Effectiveness and Safety of Early Short-Course, Moderate- to High-Dose Glucocorticoids for the Treatment of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Retrospective Study

Ye, Zhenzhen; Li, Chunting; Zhang, Hua; Zhang, Chunlei; Lu, Xin

doi:10.2147/ccid.s378106

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…Short-term application of medium- to high-dose of systemic applications of glucocorticoids can effectively treat SJS/TEN with mild complications and little effect on underlying diseases. 29 It has been reported that corticosteroids and IVIG combination therapy has significant survival benefits for patients with SJS/TEN. 30 31 In our study, all patients were treated with glucocorticoids and more than half combined with IVIG; steroid pulse therapy was administered in severe and rapidly progressive cases.…”

Section: Discussionmentioning

confidence: 99%

RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Zhang,

Lan,

et al. 2023

Allergy Asthma Immunol Res

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Purpose Our study aimed to explore potential prognostic factors in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) patients from easily accessible laboratory data and to investigate whether the combination of these indicators with a score for toxic epidermal necrolysis (SCORTEN) can improve the predictive value. Methods Data from 85 SJS/TEN patients hospitalized from 2010 to 2021 were retrospectively analyzed. The primary outcome was in-hospital mortality. Univariate analysis was used to screen for laboratory indexes associated with death. Logistic regression was used to analyze significant risk factors for death. The differentiation and calibration of SCORTEN and modified score were assessed using receiver operating characteristic (ROC) curves and Hosmer-Lemeshow goodness-of-fit test. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate the incremental prognostic value. Results Among the 85 patients (37 males, 48 females) aged 14-88 years, the mortality rate was 11.8% (n = 10). SCORTEN had good discrimination and calibration to predict mortality in this cohort of patients (area under the ROC curve [AUC] of 0.874, 95% confidence interval [CI], 0.758-0.990; Hosmer-Lemeshow goodness-of-fit test P = 0.994). Red cell distribution width-standard deviation index (RDW-SD) > 47.9 fL and procalcitonin (PCT) > 0.67 ng/mL were significant risk factors for death. When adding the 2 factors to SCORTEN, AUC was 0.915 (95% CI, 0.833–0.997), but not statistically different compared to SCORTEN alone ( P = 0.091). The NRI was 1.2 (95% CI, 0.672–1.728; P < 0.001) and the IDI was 0.09 (95% CI, 0.011–0.173; P = 0.026), still suggesting that the modified score had better discriminatory and predictive power than SCORTEN alone. The modified score also showed good calibration (Hosmer-Lemeshow goodness-of-fit test, P = 0.915). Conclusions SCORTEN is a good predictor of mortality in SJS/TEN patients in southwest China. Combining RDW-SD > 47.9 fL and PCT > 0.67 ng/mL with SCORTEN may enhance the ability to predict prognosis.

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Section: Discussionmentioning

confidence: 99%

RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Zhang,

Lan,

et al. 2023

Allergy Asthma Immunol Res

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“…Findings may include skin and mucous membrane pain, erythema, blisters, epidermal exfoliation, and other skin lesions involving the conjunctiva, oral cavity, and/or urogenital mucosa. [ 6 ] Histopathologic examination, if chosen as a diagnostic modality, is characterized by extensive apoptosis and necrosis of keratinocytes.…”

Section: Discussionmentioning

confidence: 99%

A case of Stevens-Johnson syndrome treated with oral cyclosporine

Griffith,

Ramnot,

Resnik

et al. 2023

Journal of Family Medicine and Primary Care

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can occur at any age and are commonly caused by adverse drug events. Rapid diagnosis of SJS/TEN is imperative, followed by immediate cessation of offending agent and induction of appropriate treatment. Cyclosporine, a calcineurin inhibitor, has been reported to have a promising therapeutic effect in SJS/TEN patients with few side effects. Diagnosis of SJS/TEN in children is especially challenging as many of the symptoms mimic that of an upper respiratory infection, or other viral entities such as cocksackie A, roseola, or herpes simplex virus. We recommend initiating cyclosporine modified treatment, especially in children, upon any suspicion of SJS/TEN in a patient in order to halt the disease progression as early as possible.

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“…Additionally, research on various communities demonstrate that the chance of developing SJS/TEN is maximum just after starting medication and declines after 8 weeks or longer of treatment [46]. It is noteworthy to note that long-term usage of glucocorticosteroids for a range of illnesses has no effect on the frequency of SJS/TEN incidence for the pharmaceuticals in question, but it seems that glucocorticoids increases the period between the commencement of drug consumption and the onset of SJS/TEN [47]. According to recent study on pediatric TEN, children may be more sensitive to acetaminophen than adults are and similar medications to those used in adults are being employed [48].…”

Section: Drugsmentioning

confidence: 99%

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis- An Overview

Garg¹

2022

Preprint

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Both Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are main injurious cutaneous medication reactions that mostly affect the epidermis and mucus membranes. TEN and SJS affecting nearly 1 or 2/1,000,000 people per year, and can recognized as medical crises since they may be deadly. Mucocutaneous discomfort, hemorrhagic erosions, erythema, and more or less severe epidermal separation that appear as ulcer and patches of dermic loss are their defining characteristics. The sole difference between TEN and SJS at this time is the degree of skin detachment, making them two extremes of a spectrum of severe cutaneous adverse drug reactions (cADRs). In the majority of cases, drugs are considered as the principal reason of SJS/TEN, but herpes simplex virus and Mycoplasma pneumoniae infections are also recognized causes, along with lesser number of cases in which the cause is still unknown. Among the drugs with a "high" likelihood of producing TEN/SJS are carbamazepine (CBZ), trimethoprim-sulfamethoxazole, phenytoin, aminopenicillins, allopurinol, cephalosporins, other sulfonamide antibiotics, quinolones, phenobarbital, and NSAIDs of the oxicam variety. There is strong genetic evidence for SJS and TEN in Han Chinese due to the substantial association between the human leukocyte antigen (HLA-B*1502) and SJS brought on by CBZ. The diagnosis is made mostly based on clinical symptoms and the histological study of a dermal biopsy. Pemphigus vulgaris, bullous pemphigoid, linear IgA dermatosis, paraneoplastic pemphigus, disseminated fixed bullous drug eruption, acute generalized exanthematous pustulosis (AGEP), and staphylococcal scalded skin syndrome (SSSS) are among the differential diagnoses. The management of patients with SJS/TEN is complicated by the high risk of mortality, necessitating early diagnosis, estimation of the SCORTEN prognosis, identification and discontinuation of the causative drug, specialized supportive care, and high-dose injectable Ig therapeutic interventions. The reported fatality rates for SJS are 1-5% on average and 25-35% for TEN; it can be even higher in patients who are elderly or who have a significant amount of epidermal detachment on their skin. More than 50% of TEN patients who survive the disease experience long-term consequences.

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Effectiveness and Safety of Early Short-Course, Moderate- to High-Dose Glucocorticoids for the Treatment of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: A Retrospective Study

Cited by 4 publications

References 22 publications

RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

RDW-SD and PCT Are Potential Prognostic Factors for In-hospital Death in Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

A case of Stevens-Johnson syndrome treated with oral cyclosporine

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis- An Overview

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