Stevens Johnson syndrome: A review of a vision and life-threatening mucocutaneous disease including histopathology with updates on pathogenesis and genetic risk factors

Neerukonda, Vamsee K.; Stagner, Anna M.

doi:10.1080/08820538.2021.1893764

Cited by 3 publications

(4 citation statements)

References 152 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ocular surface dryness can be managed from several aspects. Replacement of the aqueous layer with preservative-free artificial tears is frequently a first-line therapy [ 75 ]. Autologous serum eye drops contain several ingredients similar to natural tears, such as vitamin A, fibronectin and epidermal growth factor [ 76 ].…”

Section: Managementmentioning

confidence: 99%

Ophthalmic Aspects of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Narrative Review

Tóth

Lukács

Schirra³

et al. 2023

Ophthalmol Ther

View full text Add to dashboard Cite

The aim of our review article was to summarize the current literature on Stevens–Johnson syndrome (SJS) and its severe form, toxic epidermal necrolysis (TEN). SJS/TEN is a serious, rare multi-system, immune-mediated, mucocutaneous disease with a significant mortality rate that can lead to severe ocular surface sequelae and even to bilateral blindness. Restoration of the ocular surface in acute and chronic SJS/TEN is challenging. There are only limited local or systemic treatment options for SJS/TEN. Early diagnosis, timely amniotic membrane transplantation and aggressive topical management in acute SJS/TEN are necessary to prevent long-term, chronic ocular complications. Although the primary aim of acute care is to save the life of the patient, ophthalmologists should regularly examine patients already in the acute phase, which should also be followed by systematic ophthalmic examination in the chronic phase. Herein, we summarize actual knowledge on the epidemiology, aetiology, pathology, clinical appearance and treatment of SJS/TEN.

show abstract

Section: Managementmentioning

confidence: 99%

Ophthalmic Aspects of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Narrative Review

Tóth

Lukács

Schirra³

et al. 2023

Ophthalmol Ther

View full text Add to dashboard Cite

show abstract

“…Both are characterized by the acute onset of blister formation at the epidermal layer, and hemorrhagic and erosive lesions at the mucous layer after drug exposure ( Miyagawa and Asada, 2021b ). In the early stage of SJS/TEN, blister fluid over epidermis was mainly infiltrated with CTLs, Natural killer (NK) cells and NK/T cells ( Neerukonda and Stagner, 2021 ). Initially, CTLs cause keratinocyte apoptosis and cell-cell contact-dependent epidermal damage through perforin and granzyme B pathway ( Tohyama and Hashimoto, 2012 ).…”

Section: Mechanism Of Scarmentioning

confidence: 99%

“…Then, granulysin, secreted by CTLs and NK cells, is a pro-apoptotic protein which demonstrates widespread cytotoxicity indirectly ( Su et al, 2017 ; Sadek et al, 2021 ). In addition, IL-15 secreted by keratinocyte and CTLs themselves was thought to enhance the expression of granulysin-mediated apoptosis ( Stern and Divito, 2017 ; Neerukonda and Stagner, 2021 ). In the late stage, granulysin could stimulate C-C motif chemokine ligand 20 (CCL20) expression in monocytes, leading to monocyte infiltration ( Tewary et al, 2010 ).…”

Section: Mechanism Of Scarmentioning

confidence: 99%

Current understanding of genetic associations with delayed hypersensitivity reactions induced by antibiotics and anti-osteoporotic drugs

Wung¹,

Wang²,

Lai³

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

Drug-induced delayed hypersensitivity reactions (DHRs) is still a clinical and healthcare burden in every country. Increasing reports of DHRs have caught our attention to explore the genetic relationship, especially life-threatening severe cutaneous adverse drug reactions (SCARs), including acute generalized exanthematous pustulosis (AGEP), drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). In recent years, many studies have investigated the immune mechanism and genetic markers of DHRs. Besides, several studies have stated the associations between antibiotics-as well as anti-osteoporotic drugs (AOD)-induced SCARs and specific human leukocyte antigens (HLA) alleles. Strong associations between drugs and HLA alleles such as co-trimoxazole-induced DRESS and HLA-B*13:01 (Odds ratio (OR) = 45), dapsone-DRESS and HLA-B*13:01 (OR = 122.1), vancomycin-DRESS and HLA-A*32:01 (OR = 403), clindamycin-DHRs and HLA-B*15:27 (OR = 55.6), and strontium ranelate (SR)-SJS/TEN and HLA-A*33:03 (OR = 25.97) are listed. We summarized the immune mechanism of SCARs, update the latest knowledge of pharmacogenomics of antibiotics- and AOD-induced SCARs, and indicate the potential clinical use of these genetic markers for SCARs prevention in this mini review article.

show abstract

“…We noticed that the mortality rates in the above studies of Asian patients with SJS/TEN were significantly lower than those in the European and American studies, and the reasons for the difference were analysed. In addition to the possible ethnic differences in different regions, there were differences in genetic susceptibility, 20 differences in the distribution of disease types, comorbidities, complications and other clinical characteristics. We believe that the difference in treatment regimen is an important factor in the difference in mortality rates.…”

mentioning

confidence: 99%

Effectiveness and Safety of Early Short-Course, Moderate- to High-Dose Glucocorticoids for the Treatment of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Retrospective Study

Ye¹,

Li²,

Zhang³

et al. 2022

CCID

View full text Add to dashboard Cite

To summarise the clinical characteristics of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis syndrome (SJS/TEN) and analyse the efficacy and safety of systemic glucocorticoid therapy. Methods: This study was a retrospective study of 56 patients with SJS/TEN who had been systematically treated with glucocorticoids in the dermatology ward of Peking University Third Hospital from 2010 to 2020. The clinical characteristics, treatment regimen, effects on underlying diseases, incidence and outcome of hormone-related adverse reactions and skin lesion prognosis were summarised and analysed for each patient. Results: ① The allergenic drugs were found to be antibiotics (31.51%), antipyretic and analgesics (21.92%), traditional Chinese medicines and health products (15.07%) and neuropsychiatric drugs (13.70%). ② Based on the 56 patients' scores of toxic epidermal necrosis at admission, the actual mortality rate was 1.8% (1/56), which was significantly lower than the average expected mortality rate of 15.0% (P = 0.032; standardised mortality ratio = 0.13; 95% confidence interval: 0.00-0.53). ③ A total of 33 patients (58.9%) had underlying diseases, of which 10 patients (30.3%) had underlying diseases that fluctuated during treatment but stabilised after symptomatic treatment. ④ During treatment, 73.2% (41/56) of patients had complications that may have been related to systemic glucocorticoids; 97.6% (40/41) had mild symptoms, and 92.7% (38/41) had improved/recovered complications at the time of discharge. Conclusion: ① Antibiotics are still the most common sensitising drugs, and traditional Chinese medicine and health products are also common sensitising drugs. ② Early systemic application of medium-to high-dose glucocorticoids is effective in the treatment of SJS/ TEN, and it is beneficial in reducing mortality. ③ The short-term application of medium-to high-dose hormone therapy for SJS/TEN has little effect on underlying diseases. The related complications are mostly mild, and the treatment is safe.

show abstract

Stevens Johnson syndrome: A review of a vision and life-threatening mucocutaneous disease including histopathology with updates on pathogenesis and genetic risk factors

Cited by 3 publications

References 152 publications

Ophthalmic Aspects of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Narrative Review

Ophthalmic Aspects of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Narrative Review

Current understanding of genetic associations with delayed hypersensitivity reactions induced by antibiotics and anti-osteoporotic drugs

Effectiveness and Safety of Early Short-Course, Moderate- to High-Dose Glucocorticoids for the Treatment of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Retrospective Study

Contact Info

Product

Resources

About