: PMC6137653 DOI: 10.4103/idoj.idoj_81_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Cutaneous adverse drug eruptions are the most common adverse reactions attributed to drugs in which any type of skin reaction can be mimicked, induced, or aggravated. AIMS To study the pattern of various types of cutaneous adverse drug reactions (CADRs), to find out the causative drug(s) involved and to determine the response to treatment and outcome in patients with CADRs. PATIENTS AND METHODS This prospective study was done in the department of dermatology. Patients with suspected drug rash, of either sex and all age groups were included in the study. STATISTICAL ANALYSIS Frequencies and proportions were calculated using Chi-square test and t-test as the tests of significance. Data was analyzed using SPSS version 21. RESULTS A total of 258 patients were enrolled in the study. The most common CADR observed in the study was exanthematous drug eruption in 42.63% patients followed by drug induced urticaria in 21.32% patients. Antimicrobials were the most common offending drugs in 64.73% of patients, followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15.50% patients. In the study, 12 patients (4.65%) were found to have severe cutaneous adverse drug reactions (SCADRs). Stevens-Johnson syndrome (SJS) - Toxic epidermal necrolysis (TEN) was the most common SCADR (50%) and antituberculous drugs were the most common causative group of drugs causing SCADRs. CONCLUSION The most common CADR observed in the study was exanthematous drug eruption and antimicrobials were the most common causative drugs.
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Affiliation(s)
- Niharika Jha
- Department of Dermatology, Dr BC Roy Post Graduate Institute of Pediatric Sciences, Kolkata, West Bengal, India
| | - Emy Alexander
- Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Bimal Kanish
- Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Dinesh K. Badyal
- Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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9
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The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China. J Immunol Res 2018; 2018:4320195. [PMID: 29607330 PMCID: PMC5828103 DOI: 10.1155/2018/4320195] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/08/2017] [Accepted: 11/28/2017] [Indexed: 01/31/2023] Open
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI) and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5%) and anticonvulsants (24.1%). Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%). Chinese patent medicines accounted for 5.4%. There were 76 (45.8%) patients receiving systemic steroid and intravenous immunoglobulin (IVIG) in combination therapy, especially for TEN (80.3%), and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.
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Zaidi M, Zaidi SK, Bhutto M, Umer MY. Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: A case report. EXCLI JOURNAL 2017; 16:748-751. [PMID: 28827990 PMCID: PMC5547378 DOI: 10.17179/excli2017-345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/04/2017] [Indexed: 12/15/2022]
Abstract
Stevens-Johnson syndrome (SJS) is an immune mediated hypersensitivity reaction. Significant involvement of oral, nasal, eye, vaginal, urethral, GI and lower respiratory tract mucous membrane may develop. It is usually a reaction due to a medication or due to an infection. In 95 % of case reports, drugs were found to be an important cause for the development of SJS. In this case report, a 32 year old female reported chief complaint of itch skin eruptions all over the body along with erosive lesions on tongue, lips, buccal mucosa and genital mucosa. The reaction occurred after administration of augmentin (containing amoxycillin and clavulanic acid). She was treated with antimicrobials, antiallergics and conservative management. The patient improved and was discharged from the hospital. Causality assessment using Naranjo Adverse Drug Reaction Probability Scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the adverse reaction with a score of 4.
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Affiliation(s)
- Maheen Zaidi
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Moomal Bhutto
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Paik S, Sen S, Era N, Saha B, Tripathi SK. Fatal Nevirapine-Induced Toxic Epidermal Necrolysis in a HIV Infected Patient. J Clin Diagn Res 2016; 10:FD03-6. [PMID: 27134891 DOI: 10.7860/jcdr/2016/16360.7415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/07/2016] [Indexed: 11/24/2022]
Abstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are the most Severe Cutaneous Adverse Reactions (SCARs) which mainly caused by exposure to drugs and having significant morbidity and mortality. TEN represents an immunologic reaction to a foreign antigen and is most often caused by drugs. Nevirapine (NVP), a non-nucleoside reverse transcriptase inhibitor (NNRTI) is an important component of Highly Active Antiretroviral Therapy (HAART). It is sometimes associated with life-threatening adverse reactions. Here, we report the fatal case of 72-year-old male who developed TEN secondary to intake of nevirapine. This fatal case report will increase awareness among treating physicians for careful monitoring of patients on NNRTI-based antiretroviral therapy and better counseling of the patient on NVP regimen for early identification and reporting of SCARs so that fatalities due to adverse drug reactions can be prevented with timely intervention.
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Affiliation(s)
- Sabyasachi Paik
- Post Graduate Trainee, Department of Clinical & Experimental Pharmacology, Calcutta School of Tropical Medicine , Kolkata, India
| | - Sukanta Sen
- Associate Professor, Department of Pharmacology, ICARE Institute of Medical Sciences & Research , Haldia, India
| | - Nikhil Era
- Post Graduate Trainee, Department of Clinical & Experimental Pharmacology, Calcutta School of Tropical Medicine , Kolkata, India
| | - Bibhuti Saha
- Professor, Department of Tropical Medicine, Calcutta School of Tropical Medicine , Kolkata, India
| | - Santanu Kumar Tripathi
- Professor, Department of Clinical & Experimental Pharmacology, Calcutta School of Tropical Medicine , Kolkata, India
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12
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Pavelka K, Bruyère O, Cooper C, Kanis JA, Leeb BF, Maheu E, Martel-Pelletier J, Monfort J, Pelletier JP, Rizzoli R, Reginster JY. Diacerein: Benefits, Risks and Place in the Management of Osteoarthritis. An Opinion-Based Report from the ESCEO. Drugs Aging 2016; 33:75-85. [PMID: 26849131 PMCID: PMC4756045 DOI: 10.1007/s40266-016-0347-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Diacerein is a symptomatic slow-acting drug in osteoarthritis (SYSADOA) with anti-inflammatory, anti-catabolic and pro-anabolic properties on cartilage and synovial membrane. It has also recently been shown to have protective effects against subchondral bone remodelling. Following the end of the revision procedure by the Pharmacovigilance Risk Assessment Committee of the European Medicines Agency, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) constituted a panel of 11 experts to better define the real place of diacerein in the armamentarium for treating OA. Based on a literature review of clinical trials and meta-analyses, the ESCEO confirms that the efficacy of diacerein is similar to that of non-steroidal anti-inflammatory drugs (NSAIDs) after the first month of treatment, and superior to that of paracetamol. Additionally, diacerein has shown a prolonged effect on symptoms of several months once treatment was stopped. The use of diacerein is associated with common gastrointestinal disorders such as soft stools and diarrhoea, common mild skin reactions, and, uncommonly, hepatobiliary disorders. However, NSAIDs and paracetamol are known to cause potentially severe hepatic, gastrointestinal, renal, cutaneous and cardiovascular reactions. Therefore, the ESCEO concludes that the benefit-risk balance of diacerein remains positive in the symptomatic treatment of hip and knee osteoarthritis. Furthermore, similarly to other SYSADOAs, the ESCEO positions diacerein as a first-line pharmacological background treatment of osteoarthritis, particularly for patients in whom NSAIDs or paracetamol are contraindicated.
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Affiliation(s)
- Karel Pavelka
- Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit and NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK
| | - John A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Burkhard F Leeb
- 2nd Department of Medicine, State Hospital Stockerau, Centre for Rheumatology, Lower Austria, Karl Landsteiner Institute for Clinical Rheumatology, Stockerau, Austria
| | - Emmanuel Maheu
- Rheumatology Department, AP-HP, St-Antoine Hospital, Paris, France
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame-Hospital, Montreal, Canada
| | - Jordi Monfort
- Rheumatology Service, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame-Hospital, Montreal, Canada
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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13
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Quinolones-induced hypersensitivity reactions. Clin Biochem 2015; 48:716-39. [DOI: 10.1016/j.clinbiochem.2015.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
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14
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Affiliation(s)
- Sujata Sengupta
- Department of Dermatology, KPC Medical College and Hospital, 1F, Raja SC Mallik Road, Kolkata, West Bengal, - 700 032, India. E-mail:
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15
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Villano JH, Lovell EO. Mixed signals: toxic epidermal necrolysis. Am J Med 2015; 128:254-6. [PMID: 25460525 DOI: 10.1016/j.amjmed.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Janna H Villano
- Division of Medical Toxicology, Department of Emergency Medicine, University of California San Diego School of Medicine, San Diego.
| | - Elise O Lovell
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Ill
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16
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Autoimmune blistering diseases in females: a review. Int J Womens Dermatol 2015; 1:4-12. [PMID: 28491949 PMCID: PMC5418673 DOI: 10.1016/j.ijwd.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/23/2014] [Accepted: 01/13/2015] [Indexed: 12/31/2022] Open
Abstract
The autoimmune blistering diseases (AIBDs) are a group of heterogeneous skin diseases with autoantibodies directed against structural proteins in the skin. A new interest in the female bias towards autoimmune diseases in general has led to our attention to focus on how and why this female bias manifests in AIBD. The authors aim to review and explore the various aspects of AIBD affecting females more than males, including the higher prevalence, worse quality of life, and complex management issues such as pregnancy and lactation. What is already known on this topic? Echoing autoimmune diseases in general, most autoimmune blistering diseases (AIBDs) have a female predominance, but the exact level of predominance is unknown. Pregnancy raises several complicated management issues for females with an AIBD.
What does this article add to our knowledge? Review of sex-specific epidemiology and etiology of each AIBD. Exploration and explanation of the key factors underlying the detrimental impacts of AIBD on women’s quality of life (QOL). Discussion of management issues in pregnancy and lactation for females with an AIBD.
How does this information impact clinical practice and/or change patient care? An awareness and understanding of the female predominance in AIBDs will ensure more appropriate diagnosis, evaluation, and future research. Emphasizing holistic care targeting the debilitating effects of AIBDs on women’s QOL. Informing the reader of optimal, yet safe interventions for pregnant women with an AIBD.
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17
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Lalosevic J, Nikolic M, Gajic-Veljic M, Skiljevic D, Medenica L. Stevens-Johnson syndrome and toxic epidermal necrolysis: a 20-year single-center experience. Int J Dermatol 2014; 54:978-84. [PMID: 25385069 DOI: 10.1111/ijd.12702] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/27/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases that are most frequently caused by drugs. OBJECTIVES The purpose of this study was to summarize 20 years of experience with SJS and TEN in the largest dermatology clinic in Serbia. METHODS The study included 38 patients treated during the period 1993-2012. The patients were classified into three groups according to whether they were diagnosed with SJS, a condition representing an overlap of SJS and TEN (SJS/TEN), or TEN. Patients with TEN were also divided into three groups according to the modality of therapy: supportive therapy (ST) only (n = 3); ST plus systemic corticosteroids (SC) (n = 8); and ST plus SC plus IV immunoglobulins (IVIG) (n = 6). RESULTS The study population included 13 SJS patients, eight SJS/TEN patients, and 17 TEN patients. The disease had started at a mean ± standard deviation (SD) of 7.1 ± 3.5 days after the commencement of treatment with the offending drug. The disease resulted in three lethal outcomes, all of which occurred in TEN patients. However, the predicted mortality for the whole group was 5.6 in 38 patients, whereas that for the TEN group was 3.97 in 17 patients. The differences between actual and predicted rates of mortality were not significant. Among the three groups of TEN patients, there were no significant differences in the commencement of re-epithelialization or the duration of hospitalization. CONCLUSIONS In the present study, nonsteroidal anti-inflammatory and anti-infective drugs were the most frequent causative agents (eight patients in each group). In the group of SJS and SJS/TEN patients treated with ST and SC, the mortality rate was 0%. In TEN patients, the mortality rate was 17.6% (three of 17 patients). There were no significant differences in mortality rate among the three TEN treatment groups, but the results may have been biased by the small number of patients.
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Affiliation(s)
- Jovan Lalosevic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milos Nikolic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mirjana Gajic-Veljic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dusan Skiljevic
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ljiljana Medenica
- Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia.,Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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18
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Prabhu VA, Doddapaneni S, Thunga G, Thiyagu R, Prabhu MM, Naha K. Phenytoin induced Stevens-Johnson syndrome exacerbated by cefepime. J Pharmacol Pharmacother 2013; 4:291-3. [PMID: 24250210 PMCID: PMC3826009 DOI: 10.4103/0976-500x.119719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Steven Johnson syndrome (SJS) is a rare drug induced mucocutaneous reaction. Here, we present an elaborate report of a 28-year-old female patient who developed Phenytoin induced SJS, which was exacerbated by cefepime.
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Affiliation(s)
- Varsha A Prabhu
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Karnataka, India
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19
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Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: Part II. Prognosis, sequelae, diagnosis, differential diagnosis, prevention, and treatment. J Am Acad Dermatol 2013; 69:187.e1-16; quiz 203-4. [PMID: 23866879 DOI: 10.1016/j.jaad.2013.05.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/06/2013] [Accepted: 05/10/2013] [Indexed: 02/01/2023]
Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening, typically drug-induced, mucocutaneous disease. TEN has a high mortality rate, making early diagnosis and treatment of paramount importance. New but experimental diagnostic tools that measure serum granulysin and high-mobility group protein B1 (HMGB1) offer the potential to differentiate early TEN from other, less serious drug reactions, but these tests have not been validated and are not readily available. The mainstay of treatment for TEN involves discontinuation of the offending drug, specialized care in an intensive care unit or burn center, and supportive therapy. Pharmacogenetic studies have clearly established a link between human leukocyte antigen allotype and TEN. Human leukocyte antigen testing should be performed on patients of East Asian descent before the initiation of carbamezapine and on all patients before the initiation of abacavir. The effectiveness of systemic steroids, intravenous immunoglobulins, plasmapheresis, cyclosporine, biologics, and other agents is uncertain.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, Preventive Medicine, and Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis. J Am Acad Dermatol 2013; 69:173.e1-13; quiz 185-6. [DOI: 10.1016/j.jaad.2013.05.003] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/06/2013] [Accepted: 05/10/2013] [Indexed: 11/16/2022]
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Barvaliya MJ, Patel MK, Patel TK, Tripathi CB. Toxic epidermal necrolysis due to lamotrigine in a pediatric patient. J Pharmacol Pharmacother 2013; 3:336-8. [PMID: 23326109 PMCID: PMC3543558 DOI: 10.4103/0976-500x.103695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A 12-year-male child developed toxic epidermal necrolysis (TEN) probably due to lamotrigine. The patient was on antiepileptic therapy (sodium valproate and clonazepam) since 6–7 months, and lamotrigine was added in the regimen 1–2 months back. A serious cutaneous reaction is more likely to occur during the first 2 months of starting lamotrigine. The use of lamotrigine as an add-on to valproate may have precipitated the reaction. Other drugs were ruled out based on the incubation period of TEN. Drug interactions should be kept in mind with multiple antiepileptic therapies. The patient died because of the severity of reactions and delay in starting the treatment with steroids. One must be vigilant in early detection of the reaction.
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Affiliation(s)
- Manish J Barvaliya
- Department of Pharmacology, Government Medical College, Bhavnagar, India
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An analysis of drug induced Stevens-Johnson syndrome. Indian J Med Res 2012; 136:1051-3. [PMID: 23391805 PMCID: PMC3612312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Wiwanitkit S, Wiwanitkit V. Oral mucositis, Steven Johnson syndrome and amlodipine usage in a case with metabolic syndrome. Diabetes Metab Syndr 2012; 6:112. [PMID: 23153981 DOI: 10.1016/j.dsx.2012.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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