A Compilation of Drug Etiologies of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse reactions that affect the mucocutaneous surfaces by causing necrosis and detachment of the epidermis. The difference between SJS and TEN is in the percentage of the body surface area (BSA) affected. TEN is known to affect greater BSA than SJS. The pathogenesis of SJS/TEN is attributed to drug-specific cell-mediated cytotoxic reactions that directly and indirectly lead to keratinocyte apoptosis through mediators. Clinical presentation begins with influenza-like symptoms, with the disease affecting the skin, oral, ocular, and urogenital regions most frequently. Although SJS/TEN is mainly due to various drugs, infection and vaccination can also induce SJS/TEN. This review outlines a compilation of all drugs implicated in SJS/TEN cases based on studies, mainly in case reports and other study types. Drug classes implicated in SJS/TEN cases include antibiotics, anticonvulsants, antineoplastics, analgesics, and diuretics, among others. There is no fully established diagnostic modality for SJS/TEN; treatment is done mainly by withdrawing the offending agent. In addition to withdrawing the offending agent, a multidisciplinary care team is essential in managing these patients. Several pharmacologic modalities have also been proposed in treatment, but there is still insufficient evidence for the efficacy of one against the other.

Atuação da farmacovigilância hospitalar no manejo da síndrome de Stevens-Johnson: um relato de caso

“…Despite the clinical presentation being compatible with Stevens-Johnson syndrome and overlapping with Toxic Epidermal Necrolysis, no histopathological tests were carried out to confirm the diagnosis, which is a limitation of the case reported. the systematic evaluation carried out during the follow-up of the episode, including causality analysis using the decision algorithm indicated in the scientific literature 22 , reinforces the association of the reaction with the medication used by the patient.…”

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Analysis of the Russian Database of Spontaneous Reports

“…Among the culprit pharmacological groups, antibacterial agents and anticonvulsants were the most frequently reported [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ], followed by many others, including non-steroid anti-inflammatory drugs (NSAIDs), allopurinol, angiotensin-converting enzyme inhibitors, and antipsychotics [ 20 , 21 , 22 , 23 , 24 ]. Genetic predisposition is an important factor in SJS and TEN.…”