Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine

Kirchhof, Mark G.; Miliszewski, Monica A.; Sikora, Sheena; Papp, Anthony; Dutz, Jan P.

doi:10.1016/j.jaad.2014.07.016

Cited by 157 publications

(98 citation statements)

References 29 publications

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“…A majority etiology of this study was drug-induced causes, which is consistent with most other earlier studies [4][5][6][7][8]. However, the most prevalent drug group found in this study was antiepileptics, rather than antibiotics, in contrasts with a previous study in Thai children [4].…”

Section: Discussionsupporting

confidence: 90%

Stevens-Johnson Syndrome and toxic epidermal necrolysis in children: a retrospective study at Srinagarind Hospital, Khon Kaen, Thailand 1992–2012

Paipool

Sriboonnark

2015

Asian Biomedicine

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Background: Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening skin conditions with an etiology of drug exposure or infections. Objectives: To determine the cause, treatments, complications, and outcomes of SJS/TEN in children admitted to Srinagrind Hospital during 1992−2012. Methods: Retrospective chart review. A diagnosis of SJS and TEN was confirmed by pediatric dermatologists. Results: A total of 38 patients was recorded. They consisted 31 (82%) SJS patients and 7 (18%) TEN patients. Mean age 6.6 years (range 1 to 14 years). Male to female was 1.1:1. Most cases (30 or 79%) were caused by drug exposure. Three cases (8%) by infection, and 5 cases (13%) were of unknown cause. The antiepileptic drug group was the most common cause. Systemic corticosteroids were used in 33 cases (87%). Intravenous immunoglobulin was used in one TEN patient (3%). There were 18 cases (47%) with acute complications. Ocular complications (7 cases, 39%), septicemia (4 cases, 22%), and secondary skin infections (3 cases, 17%) were the most common. Mean difference in length of hospital stay between those with and without acute complications was 12.3 days (P < 0.01, 95% CI 5.9-18.6). Ocular complications were the only long-term complications at 1-year follow up, and included symblepharon, corneal pannus, and dry eyes. Two patients (5%), both having cases of TEN, died. Conclusions: Antiepileptic drugs were the most common causes of SJS/TEN in our study. Good ophthalmologic care of the prevalent acute eye complications in these patients is needed to prevent long-term ophthalmic complications.

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Section: Discussionsupporting

confidence: 90%

Stevens-Johnson Syndrome and toxic epidermal necrolysis in children: a retrospective study at Srinagarind Hospital, Khon Kaen, Thailand 1992–2012

Paipool

Sriboonnark

2015

Asian Biomedicine

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“…It has been reported that successful outcomes are obtained with cyclosporine in treatment of patients with a diagnosis of toxic epidermal necrolysis (22). There are studies reporting that cyclosporine is superior to IVIG, corticosteroid and cyclophosphamide in lowering the morbidity and mortality rates (23,24). In this study, cyclosporine was used in one patient who did not respons to supportive treatment, IVIG and cotricosteroid treatment and a positive outcome was obtained.…”

Section: Discussionmentioning

confidence: 80%

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

2016

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Aim: Stevens Johnson syndrome and toxic epidermal necrolysis are severe acute mucocutaneous diseases. In this study, we evaluated the clinical aspects of Steven Johnson syndrome, toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap patients who admitted to our clinics in the last five years. Material and Methods: Eleven patients diagnosed as Stevens-Johnson syndrome, toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in Department of Pediatric Allergy in Uludağ University School of Medicine were included in this study. Clinical findings, laboratory tests and response to treatments were evaluated via electronic files. Results: Two of the patients had Stevens-Johnson syndrome, four had Stevens-Johnson syndrome/toxic epidermal necrolysis overlap, and five had toxic epidermal necrolysis. The median period for drug usage was 10 days (2-44 days). Herpes simpleks virus IgM antibody was detected two patients. The median healing time was 38 days 26-94 days). Maculopapular eruptions and oral mucositis were seen in all patients. Vesicul or bullae, epidermal detachment and ocular involvement in 10 of patients. Wound care, H1 antihistamine and methyl prednisolon were used in all patients, intravenous immunoglobulin were used in 7 patients and cyclosporine in 1 patient. Sequel lesions developed in 2 of the patients and there was no death. Conclusion: Anticonvulsants, antibiotics and non steroid anti-inflammatory drugs play a major role in the etiology of Stevens-Johnson syndrome and toxic epidermal necrolysis. Anticonvulsants are associated with severe disease. The patients with proper wound care and treatment with immunosuppressive drugs can be recovered without or with minimal sequelae. (Turk Pediatri Ars 2016; 51: 152-8)

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“…In a systematic review study published in the literature, treatment of patients with SJS and TEN with immunomodulating therapies, including glucocorticosteroids, intravenous immunoglobulins, cyclosporine, plasmapheresis, thalidomide, cyclophosphamide, hemoperfusion, tumor necrosis factor inhibitors, and granulocyte colony-stimulating factors, only glucocorticosteroids and cyclosporine were the most promising (Zimmermann et al, 2017). Another study showed that the use of cyclosporin in patients with SJS and TEM was associated with decreased mortality (Kirchhof et al, 2014). One systematic review with metaanalysis suggested that intravenous immunoglobulin combined with corticosteroid may reduce the recovery time of patients with SJS and TEN, mainly among Asians (Ye et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Risk factors for, and treatment of, Stevens-Johnson syndrome and toxic epidermal necrolysis: Evidence from the literature

Silva¹,

Novaes²,

GÃ¶ttems³

et al. 2018

Afr. J. Pharm. Pharmacol.

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions.They occur in the form of mild and sometimes severe cutaneous eruptions, with high morbidity and mortality, requiring fast and appropriate diagnosis and treatment. The aim of this study was to describe and discuss the evidence regarding the risk factors, complications and treatment of SJS and TEN in inpatients. The present study is a literature review of case reports published between January 1981 and December 2016, in the following databases: The Virtual Health Library (Biblioteca Virtual da Saúde -BVS), MEDLINE (National Library of Medicine, USA), LILACS (Latin American and Caribbean Health Sciences Literature), and PUBMED -NCBI (National Center for Biotechnology Information). A total of thirteen case reports were selected. Most of the cases (54%) developed adverse reactions to anticonvulsant drugs. The most common were valproic acid, lamotrigine and carbamazepine. In 69% of all cases, the patients were female. The patients' age range varied from 18 to 82 years old. In two cases which correspond to 15%, the patients were either infected with HIV or were receiving chemotherapy treatment for cancer. These patients had a higher possibility for immunosuppression. In relation to the actions taken as treatment, the suspension of the drugs or the treatment of the skin lesions occurred in 85 and 54% of the cases, respectively. A total of 6 cases, corresponding to 46%, occurred in the Latin American and Caribbean region. In conclusion, the use of anticonvulsants, and female gender, are among the main risk factors identified by the study. The main therapeutic action for SJS and TEN is the suspension of the use of the drug that triggered the inflammatory process and the topical treatment of the lesions caused.

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Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine

Cited by 157 publications

References 29 publications

Stevens-Johnson Syndrome and toxic epidermal necrolysis in children: a retrospective study at Srinagarind Hospital, Khon Kaen, Thailand 1992–2012

Stevens-Johnson Syndrome and toxic epidermal necrolysis in children: a retrospective study at Srinagarind Hospital, Khon Kaen, Thailand 1992–2012

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

Risk factors for, and treatment of, Stevens-Johnson syndrome and toxic epidermal necrolysis: Evidence from the literature

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