Clinical Features and Prognostic Factors in Severe Cutaneous Drug Reactions

Abstract

Background: Severe cutaneous adverse reactions (SCARs) include Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). SJS and TEN (SJS/TEN) and DRESS are thought to be different diseases; however, they share some clinical and laboratory features. Although SCORTEN serves as an excellent prognostic marker for SJS/TEN, there is still a need for development of other prognostic markers for SCARs. Methods: The study population consisted of 88 SCAR patients. Clinical characteristics and clinical manifestations were compared between SJS/TEN and DRESS. Risk factor analyses for prolonged hospitalization were performed. Results: Of the 88 patients, 41 were SJS/TEN and 47 were DRESS. Mortality rates of TEN and DRESS were 9.8 and 2.1%, respectively. Allopurinol and carbamazepine were the most common causes of both SJS/TEN and DRESS (34.7 and 62.9%, respectively). Some of the systemic presentations, such as fever and laboratory abnormalities were common in both phenotypes. Thrombocytopenia tended to be related to prolonged hospitalization (longer than 3 weeks) in SJS/TEN (odds ratio, OR = 5.1, 95% confidence interval, CI 0.8-31.8, p = 0.076). In DRESS patients, leukocytosis at presentation (OR 4.8, 95% CI 1.1-20.3, p = 0.03) was related to prolonged hospitalization. Conclusions: Clinical features of SCARs in a tertiary hospital in Korea were similar to those reported previously. SJS/TEN and DRESS shared some clinical and laboratory features. Thrombocytopenia for SJS/TEN and leukocytosis at presentation for DRESS may be useful prognostic markers for prolonged hospitalization.

Toxidermias em idade pediátrica

“…Contrariamente, na idade adulta o alopurinol, os tuberculostáticos, a nevirapina e os inibidores da enzima de conversão da angiotensina (IECAs) são fármacos frequentemente implicados. (26,37,38,49) Esta diferença tem por base o facto de as próprias patologias inerentes a cada faixa etária serem também elas diferentes, verificando-se uma maior proporção de casos de doenças infeciosas e doenças do foro neurológico (epilepsia) nas crianças. (10) Relativamente ao padrão de toxidermia mais frequentemente encontrado em idade pediátrica verificou-se que a urticária e o exantema maculopapular foram as reações mais frequentemente relatadas, seguidas do EM e eritema pigmentado fixo; ao passo que, na idade adulta, para além de exantema maculopapular, há uma maior proporção de casos de SSJ, NET, DRESS e reações de fotossensibilidade.…”

“…(36) Os principais fármacos implicados na idade pediátrica foram os antiepiléticos e os antibióticos; contrariamente aos adultos em que, para além destes, parece estar implicado o alopurinol, a dapsona e os tuberculostáticos. (37,38) …”

Toxidermias em Idade Pediátrica

“…37 Os principais fármacos implicados na idade pediátrica foram os antiepiléticos e os antibióticos, contrariamente aos adultos em que, para além destes, parecem estar implicados o alopurinol, a dapsona e os tuberculostáticos. 38,39…”

MicroRNA and gene signature of severe cutaneous drug hypersensitivity reactions reveal the role of miR-483- 5p/miR-28-5p in inflammation by targeting Granulysin gene

“…SJS and TEN rely on immune mediators in their hypersensitivity reactions that involve the cutaneous tissues and layers [4]. Mortality still occurs in over 5 % of hypersensitivity adverse patients with SJS and greater than 30 % of the same patients [5]. Nevertheless, the mechanisms of SJS and TEN are not fully elucidated.…”