Oculocutaneous Manifestations of the Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum

Wilkins, J. H.; Morrison, Lynne; White, Clifton R.

doi:10.1016/s0733-8635(18)30324-3

Cited by 67 publications

(33 citation statements)

References 41 publications

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“…In our series, long-term ocular complications, particularly keratinization of the tarsal conjunctiva, were more frequent than in other studies [7, 12, 13, 14]. This might be due to the inclusion, in some series, of patients with Stevens-Johnson syndrome (SJS) and overlap SJS/TEN.…”

Section: Discussionmentioning

confidence: 52%

Dermatological and Ophthalmological Sequels in Toxic Epidermal Necrolysis

Magina¹,

Lisboa²,

Leal³

et al. 2003

Dermatology

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Background: Toxic epidermal necrolysis (TEN) is a rare, drug-induced disease characterized by epidermal detachment and mucosal involvement. After an acute period, potentially disabling cutaneous and ocular sequels may appear. Although long-term complications are not rare, only few outcome studies are published. Objective: To evaluate the incidence of dermatological and ophthalmological sequels following TEN, to describe its clinical aspects and correlation with acute involvement. Patients and Methods: Eight patients surviving to TEN were submitted to dermatological and ophthalmological observation ranging from 0.5 to 8 years after hospitalization. Cutaneous and ocular involvement, during the acute phase, was retrospectively analysed. Results: Dermatological sequels were observed in 6 patients (75%) corresponding to those with more extensive skin involvement in the acute phase. The most frequent complications were cutaneous dyschromia (62.5%) and nail dystrophies (37.5%). Six patients (75%) had ocular complications with tarsal conjunctiva keratinization in 5 (62.5%) and keratoconjunctivitis sicca in 4 of them (50%). Trichiasis, corneal neovascularization and symblepharon were observed in 1 case. There was no correlation between the severity of acute ocular involvement and long-term complications. Conclusion: Following TEN, most patients have dermatological and ophthalmological sequels that persist for several years.

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Section: Discussionmentioning

confidence: 52%

Dermatological and Ophthalmological Sequels in Toxic Epidermal Necrolysis

Magina¹,

Lisboa²,

Leal³

et al. 2003

Dermatology

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“…Late complications include impaired tear production and drainage, aberrant lashes, and metaplasia of the conjunctiva (Fig 1). [35][36][37][38] These phenomena are inflammatory in nature and will respond to the cautious use of ophthalmic steroid preparations and vigorous lubrication programs. Although there are no data on the efficacy of these measures in reducing long-term eye complications, it seems logical that good lubrication is essential, given that unlubricated globes in children with thermal burns of the eye will predictably develop corneal ulceration and globe rupture.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

et al. 2002

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ABSTRACT. Objective. Toxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury not just to the skin. Historically, it has been associated with a high mortality but few long-term consequences among survivors. With improved survival, long-term consequences may be becoming more apparent. The objective of this study was to define these longterm consequences and their frequency.Methods. From July 1, 1991, to June 30, 2000, 11 children with severe TEN were referred to a regional pediatric burn facility. Wounds were managed with a strategy involving prevention of wound desiccation and superinfection, including the frequent use of biological wound coverings. All children survived and have been followed in the burn clinic. The records of all children were reviewed in detail.Results. Two boys and 9 girls with an average age of 7.2 ؎ 1.8 years (range: 6 months-15 years) and sloughed surface area of 76 ؎ 6% of the body surface (range: 50%-95%) were admitted to the burn unit for care. Antibiotics (3 children), anticonvulsants (4 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were believed to have triggered the syndrome. Six (55%) children required intubation for an average of 9.7 ؎ 1.8 days (range: 2-14 days). Mucosal involvement occurred in 10 (91%) and ocular involvement in 10 (91%). Lengths of stay averaged 19 ؎ 3 days (range: 6 -40 days). Overall follow-up averaged 14 ؎ 13 months. Three children had no apparent long-term consequences of the disease and were referred to primary care follow-up after the 2-month burn clinic visit. The remaining children had follow-up averaging 23 ؎ 13 months. The most common long-term morbidity involved eyes (3 children T oxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury to the skin, mucous membrane, and sometimes bowel and respiratory epithelium. The syndrome was first clearly described by Lyell in 1956 1,2 and is now believed to represent the most severe form of a disease spectrum beginning with Stevens-Johnson syndrome (SJS). [3][4][5] In SJS, mucous membranes are characteristically denuded. Some children with SJS have macular skin lesions as well, usually involving Ͻ30% of the body surface. In TEN, both skin and mucous membranes are denuded, involvement of Ͼ30% of the body surface is characteristic, 6 and mucosal surface involvement may extend into the respiratory and gastrointestinal tracts. Patients with TEN can therefore be considered as having both a cutaneous and a visceral wound. The morbidity and mortality of the condition is as related to involvement of visceral surfaces as it is to that of the cutaneous wound.[Although there are no large exclusively pediatric data sets, patients with TEN are generally reported to have a mortality as high as 70% 7 ; death usually results from sepsis or organ failure. During the past several years, these children have been increasingly referred to burn units, as their needs are similar to those of children with extensiv...

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“…Drug-induced hypersensitivity syndrome (DIHS) 6 The first three syndromes above are considered to be three severities of the same syndrome. 7 These severe skin conditions may result in prolonged hospitalisation, substantial disability, and even death. 8 Erythema multiforme (EM) is characterised by erythema and oedema.…”

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confidence: 99%

SSRI‐induced severe adverse cutaneous reaction – a case report

Byrne¹,

Arkell²,

Bandi³

2017

Prog Neurol Psychiatry

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As selective serotonin re‐uptake inhibitors (SSRIs) are commonly prescribed, less common side‐effects such as severe adverse cutaneous drug reactions (ACDRs) can be seen more frequently than with less frequently prescribed antidepressants. Sertraline is among the better tolerated SSRIs. Here, we describe a case of a sertraline‐induced severe ACDR in a patient with depressive symptoms and cognitive impairment. The selection of an appropriate antidepressant proved challenging. A review of recent literature on the clinical and temporal presentation of SSRI‐induced ACDRs is presented with management strategies.

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Oculocutaneous Manifestations of the Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum

Cited by 67 publications

References 41 publications

Dermatological and Ophthalmological Sequels in Toxic Epidermal Necrolysis

Dermatological and Ophthalmological Sequels in Toxic Epidermal Necrolysis

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

SSRI‐induced severe adverse cutaneous reaction – a case report

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