Retrospective Analysis of Corticosteroid Treatment in Stevens-Johnson Syndrome and/or Toxic Epidermal Necrolysis over a Period of 10 Years in Vajira Hospital, Navamindradhiraj University, Bangkok

Abstract

Background. Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN) are uncommon and life-threatening drug reaction associated with a high morbidity and mortality. Objective. We studied SJS and/or TEN by conducting a retrospective analysis of 87 patients treated during a 10-year period. Methods. We conducted a retrospective review of the records of all patients with a diagnosis of SJS and/or TEN based on clinical features and histological confirmation of SJS and/or TEN was not available at the Department of Medicine, Vajira hospital, Bangkok, Thailand. The data were collected from two groups from 2003 to 2007 and 2008 to 2012. Results. A total of 87 cases of SJS and/or TEN were found, comprising 44 males and 43 females whose mean age was 46.5 years. The average length of stay was 17 days. Antibiotics, anticonvulsants, and allopurinol were the major culprit drugs in both groups. The mean SCORTEN on admission was 2.1 in first the group while 1.7 in second the group. From 2008 to 2012, thirtynine patients (76.5%) were treated with corticosteroids while only eight patients (22.2%) were treated between 2003 and 2007. The mortality rate declined from 25% from the first group to 13.7% in the second group. Complications between first and second groups had no significant differences. Conclusions. Short-term corticosteroids may contribute to a reduced mortality rate in SJS and/or TEN without increasing secondary infection. Further well-designed studies are required to compare the effect of corticosteroids treatment for SJS and/or TEN.

Incidence, causative drugs, and economic consequences of drug-induced SJS, TEN, and SJS–TEN overlap and potential drug–drug interactions during treatment: a retrospective analysis at an Indonesian referral hospital

“…Patients with TEN have a more severe disease and are likely to have longer hospital stay than patients with SJS. However, these findings were less significant than those reported in a previous study in Thailand 28. In particular, a longer hospital stay was observed among SJS–TEN patients than among TEN patients in our study.…”

A retrospective analysis of Stevens–Johnson syndrome/toxic epidermal necrolysis treated with corticosteroids

“…Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are severe, life‐threatening, mucocutaneous reactions with high mortality and are currently considered to represent different levels of severity of the same disease. Although most cases of TEN/SJS are thought to be caused by drug reactions, they may also be related to Mycoplasma pneumoniae infection and herpes simplex virus . Both TEN and SJS may cause damage to multiple organ systems and may cause skin pain (erythema, blisters, extensive epidermal exfoliation), eye, mouth and genital mucosa reactions, and multiple organ dysfunction.…”

“…Although specific treatment has not been indicated, current systemic treatment includes corticosteroids, intravenous immunoglobulin (IVIG), and cyclosporine. Previous studies have shown that these treatments can reduce mortality and improve patient prognosis . However, the systemic application of corticosteroids and their usage and dosage are controversial.…”

Evaluation of the patients diagnosed with Stevens Johnson syndrome and toxic epidermal necrolysis: a single center experience

“…Kardaun et al (17) reported that use of high dose corticosteroid for short-term was helpful. In the retrospective study of Roongpisuthipong et al (18) published in 2014, it was reported that use of short-term corticosteroid contributed to reduction in mortality rates. However, there are also studies which reported that steroid treatment did not contribute additionally to care therapy (16).…”