Stevens‐Johnson syndrome and toxic epidermal necrolysis: retrospective review of 10‐year experience

Abstract

Background Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care. Methods A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN. Data were obtained for demographics, causative drug, hospital course, supportive care, medical management, complications, and disposition. Results A total of 48 were diagnosed with SJS/TEN during the study period. A total of 41.7% (20/48) were men, and the mean age was 49.2 years. Sulfa antibiotics and nonsulfa antibiotics were the most common causative drug categories, each accounting for a quarter of cases. Supportive measures included intravenous fluid resuscitation in 4.2% of cases, enteral nutrition in 75%, surgical debridement in 27.1%, and porcine xenograft in 16.7%. Wound care consisted of use of a cleanser in 95.8% of patients, topical antibiotic in 95.8%, topical steroid in 20.8%, topical antifungal in 14.6%, emollient in 83.3%, nonadherent dressing in 97.9%, silver impregnated dressing in 39.6%, nonsilver impregnated dressing in 79.2%, and general wrap in 93.8%. For medical treatment, 64.6% of patients received intravenous immunoglobulin (IVIG), and 8.3% of patients received cyclosporine. Mortality rate was 12.5% overall, compared to an expected mortality rate of 25.2% as predicted by SCORTEN. Conclusions Patients treated with our current regimen of care showed a mortality rate half of that predicted by SCORTEN.

Toxic Epidermal Necrolysis (TEN)/Stevens-Johnson Syndrome (SJS) Epidemiology and Mortality Rate at King Fahad Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia: A Retrospective Study

“…The most commonly causative medications reported in the literature are antibiotics, anticonvulsants, allopurinol, and NSAID [ 3 , 7 , 8 ].…”

Case Report: Clinical and Immunological Features of a Chinese Cohort With Mycoplasma-Induced Rash and Mucositis

“…Second, the etiology of atypical pneumonia in MIRM could be opposed to the HSV associated with EM and the medication etiology of SJS/TEN. It is also notable that there is a better prognosis of MIRM even with support treatment alone ( 11 , 21 – 25 ). All these clinical features may help physicians distinguish the clinical spectrum of EM, SJS/TEN and MIRM, where skin lesions are different and milder, explaining its previous and obsolete name of incomplete SJS ( 11 , 26 ).…”

Nursing Care of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Case Study of Dermatology Unit of Referral Hospital, Kenya

“…When used, biological dressings prevents frequent dressing changes and minimizes pain and discomfort for the patient and to nurses it reduces workload of frequent baths and contaminating the affected skin areas when procedures are being practiced. In other studies, wound care consisted of use of a cleanser, topical antibiotic, topical steroids, topical antifungal, emollient, non-adherent dressing, silver impregnated and non-silver impregnated dressing and general wrap [23] [ 24]. Bathing patients with chlorhexidine-impregnated wipes also improved wounds, and oral lesions in some studies [25].…”