10-years register of Stevens-Johnson syndrome and toxic epidermal necrosis analysis

Abstract

Minocycline-induced hyperpigmentation is a rare but documented side effect of the drug. It has an approximate incidence of 3-15%.[1] Patients being treated with minocycline for rosacea have a 15% general incidence of developing hyperpigmentation. Patients treated with minocycline for acne have a lesser incidence of 3%.[1] While specific causation remains unconfirmed, there appears to be a strong correlation noted in the literature of dose-and durationdependent development.[1] There are three main types of minocycline-induced hyperpigmentation. Type I has been seen as early as a few weeks after initiation of minocycline treatment, whereas type II and III appear to develop after several months for cumulative doses of 70-100 grams. The patient may fit the classification of type II, which is often seen on healthy cutaneous tissue as brown-gray or blue-black coloration of shins, ankles and arms. Type II is thought to be due to minocycline or its oxidation products being deposited into insoluble complexes within the cutaneous tissue.[1] Discontinuation of minocycline usually results in resolution of hyperpigmentation in a few months.[1,2] Though rare, type III has been known to cause permanent changes.[2]

Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

“…Therefore, a multi-disciplinary approach is required. In a first step, immediate withdrawal of potentially causative drugs, ideally in the early stages of the disease, is mandatory to reduce fatality in SJS/TEN; in addition, supportive cares such as: fluid replacement, would care, and nutritional support is commended [1,5,8,12,15]. In the present case, the identified offending drug was Phenobarbitone, which we immediately discontinued.…”

“…The present case describes a case of TEN in a young boy. However, previous studies shows low prevalence of toxic epidermal necrosis in pediatric age group; furthermore, mortality rates in children with TEN are lower ranging from 0 to 7.5% compared to an overall mortality in adults which is ~30% [1,8,12,13,15]. Therefore, it's vital to have high index of suspicion towards this severe adverse drug reactions characterized by a low incidence but high mortality, even in a young children.…”

“…In addition, the child was given fluid replacement, intravenous antibiotics, and daily wound care; and discharged home improved. Epilepsy is a common neurological disorder in sub-Saharan Africa; epilepsy is characterized as a chronic condition of recurrent unprovoked seizures [1,15,18,21]. Antiepileptic drugs (AEDs) are vital in controlling the seizure attaché in epileptic patients.…”

“…TEN is considerable associated with high morbidity and mortality; it is an exfoliative disease and results in full-thickness damage to the epidermis, characterized by a widespread bullae formation with epidermal necrosis and idiosyncratic of the skin and mucous membranes. TEN mainly occurs in adults and is often attributable to drug sensitivity and considered to be a severe form of Stevens-Johnson syndrome [1,3,[5][6][7][8]. To the best of our knowledge, this is the first case of phenobarbitone-induced toxic epidermal necrosis in a young adolescent patient from the sub Saharan Africa.…”

“…Toxic epidermal necrolysis (TEN)/Stevens-Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, T-cell mediated delayed type IV hypersensitivity reaction; universally related to different drugs; which typically appears 1-3 weeks after the beginning of therapy. More than 100 medications have been implicated in this syndrome [1][2][3][4]. The incidence of TEN is 2 cases per million persons per year [5].…”