Main Article Content
Background: Severe skin diseases with high morbidity and mortality rates include toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). For best management, it is essential to comprehend the variables that predict how certain circumstances will turn out.
Methods: The objective of this retrospective study was to discover the variables that predicted the results of SJS and TEN. Data were gathered from the medical files of patients with SJS or TEN diagnoses. The analysis covered 150 patients in total. The evaluation of clinical traits, triggers, treatment patterns, and test results. Mortality was the main result, and mucosal involvement and the degree of skin detachment were the secondary results.
Results: The most frequent cause of SJS and TEN was medication, particularly antibiotics. Poor outcomes were linked to mucosal involvement and extensive body surface area (BSA) involvement. A considerable portion of patients had leukocytosis and hypoalbuminemia, according to laboratory results. Supportive care, such as managing fluids and caring for wounds, was given to everyone. In most instances, systemic corticosteroids were utilized. Age, significant BSA involvement, and hypoalbuminemia were found to be independent indicators of poor outcomes, with the overall death rate being 20%.
Conclusion: This retrospective investigation found characteristics predicting the course of SJS and TEN, including pharmaceutical triggers, the degree of BSA involvement, mucosal involvement, and laboratory abnormalities. These results highlight how crucial it is to identify these factors early and to manage and monitor them appropriately in order to enhance patient outcomes. To validate these results and create evidence-based management guidelines for SJS and TEN, prospective trials are required.
Creamer D, et al. U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016;174(6):1194-1227. doi:10.1111/bjd.14463
Bastuji-Garin S, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129(1):92-96. doi:10.1001/archderm.1993.01680220104020
Thakur V, Vinay K, Kumar S, et al. Factors Predicting the Outcome of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A 5-Year Retrospective Study. Indian Dermatol Online J. 2021;12(2):258-265. Published 2021 Mar 2. doi:10.4103/idoj.IDOJ_437_20
Stavropoulos PG, Soura E, Antoniou C. Drug-induced pemphigoid: a review of the literature. J Eur Acad Dermatol Venereol. 2014 Sep;28(9):1133-40. doi: 10.1111/jdv.12366. Epub 2014 Jan 10. PMID: 24404939.
Al-Shaqsi S. Important Points in Toxic Epidermal Necrolysis Management. Oman Med J. 2019;34(4):357-358. doi:10.5001/omj.2019.70
Mockenhaupt M, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: Assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol. 2008;128(1):35-44. doi:10.1038/sj.jid.5701033
Wakamatsu TH, Ueta M, Inoue C, Costa KA, Sakano LY, Sallum JMF, Pereira Gomes JÁ, Kinoshita S. Human leukocyte antigen class I and II genes associated with dipyrone-related Stevens-Johnson syndrome and severe ocular complications in a Brazilian population. Ocul Surf. 2021 Apr;20:173-175. doi: 10.1016/j.jtos.2021.02.008. Epub 2021 Feb 19. PMID: 33617977.
Chung WH, Hung SI. Genetic markers and danger signals in stevens-johnson syndrome and toxic epidermal necrolysis. Allergol Int. 2010 Dec;59(4):325-32. doi: 10.2332/allergolint.10-RAI-0261. Epub 2010 Oct 25. PMID: 20962567.
Mockenhaupt M. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol. 2011;7(6):803-813. doi:10.1586/eci.11.65
Widgerow AD. Toxic epidermal necrolysis - management issues and treatment options. Int J Burns Trauma. 2011;1(1):42-50.
Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010 Dec 16;5:39. doi: 10.1186/1750-1172-5-39. PMID: 21162721; PMCID: PMC3018455.
Huong PT, Ha TN, Nhu TTQ, Nga NTH, Anh NH Jr, Hoa VD, Binh NQ, Anh NH. Allopurinol-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: Signal detection and preventability from Vietnam National pharmacovigilance database. J Clin Pharm Ther. 2022 Dec;47(12):2014-2019. doi: 10.1111/jcpt.13740. Epub 2022 Jul 18. PMID: 35848069.