Stevens-Johnson syndrome and toxic epidermal necrolysis in pregnant patients: A systematic review

Abstract

Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two of the most severe dermatologic emergencies. Although pregnant women comprise a subset of individuals at risk for SJS and TEN development, little is known with regard to outcomes and treatment. Objective This study aimed to conduct a systematic review to characterize the risk factors, outcomes, and treatment of SJS and TEN in pregnant patients and newborns. Methods A primary literature search was conducted using PubMed in September 2019, using the following search terms entered in separate pairs: pregnant or pregnancy and stevens-johnson or SJS or toxic epidermal necrolysis. Reviews, studies in a language other than English, and articles not including pregnant patients were excluded. Results Twenty-six articles were included for review, including a total of 177 patients. The average maternal age for a reaction was 29.9 years, gestational age was 24.9 weeks, and time to reaction after drug initiation was 27.5 days. Approximately 85% of pregnant women in this review were infected with HIV. The most common causative medications were antiretroviral therapy (90% of all cases), antibiotics (3%), and gestational drugs (2%). Of the 94 cases in which outcome data were available, the survival rates of pregnant women and newborns after delivery were 98% and 96%, respectively. Withdrawal of the offending agent and supportive care was often sufficient for treatment, but antibiotics, steroids, and intravenous immunoglobulin were implemented in some cases. Complications included preterm labor, vaginal stenosis, and vaginal adhesions. Conclusion Given the predominance of studies focusing on the subset of pregnant patients who are infected with HIV, SJS and TEN is most commonly reported in young patients after antiretroviral therapy, primarily nevirapine. Overall mortality is lower than that of the general population, but similar to the expected mortality rates of younger adults. Early recognition and withdrawal of the offending agent is essential to mitigate the distinct consequences of these conditions in the pregnant population.

Stevens-Johnson syndrome in a pregnant woman who received the influenza vaccine

“… 4 Although no randomized controlled trials exist for its use during pregnancy, it has a short half-life, and studies demonstrate that there is low transplacental transfer of etanercept in the third trimester 5 ; however, there are no published data regarding its use for the treatment of SJS in pregnant patients. 6 …”

Komplikasi Sindrom Stevens-Johnson (SSJ) dan Nekrolisis Epidermal Toksik (NET)

“…Jika vagina terlibat, akan muncul erosi vagina dengan keputihan bernoda darah dan bernanah. 27 Erosi vagina dapat menyebabkan sinekia vagina, aglutinasi vulva, stenosis, atau oklusi vagina. Gejala sisa akibat oklusi vagina termasuk hematokolpos, hematometra, dan endometriosis.…”

“…Tanpa pengobatan, waktu penyembuhan lesi vulvovaginal berkisar antara 7 hingga 56 hari. 26,27 Penyintas SSJ/NET dengan gejala atau lesi ginekologi persisten harus menjalani biopsi punch pada vulva dan vagina serta observasi ketat dengan kolposkopi jika biopsi positif untuk adenosis vulvovaginal, adenosis vulvovaginal memiliki potensi berubah menjadi sel skuamosa dan karsinoma sel bening pada vagina. 28…”

Epilepsy management in pregnant HIV+ women in sub-Saharan Africa, clinical aspects to consider: a scoping review

“…A meta-analysis reported an incidence of skin rash with lamotrigine of almost 10% of persons from prospective studies [63] from high-income countries (HIC). Similarly, a recent review suggested that HAART, being implicated in 90% of cases, constitutes the most common putative medications in pregnant women [64].…”