Which immunosuppressive drug is preferred in the treatment of toxic epidermal necrolysis during COVID‐19 outbreak?

Farajzadeh, Saeedeh; Ahramiyanpour, Najmeh

doi:10.1002/ccr3.4249

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Cyclosporine is a treatment option that addresses both TEN/SJS and COVID‐19. 17 , 21 , 23 By inhibiting the calcineurin inflammatory pathway, cyclosporine can treat TEN/SJS by inducing immunosuppression; furthermore, cyclosporine targets cyclophilins to inhibit viral replication. 17 , 21 , 23 Cyclosporine was also associated with significantly reduced mortality rates in both COVID‐19 and TEN patients in retrospective studies and has rarely been associated with infection as an adverse effect.…”

Section: Discussionmentioning

confidence: 99%

“… 17 , 21 , 23 By inhibiting the calcineurin inflammatory pathway, cyclosporine can treat TEN/SJS by inducing immunosuppression; furthermore, cyclosporine targets cyclophilins to inhibit viral replication. 17 , 21 , 23 Cyclosporine was also associated with significantly reduced mortality rates in both COVID‐19 and TEN patients in retrospective studies and has rarely been associated with infection as an adverse effect. 17 , 23 Etanercept, a TNF‐ɑ inhibitor, is another option that demonstrated significant oedema reduction, rapid cessation of disease progression and greater reduction of TNF‐ɑ and granulysin expression levels relative to systemic corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…17,21,23 Cyclosporine was also associated with significantly reduced mortality rates in both COVID-19 and TEN patients in retrospective studies and has rarely been associated with infection as an adverse effect. 17,23 Etanercept, a TNF-ɑ inhibitor, is another option that demonstrated significant oedema reduction, rapid cessation of disease progression and greater reduction of TNF-ɑ and granulysin expression levels relative to systemic corticosteroids. 2,22 Etanercept also demonstrated lower rates of gastrointestinal haemorrhage and higher efficacy in promoting re-epithelialization compared to corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

“…Treatments for post‐infection and post‐vaccination TEN/SJS varied significantly. Cyclosporine is a treatment option that addresses both TEN/SJS and COVID‐19 17,21,23 . By inhibiting the calcineurin inflammatory pathway, cyclosporine can treat TEN/SJS by inducing immunosuppression; furthermore, cyclosporine targets cyclophilins to inhibit viral replication 17,21,23 .…”

Section: Discussionmentioning

confidence: 99%

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Toxic epidermal necrolysis and Stevens‐Johnson syndrome after COVID‐19 infection and vaccination

Zou

Daveluy

2022

Aust J Dermatology

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Stevens‐Johnson Syndrome (SJS) is a rare but severe skin reaction characterized by blistering and peeling of the skin and ulcerations of mucous membranes; toxic epidermal necrolysis (TEN) is a subset of SJS characterized by the involvement of >30% of the skin. Though previously associated with drugs and infections, discussions on the association between TEN/SJS and COVID‐19 have been limited. We present a review of TEN/SJS after COVID‐19 infection and vaccination. Literature searches were conducted on PubMed and Google Scholar from 2019 to 8/2022. Thirty‐eight articles were selected based on subject relevance, and references within selected articles were also screened for relevance. As of 8/2022, there have been 34 published cases of TEN, SJS, and SJS‐TEN overlap after COVID‐19 infection and vaccination, including 12 cases after vaccination and 22 cases after infection. Multiple authors hypothesize that virotopes or excipients in COVID‐19 vaccines can activate T‐cells or cytokines to induce TEN/SJS. Meanwhile, some hypothesize that COVID‐19 infection induces immune activation that can trigger TEN/SJS or increase susceptibility to drug‐induced TEN/SJS. Treatments for post‐infection and post‐vaccination TEN/SJS vary significantly. We recommend remaining vigilant for this rare and severe potential complication.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Toxic epidermal necrolysis and Stevens‐Johnson syndrome after COVID‐19 infection and vaccination

Zou

Daveluy

2022

Aust J Dermatology

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Toxic Epidermal Necrolysis associated with COVID‐19 infection: A case report

Jouhar

Yahya

Elsiddiq

2022

Clinical Case Reports

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Toxic Epidermal Necrolysis/Steven–Johnson Syndrome (TEN/SJS) is one of the most serious dermatological adverse reactions triggered mainly by drugs and less likely by infections. COVID‐19 disease is caused by Sever Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) with a wide range of clinical manifestations. Skin involvement is common in COVID‐19 patients including urticaria, purpura, and vasculitis. There were reported cases of TEN/SJS in adults with COVID‐19 infections and only two reported cases in pediatric patients. The causality relationship between COVID‐19 infection and TEN/SJS was not established in most cases due to history of drug usage that could be the trigger. In this study, we are reporting a case of previously healthy child apart from COVID‐19 infection who was admitted to the intensive care unit with TEN involving more than 30% of body surface area confirmed by skin biopsy. The child was treated with intravenous immunoglobulins, steroids, and cyclosporin with a very good outcome.

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Cyclosporin for the treatment of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN): a systematic review of observational studies and clinical trials focusing on single therapy, combination therapy, and comparative assessments

Nazerian,

Jafarzadeh,

Salehi

et al. 2024

Inflammopharmacol

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Which immunosuppressive drug is preferred in the treatment of toxic epidermal necrolysis during COVID‐19 outbreak?

Abstract: Cyclosporine is an effective and safe immunosuppressant in the management of Toxic epidermal necrolysis (TEN) during COVID‐19 outbreak for patients that intravenous immunoglobulin (IVIG) is contraindicated or is not affordable.

Cited by 5 publications

References 22 publications

Toxic epidermal necrolysis and Stevens‐Johnson syndrome after COVID‐19 infection and vaccination

Toxic epidermal necrolysis and Stevens‐Johnson syndrome after COVID‐19 infection and vaccination

Toxic Epidermal Necrolysis associated with COVID‐19 infection: A case report

Cyclosporin for the treatment of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN): a systematic review of observational studies and clinical trials focusing on single therapy, combination therapy, and comparative assessments

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