Methylprednisolone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis: Clinical evaluation and analysis of biomarkers

Hirahara, Kazuki; Kano, Yoko; Sato, Yohei; Horie, Chiho; Okazaki, Aki; Ishida, Tadashi; Aoyama, Yumi; Shiohara, Tetsuo

doi:10.1016/j.jaad.2013.04.007

Cited by 59 publications

(46 citation statements)

References 5 publications

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“…SCS treatment can decrease the percentage of perforin-positive CD8+ T lymphocytes [30] and decrease excessive immune response [7]. SCS has been suggested to be a valid treatment [31, 32] for the disease but the result of this study did not support the efficacy of SCS treatment over the supportive care alone. The duration of hospital stay, short-term and long-term sequel, and recurrence were comparable between systemic treatment group and the supportive care alone group.…”

Section: Discussionmentioning

confidence: 77%

Clinical Features and Treatment Outcomes among Children with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A 20-Year Study in a Tertiary Referral Hospital

Chatproedprai

Wutticharoenwong

Tempark

et al. 2018

Dermatology Research and Practice

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Aim To determine the probable causative factors, clinical features, and treatment outcomes of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap in children. Methods A 20-year database review of all children diagnosed with SJS/TEN/SJS-TEN overlap at the King Chulalongkorn Memorial Hospital, Thailand. Results 36 patients (M : F, 16 : 20) with the mean age of 9.2 ± 4.0 years were identified. There were 20 cases of SJS, 4 cases of SJS-TEN overlap, and 12 cases of TEN. Drugs were the leading cause for the diseases (72.3%); antiepileptics were the most common culprits (36.1%). Cutaneous morphology at presentation was morbilliform rash (83.3%), blister (38.9%), targetoid lesions (25.0%), and purpuric macules (2.8%). Oral mucosa (97.2%) and eye (83.3%) were the 2 most common mucosal involvements. Majority of the cases (77.8%) were treated with systemic corticosteroids, intravenous immunoglobulin, or both. Treatment outcomes between those who received systemic therapy and those who received only supportive care were comparable. Skin and eye were the principal sites of short-term and long-term complications. Conclusions SJS/TEN are not common but are serious diseases which lead to significant morbidities in children. Early withdrawal of suspicious causes and meticulous supportive care are very important. This study found that the systemic therapy was not superior to supportive care because the treatment outcomes for both groups were comparable.

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Section: Discussionmentioning

confidence: 77%

Clinical Features and Treatment Outcomes among Children with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A 20-Year Study in a Tertiary Referral Hospital

Chatproedprai

Wutticharoenwong

Tempark

et al. 2018

Dermatology Research and Practice

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“…Anticonvulsants, antibiotics and non-steroidal anti-inflammatory drugs were the major causative drugs from studies in Japan 14 and Singapore. 11 Recently, Hirahara et al 8 studied methylprednisolone pulse therapy for SJS/TEN at a starting dose 1000 mg/day for 3 days consecutively and then changed to oral prednisolone at 0.8-1 mg/kg per day. 14,15 In the current study, phenytoin (16.7%) and carbamazepine (11.1%) were the most commonly involved antiepileptic drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Minimizing the time between the onset of cutaneous manifestations and the arrival at the special unit is crucial for improving the potential survival. [8][9][10][11][12] The aim of this retrospective study was to demonstrate the clinical profiles of TEN in Thai patients, to evaluate the efficacy of systemic corticosteroid therapy at the acute stage of TEN and to determine the optimal cut-off point to predict mortality among patients with TEN who received systemic corticosteroids. Drug-specific cytotoxic CD8 + T lymphocytes, TNF and interferon (IFN)-c also are involved in the mechanism of epidermal necrosis.…”

Section: Introductionmentioning

confidence: 99%

Clinical profiles and treatment outcomes of systemic corticosteroids for toxic epidermal necrolysis: A retrospective study

Choonhakarn

Limpawattana

Chaowattanapanit

2015

The Journal of Dermatology

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Toxic epidermal necrolysis (TEN) is an uncommon severe cutaneous adverse reaction. Although controversies remain in the pathophysiology and management of this condition, improvements in survival and morbidity have been observed over the past decade. The aim of the present study was to demonstrate the clinical profiles of TEN in Thai patients and the treatment outcome with dexamethasone pulse therapy assessed by using the Severity of Illness Score for Toxic Epidermal Necrolysis (SCORTEN). Medical records of all patients with TEN were collected retrospectively from January 2002 to December 2012. Epidemiological features, etiologies, treatments and clinical outcomes were reviewed. Of 18 patients, the female to male ratio was 1:1 and the mean age was 49.7 years. Cephalosporins (27.8%), phenytoin (16.7%), carbamazepine, sulfonamide drugs and allopurinol (11.1% each) were implicated as leading causes of TEN. Hepatitis was the most frequent complication (77.8%). Pulsed high doses of dexamethasone 1-1.5 mg/kg per day for a short period were administrated in all cases. Two of the 18 patients receiving corticosteroids (SCORTEN 5 and 6) died. The mortality rate was 11% (2/18 patients), however, no patient receiving systemic corticosteroids died if the patients had less than 4 points on SCORTEN. The clinical features of Thai patients with TEN were similar to other reports. In conclusion, in addition to withdrawal of the suspected agent and intensive supportive care, the administration of short-term dexamethasone pulse therapy, particularly during the initial phase, may be beneficial in reducing the mortality rate.

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“…Two small case series have reported decreased anticipated mortality rates with high dose corticosteroids dexamethasone (100 mg IV for 3 days) [38] and methylprednisone (1000 mg IV for 3 days) [39]. In the absence of larger-powered quality data, the use of corticosteroids has not been recommended in recent UK guidelines [7].…”

Section: Managementmentioning

confidence: 99%

Review of Toxic Epidermal Necrolysis

Harris

Jackson

Cooper

2016

IJMS

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Toxic epidermal necrolysis (TEN) is a rare but life threatening mucocutaneous reaction to drugs or their metabolites. It is characterised by widespread keratinocyte apoptosis and sloughing of the skin, erosions of the mucous membranes, painful blistering, and severe systemic disturbance. The pathophysiology of TEN is incompletely understood. Historically, it has been regarded as a drug-induced immune reaction initiated by cytotoxic lymphocytes via a human leukocyte antigen (HLA)-restricted pathway. Several mediators have been identified as contributors to the cell death seen in TEN, including; granulysin, soluble Fas ligand, perforin/granzyme, tumour necrosis factor-α (TNF-α), and TNF-related apoptosis-inducing ligand. Currently, granulysin is accepted as the most important mediator of T cell proliferation. There is uncertainty around the accepted management of TEN. The lack of definitive management guidelines for TEN is explained in part by the rarity of the disease and its high mortality rate, which makes it difficult to conduct randomised control trials on emerging therapies. Developments have been made in pharmacogenomics, with numerous HLA alleles identified; however, these have largely been ethnically specific. These associations have translated into screening recommendations for Han Chinese.

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Methylprednisolone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis: Clinical evaluation and analysis of biomarkers

Cited by 59 publications

References 5 publications

Clinical Features and Treatment Outcomes among Children with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A 20-Year Study in a Tertiary Referral Hospital

Clinical Features and Treatment Outcomes among Children with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A 20-Year Study in a Tertiary Referral Hospital

Clinical profiles and treatment outcomes of systemic corticosteroids for toxic epidermal necrolysis: A retrospective study

Review of Toxic Epidermal Necrolysis

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