Profile and Pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a General Hospital in Singapore: Treatment Outcomes

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but potentially life-threatening, reactions to medications. Both conditions have significant morbidity and mortality. The aim of this study was to document the epidemiological features, aetiologies, treatment and clinical outcomes of retrospectively reviewed data of all patients with SJS or TEN treated from January 2004 to November 2010 in a general hospital. There were 18 cases of SJS, seven cases of SJS/TEN overlap and three cases of TEN. Mean age was 50.6 years, with a range of 13-85 years. The male/female ratio was 1. Drugs accounted for 26 cases; one case was caused by Neisseria gonorrhoea infection. Anti-convulsants (35.7%) were the most common implicated drugs followed by antibiotics (28.5%), non-steroidal anti-inflammatory drugs (NSAIDS) (14.3%), allopurinol (7.1%) and traditional Chinese medication (7.1%). In seven cases, multiple drugs were implicated. Most SJS cases (88%) were treated with corticosteroids, of which 61% were given high-dose systemic corticosteroids. No infective complications were observed. Six out of the seven SJS/TEN overlap syndrome and all three TEN cases were given intravenous immunoglobulins. One patient with TEN died. In conclusion, anti-convulsants, especially carbamazepine, were the most frequently implicated drugs, followed by antibiotics and NSAIDS. High-dose corticosteroids were effective in SJS, whereas intra-venous immunoglobulin were useful in TEN and SJS/TEN overlap syndrome.

A study on drug induced Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and SJS-TEN overlap in a tertiary care hospital of Northeast India

“…HLA-B*5801 allele is another genetic marker reported to have strong association with allopurinol-induced SJS/TEN. 21 In Europe & Asia, allopurinol is commonly reported offending drug for SJS & TEN 18 whereas in present study, only 1 case of allopurinol-induced TEN was reported. Few cases of SJS/TEN due to antituberculars (isoniazid), cytotoxic drugs (lenalidomide, methotrexate), antimalarials (artesunate), antileprotics (clofazimine), antiamoebic (metronidazole) and antidepressant (reboxetine) were also reported in our study.…”

“…19 Penicillins and cephalosporins were the commonly reported causative drugs from Japan & Singapore. 17,18 In present study, among β-lactam antibiotics, cephalosporins were implicated in 4 cases. Fluoroquinolones were commonly reported from Indian state, Gujarat & Karnataka.…”

“…In several studies, antimicrobials, anticonvulsants and NSAIDs were the most common group of drugs causing SJS, TEN and SJS-TEN overlap. [15][16][17][18][19] Similarly in our study, antimicrobials were commonly reported group of drugs followed by anticonvulsants, antipyretics, and NSAIDs. Sixteen patients (35.5%) had experienced SJS/TEN due to antimicrobials.…”

Untitled

“…The syndrome is causes are certain medications (such as lamotrigine), but it can also be due to infections, or more rarely, cancers, or hypersensitivity reaction to some compounds [1,2]. The blisters and erosions in SJS cover between 3% and 10% of the entire body surface [3]. It is associated with factors ranging from immunoreactions, infections, genetic factors, and adverse drug reactions [4,5].…”

Anatomy, Physiology and Drugs Triangular Dynamics in Steven Johnsons Syndrome

“…1,2 The blisters and erosions in SJS cover between 3% and 10% of the entire body surface. 3 It is associated with factors ranging from immunoreactions, infections, genetic factors, and adverse drug reactions. 4,5 Immunocompromised patients who are slow acetylators and brain tumor patients on anticonvulsant drugs who are undergoing radiotherapy are usually more prone to SJS.…”