Toxic epidermal necrolysis successfully treated with etanercept

Gubinelli, Emanuela; Canzona, Flora; Tonanzi, Tiziano; Raskovic, Desanka; Didona, Biagio

doi:10.1111/j.1346-8138.2009.00616.x

Cited by 73 publications

(56 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, several recent reports have shown that the TNF-a antagonist etanercept can be used to effectively treat TEN. 14,15 Thus, TNF-a antagonists should be prescribed with caution because of the risk of severe drug reactions. These antagonists modify the immune response in the same manner as corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis caused by acetaminophen featuring almost 100% skin detachment: Acetaminophen is associated with a risk of severe cutaneous adverse reactions

Watanabe

Kamiyama

Sasaki

et al. 2015

The Journal of Dermatology

View full text Add to dashboard Cite

Toxic epidermal necrolysis (TEN) is an adverse reaction that can be induced by various drugs; the associated mortality rate is 20-25%. A previous report showed a weak association between TEN and acetaminophen. Recently, the US Food and Drug Administration declared that acetaminophen is associated with a risk of serious skin reactions, including TEN. Here, we describe the case of a 43-year-old Japanese woman with TEN caused by acetaminophen. She had poorly controlled ulcerative colitis and was treated with high doses of prednisolone, infliximab, acetaminophen and lansoprazole. Nine days after administrating acetaminophen, targetoid erythematous and bullous lesions appeared on the patient's trunk, palms and the soles of her feet. The skin lesions expanded rapidly; within 3 weeks, skin detachment was detected across nearly 100% of the patient's body. However, no mucosal involvement of the eyes, oral cavity or genitalia was found. We performed lymphocyte transformation tests using various drugs; however, a high stimulation index was obtained only with acetaminophen. The patient recovered following treatment with plasmapheresis, i.v. immunoglobulin therapy, topical medication and supportive therapy. Acetaminophen is included in many prescription and over-the-counter products; thus, clinicians should monitor their patients for severe drug reactions, including TEN.

show abstract

Section: Discussionmentioning

confidence: 99%

Toxic epidermal necrolysis caused by acetaminophen featuring almost 100% skin detachment: Acetaminophen is associated with a risk of severe cutaneous adverse reactions

Watanabe

Kamiyama

Sasaki

et al. 2015

The Journal of Dermatology

View full text Add to dashboard Cite

show abstract

“…Etanercept can quickly reduce the detachment of skin symptoms, shorten healing time and should be considered an anti-TNF preparations as first-line drugs. 14,15 However there are also descriptions of cases where these drugs caused SJS or TEN. 16,17 The first step in the treatment of patients with drug-induced SJS is immediate to withdrawal of the drug which is suspected of the reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, etanercept or other anti-TNF drugs are used in the treatment of severe drug reactions. 14,15 The available literature describes several cases of TEN patients treated with etanercept successfully. Etanercept can quickly reduce the detachment of skin symptoms, shorten healing time and should be considered an anti-TNF preparations as first-line drugs.…”

Section: Discussionmentioning

confidence: 99%

Stevens-Johnson syndrome in a patient with rheumatoid arthritis during long-term etanercept therapy

Owczarczyk‐Saczonek¹,

Zdanowska²,

Znajewska-Pander³

et al. 2016

J Dermatol Case Rep

View full text Add to dashboard Cite

Background: Etanercept and other anti-TNF-alpha agents have been indicated as a therapeutic option in severe drug reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Etanercept has been shown to quickly reduce the detachment of the epidermis and shorten healing time. Cases of etanercept-induced severe adverse drug reactions were also described. Main observations:A 27-year-old woman with a 4-year history of etanercept and sulfasalazine treatment for rheumatoid arthritis was admitted with StevensJohnson syndrome. The patient received one dose of an OTC drug containing acetaminophen, phenylephrine and pheniramine two days prior to developing fist mucocutaneous symptoms. The most probable causative agent was paracetamol. Throughout the successful routine therapy of Stevens-Johnson syndrome etanercept therapy was continued. Sulfosalazin administration was stopped and administered again after recovery with no recurrence of the skin and mucosal symptoms. Conclusions:This case indicates that there is no justification for discontinuation of long-term anti-TNF-alpha treatment in patients who develop StevensJohnson syndrome / toxic epidermal necrolysis.

show abstract

“…Three case reports have shown a good effect from using a single dose of infliximab at 5 mg kg -1 (anti-TNF-a monoclonal antibody) [48][49][50] and in one case showed evidence that epidermal and dermal TNF-a sources were dramatically switched off by this drug [49]. In one further case, etanercept, a soluble TNF-a receptor, was reported to have good therapeutic efficacy [51].…”

Section: Intravenous Immunoglobulin (Ivig)mentioning

confidence: 99%

Skin manifestations of drug allergy

Ardern‐Jones

Friedmann

2011

Brit J Clinical Pharma

View full text Add to dashboard Cite

Cutaneous adverse drug reactions range from mild to severe and from those localized only to skin to those associated with systemic disease. It is important to distinguish features of cutaneous drug reactions which help classify the underlying mechanism and likely prognosis as both of these influence management decisions, some of which necessarily have to be taken rapidly. Severe cutaneous reactions are generally T cell-mediated, yet this immunological process is frequently poorly understood and principles for identification of the culprit drug are different to those of IgE mediated allergic reactions. Furthermore, intervention in severe skin manifestations of drug allergy is frequently necessary. However, a substantial literature reports on success or otherwise of glucocorticoids, cyclophsphamide, ciclosporin, intravenous immunoglobulin and anti-tumour necrosis factor therapy for the treatment of toxic epidermal necrolysis without clear consensus. As well as reviewing the recommended supportive measures and evidence base for interventions, this review aims to provide a mechanistic overview relating to a proposed clinical classification to assist the assessment and management of these complex patients.

show abstract

Toxic epidermal necrolysis successfully treated with etanercept

Cited by 73 publications

References 10 publications

Toxic epidermal necrolysis caused by acetaminophen featuring almost 100% skin detachment: Acetaminophen is associated with a risk of severe cutaneous adverse reactions

Toxic epidermal necrolysis caused by acetaminophen featuring almost 100% skin detachment: Acetaminophen is associated with a risk of severe cutaneous adverse reactions

Stevens-Johnson syndrome in a patient with rheumatoid arthritis during long-term etanercept therapy

Skin manifestations of drug allergy

Contact Info

Product

Resources

About