Deflazacort-Induced Erythema Multiforme Exudativum Successfully Treated With a Single Dose of Etanercept

Trujillo-Trujillo, M.; González-Mancebo, E; Gandolfo-Cano, M; Mohedano-Vicente, E; Martínez‐Morán, C.

doi:10.18176/jiaci.0277

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…Interestingly, corticosteroids, which are potent anti-inflammatory agents used in the treatment of various inflammatory diseases, can induce SJS/TEN [10]. Deflazacort induced drug reactions, including maculopapular rash, acute exanthematous pustulosis, erythema multiforme and SJS/TEN have been reported previously [11]- [13]. Similarly, deflazacort was responsible for SJS development in 8.9% (n=2) of our patients.…”

Section: Treatment Protocolsupporting

confidence: 66%

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Analysis of 23 Patients

Yalıcı-Armağan

Demircan²,

Akdoğan

et al. 2021

Acta Medica

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Objective: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are dermatologic emergencies. There is a lack of consensus regarding appropriate management of SJS/TEN. The aim of this study was to evaluate demographic and clinical features, management and outcomes of SJS/TEN patients. Materials and Methods: The data of patients who were ≥18 years old and hospitalized with the diagnosis of SJS, SJS-TEN overlap and TEN at Hacettepe University, between 1992 and 2018 were analyzed retrospectively. Patient demographics, medications, time between the first causative drug intake and the onset of symptoms, mucous membrane involvement, treatment modalities including supportive measures, intravenous immunoglobulin, cyclosporine and systemic corticosteroids, duration of hospitalization, and mortality outcomes were recorded from patient charts. Results: A total of 23 patients (11 men; 12 women) with a mean age of 46.4 ± 19.5 years were included in the study. Twelve patients (52.2%) had SJS, 8 patients (34.8%) had SJS/TEN overlap and 3 patients (13%) had TEN. Mean duration of hospitalization was 12.6 ± 6.5 days. Twenty-two patients (95.7%) were attributed to a specific medication, whereas triggering factor was not detected in 1 patient (4.3%). More than one drug was responsible for 9 patients, including antimicrobials (n=11, 47.8%), anticonvulsants (n=8, 34.8%) and/or non-steroid anti-inflammatory drugs (n=5, 21.7%). The median time between the intake of medication and the onset of symptoms was 20 days (IQR 5.5-30). Sixteen patients used systemic corticosteroids (69.6%) and 4 patients used intravenous immunoglobulin (17.4%) whereas 3 patients used systemic corticosteroids in combination with intravenous immunoglobulin (n=2, 8.7%) or cyclosporin (n=1, 4.3%). The median time between the onset of symptoms and the onset of the rash to the treatment was 5 days (IQR 3-7). Mortality was not observed in our cohort. Conclusion: SJS/TEN was most commonly developed because of drugs, mainly antimicrobials, anticonvulsants and/or non-steroid anti-inflammatory drugs. The absence of mortality in our cohort was considered to be associated with younger age, low rate of TEN, prompt initiation of treatment (mainly corticosteroids) following the rapid discontinuation of the suspected drug.

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Section: Treatment Protocolsupporting

confidence: 66%

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Analysis of 23 Patients

Yalıcı-Armağan

Demircan²,

Akdoğan

et al. 2021

Acta Medica

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“…Excitingly, TNF-α antagonists are translated into clinical therapeutics for SJS/TEN in recent years. Tons of evidence supports TNF antagonists halt SJS/TEN ( Paradisi et al, 2014 ; Gavigan et al, 2018 ; Shear et al, 2018 ; Trujillo-Trujillo et al, 2018 ; Chafranska et al, 2019 ; Coulombe et al, 2019 ; Pham et al, 2019 ; Zhang et al, 2020 ). A randomized controlled trial compared etanercept (a TNF inhibitor) with systemic corticosteroid treatment in adult SJS/TEN patients and showed a decreased SCORTEN-predicted mortality rate, reduced skin healing time, and less gastrointestinal hemorrhage in the etanercept group.…”

Section: T-cell-mediated Apoptosis Signaling Pathways In Sjs/tenmentioning

confidence: 99%

Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Cheng

2021

Front. Pharmacol.

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Adverse drug reactions are a public health issue that draws widespread attention, especially for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) which have high mortality and lack of efficacious treatment. Though T-cell-mediated HLA-interacted immune response has been extensively studied, our understanding of the mechanism is far from satisfactory. This review summarizes infection (virus, bacterial, and mycoplasma infection), an environmental risk factor, as a trigger for SJS/TEN. The mutations or polymorphisms of drug metabolic enzymes, transporters, receptors, the immune system genes, and T-cell-mediated apoptosis signaling pathways that contribute to SJS/TEN are discussed and summarized. Epigenetics, metabolites, and mobilization of regulatory T cells and tolerogenic myeloid precursors are emerged directions to study SJS/TEN. Ex vivo lymphocyte transformation test has been exploited to aid in identifying the causative drugs. Critical questions on the pathogenesis of SJS/TEN underlying gene polymorphisms and T cell cytotoxicity remain: why some of the patients carrying the risky genes tolerate the drug and do not develop SJS/TEN? What makes the skin and mucous membrane so special to be targeted? Do they relate to skin/mucous expression of transporters? What is the common machinery underlying different HLA-B alleles associated with SJS/TEN and common metabolites?

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Deflazacort

2018

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Deflazacort-Induced Erythema Multiforme Exudativum Successfully Treated With a Single Dose of Etanercept

Cited by 3 publications

References 3 publications

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Analysis of 23 Patients

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Analysis of 23 Patients

Current Pharmacogenetic Perspective on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Deflazacort

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