Supportive Therapy for a Patient With Toxic Epidermal Necrolysis Undergoing Plasmapheresis

Seczyńska, Bożena; Nowak, Ireneusz; Sega, Aurelia; Kózka, Maria; Wodkowski, Michael; Królikowski, Wiesław; Szczeklik, Wojciech

doi:10.4037/ccn2013555

Cited by 14 publications

(3 citation statements)

References 25 publications

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“…Some patients may develop inferiority and anxiety during the course of illness, which could persist. It is important to address psychological complications to improve their quality of life [101][102][103][104].…”

Section: Symptomatic and Supportive Treatmentmentioning

confidence: 99%

Current Perspectives on Severe Drug Eruption

Zhang

Lei

et al. 2021

Clinic Rev Allerg Immunol

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Adverse drug reactions involving the skin are commonly known as drug eruptions. Severe drug eruption may cause severe cutaneous adverse drug reactions (SCARs), which are considered to be fatal and life-threatening, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). Although cases are relatively rare, approximately 2% of hospitalized patients are affected by SCARs. There is an incidence of 2 to 7 cases/million per year of SJS/TEN and 1/1000 to 1/10,000 exposures to offending agents result in DRESS. However, the mortality rate of severe drug eruptions can reach up to 50%. SCARs represent a real medical emergency, and early identification and proper management are critical to survival. The common pathogenesis of severe drug eruptions includes genetic linkage with HLA-and non-HLA-genes, drug-specific T cell-mediated cytotoxicity, T cell receptor restriction, and cytotoxicity mechanisms. A multidisciplinary approach is required for acute management. Immediate withdrawal of potentially causative drugs and specific supportive treatment is of great importance. Immunoglobulins, systemic corticosteroids, and cyclosporine A are the most frequently used treatments for SCARs; additionally, new biologics and plasma exchange are reasonable strategies to reduce mortality. Although there are many treatment methods for severe drug eruption, controversies remain regarding the timing and dosage of drug eruption. Types, dosages, and indications of new biological agents, such as tumor necrosis factor antagonists, mepolizumab, and omalizumab, are still under exploration. This review summarizes the clinical characteristics, risk factors, pathogenesis, and treatment strategies of severe drug eruption to guide clinical management. Keywords Severe drug eruption • Stevens-Johnson syndrome • Toxic epidermal necrolysis • Acute generalized exanthematous pustulosis • Drug reaction with eosinophilia and systemic symptoms Abbreviations AGEP Acute generalized exanthematous pustulosis ALT Alanine aminotransferase APCs Antigen-presenting cells AST Aspartate aminotransferase CBZ Carbamazepine CCR CC-chemokine receptor COVID-19 Coronavirus disease 2019 CTL Cytotoxic T cells CXCR CXC chemokine receptor DiHS

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Section: Symptomatic and Supportive Treatmentmentioning

confidence: 99%

Current Perspectives on Severe Drug Eruption

Zhang

Lei

et al. 2021

Clinic Rev Allerg Immunol

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“…Es indispensable la evaluación oftalmológica al ingreso del paciente. Se deben aplicar gotas lubricantes, limpieza de detritos inflamatorios para evitar sinequias, corticoesteroide tópico y colirio antibiótico (27,31) . En la cavidad oral, es importante la limpieza diaria (27) .…”

Section: Abordaje Y Tratamientounclassified

Síndromes de hipersensibilidad inducidos por medicamentos en las unidades de cuidados intensivos

Cardona¹,

Galindo²,

Díaz-Guío³

2018

rev. asoc. colomb. dermatol. cir. dematol.

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Las enfermedades cutáneas desencadenadas por medicamentos son comunes y, en su mayoría, no fatales; sin embargo, algunas de ellas menos frecuentes, son potencialmente mortales. Se destaca el espectro del síndrome de Stevens-Johnson/necrólisis epidérmica tóxica y el síndrome de hipersensibilidad a medicamentos con eosinofilia y síntomas sistémicos.Al ser enfermedades de baja incidencia, es común que el personal de cuidados intensivos no esté familiarizado con su presentación, diagnóstico y tratamiento, lo que puede asociarse con demoras en la atención adecuada y con impacto en lamorbimortalidad.En esta revisión narrativa se abordan estas entidades clínicas y se describe su asociación con medicamentos de uso frecuente en las unidades de cuidados intensivos; además, se tratan la fisiopatología, la presentación clínica y el tratamiento.

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“…Individual problems / nursing diagnoses are defined in the light of this objective and subjective data analyzed and confirmed with observation, interview and physical examination (Birol, 2007;Evans, 2009;Özsaban, & Acaroğlu, 2015;Seczynska, et al, 2013).…”

Section: In the Evaluation Of Activities Of Daily Life;mentioning

confidence: 99%