Clinical parameters and biological markers associated with acute severe ocular complications in Stevens-Johnson syndrome and toxic epidermal necrolysis

Panpruk, Rawiphan; Puangsricharern, Vilavun; Klaewsongkram, Jettanong; Rerknimitr, Pawinee; Kittipibul, Thanachaporn; Chongpison, Yuda; Buranapraditkun, Supranee

doi:10.1038/s41598-021-99370-1

Cited by 8 publications

(9 citation statements)

References 52 publications

(70 reference statements)

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“…From our ThaiSCAR recent study, body surface area detachment of ≥10% was a significant predictive factor for acute SOCs. In addition, serum levels of inflammatory mediators, especially S100A8/A9 and granulysin, showed a significantly higher trend in the severe group compared to those of non-severe individuals ( Panpruk et al, 2021 ).…”

Section: Severe Cutaneous Adverse Drug Reactions In Thai Population: ...mentioning

confidence: 90%

Drug-Induced Severe Cutaneous Adverse Reactions: Insights Into Clinical Presentation, Immunopathogenesis, Diagnostic Methods, Treatment, and Pharmacogenomics

et al. 2022

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SCARs are rare and life-threatening hypersensitivity reactions. In general, the increased duration of hospital stays and the associated cost burden are common issues, and in the worst-case scenario, they can result in mortality. SCARs are delayed T cell-mediated hypersensitivity reactions. Recovery can take from 2 weeks to many months after dechallenging the culprit drugs. Genetic polymorphism of the HLA genes may change the selection and presentation of antigens, allowing toxic drug metabolites to initiate immunological reactions. However, each SCARs has a different onset latency period, clinical features, or morphological pattern. This explains that, other than HLA mutations, other immuno-pathogenesis may be involved in drug-induced severe cutaneous reactions. This review will discuss the clinical morphology of various SCARs, various immune pathogenesis models, diagnostic criteria, treatments, the association of various drug-induced reactions and susceptible alleles in different populations, and the successful implementation of pharmacogenomics in Thailand for the prevention of SCARs.

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Section: Severe Cutaneous Adverse Drug Reactions In Thai Population: ...mentioning

confidence: 90%

Drug-Induced Severe Cutaneous Adverse Reactions: Insights Into Clinical Presentation, Immunopathogenesis, Diagnostic Methods, Treatment, and Pharmacogenomics

et al. 2022

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“…There have been much fewer studies focusing on biomarkers to monitor severity, progression, and response to therapy during the acute stages of SJS/TEN and how these correlate with long-term morbidity and delayed mortality. Biomarkers that have been studied either singly or in combination in SJS/TEN include procalcitonin ( 32 ); granulysin ( 123 ); IFN-g ( 124 ); interleukin (IL)-8 and granzyme B ( 125 ); endocan, tumor necrosis factor-α, vascular endothelial growth factor, and C-reactive protein; serum IL-17 ( 126 ); complement components ( 127 ); alarmins like the heterodimeric form of S100 calcium-binding protein A8 and S100 calcium-binding protein (A9 S100A8/A9) ( 123 ); chemokines like CXCL9/MIG and CXCL10/IP-10 ( 124 ); antimicrobial peptides like LL-37 ( 128 ); exosomal nucleic acids like miR-375-3p ( 129 ); plasma lipid profiles ( 130 ); renal functions ( 78 , 79 ); neutrophil:lymphocyte ratio; and C-reactive protein:albumin ratio ( 131 ).…”

Section: Potential Future Research Directionsmentioning

confidence: 99%

Disease severity and status in Stevens–Johnson syndrome and toxic epidermal necrolysis: Key knowledge gaps and research needs

Lehloenya

2022

Front. Med.

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Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are on a spectrum of cutaneous drug reactions characterized by pan-epidermal necrosis with SJS affecting < 10% of body surface area (BSA), TEN > 30%, and SJS/TEN overlap between 10 and 30%. Severity-of-illness score for toxic epidermal necrolysis (SCORTEN) is a validated tool to predict mortality rates based on age, heart rate, BSA, malignancy and serum urea, bicarbonate, and glucose. Despite improved understanding, SJS/TEN mortality remains constant and therapeutic interventions are not universally accepted for a number of reasons, including rarity of SJS/TEN; inconsistent definition of cases, disease severity, and endpoints in studies; low efficacy of interventions; and variations in treatment protocols. Apart from mortality, none of the other endpoints used to evaluate interventions, including duration of hospitalization, is sufficiently standardized to be reproducible across cases and treatment centers. Some of the gaps in SJS/TEN research can be narrowed through international collaboration to harmonize research endpoints. A case is made for an urgent international collaborative effort to develop consensus on definitions of endpoints such as disease status, progression, cessation, and complete re-epithelialization in interventional studies. The deficiencies of using BSA as the sole determinant of SJS/TEN severity, excluding internal organ involvement and extension of skin necrosis beyond the epidermis, are discussed and the role these factors play on time to healing and mortality beyond the acute stage is highlighted. The potential role of artificial intelligence, biomarkers, and PET/CT scan with radiolabeled glucose as markers of disease status, activity, and therapeutic response is also discussed.

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“…In a previous study, we identified that S100A8/A9 and granulysin levels may help predict the occurrence of severe ocular complications in SJS/TEN 11 . However, the role of cytokines and chemokines in association with histopathologic features and the progression of the skin disease is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Correlations between histopathologic findings, serum biomarker levels, and clinical outcomes in Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)

Chuenwipasakul,

Washrawirul,

Panpruk

et al. 2023

Sci Rep

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Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatological emergencies. The role of cytokines and chemokines in the pathogenesis, progression of the disease, and histopathologic features is not fully elucidated. To address this gap, we conducted a retrospective study examining the associations between 42 serum biomarkers, histopathologic findings, and clinical outcomes in SJS/TEN patients. We reviewed the medical records of 23 patients diagnosed with SJS/TEN. Regarding histopathology, our study did not reveal any significant associations between the degree of epidermal necrosis, dermal mononuclear cell infiltration, and clinical outcomes. However, an intriguing observation was made regarding the degree of dermal infiltration of CD8 + cells, which showed a negative correlation with the severity of acute ocular complications. Notably, serum levels of IFN-γ positively correlated with the number of CD8 + cells in dermal infiltration. Additionally, higher serum levels of myeloperoxidase were associated with greater degrees of epidermal necrosis, while serum Fas ligand and stem cell factor levels were elevated in individuals with increased dermal mononuclear cell infiltration. Furthermore, the levels of S100A8/A9 were significantly correlated with the SCORTEN and mortality rate. These findings provide insights into the intricate pathogenesis of the disease.

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Clinical parameters and biological markers associated with acute severe ocular complications in Stevens-Johnson syndrome and toxic epidermal necrolysis

Cited by 8 publications

References 52 publications

Drug-Induced Severe Cutaneous Adverse Reactions: Insights Into Clinical Presentation, Immunopathogenesis, Diagnostic Methods, Treatment, and Pharmacogenomics

Drug-Induced Severe Cutaneous Adverse Reactions: Insights Into Clinical Presentation, Immunopathogenesis, Diagnostic Methods, Treatment, and Pharmacogenomics

Disease severity and status in Stevens–Johnson syndrome and toxic epidermal necrolysis: Key knowledge gaps and research needs

Correlations between histopathologic findings, serum biomarker levels, and clinical outcomes in Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)

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