The culprit drugs in 87 cases of toxic epidermal necrolysis (Lyell's syndrome)

Guillaume, J C

doi:10.1001/archderm.123.9.1166

Cited by 80 publications

(61 citation statements)

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“…In our study group, antibacterial agents, mostly sulfonamide and ␤-lactam antibiotics, and phenobarbital were the main culprit drugs. This is in accordance with studies performed by Roujeau et al 8,11,13 and Schoepf…”

Section: Discussionsupporting

confidence: 94%

“…8 -11 Antibacterials and antifungals (36%), anticonvulsants (24%), analgesics, nonsteroidal anti-inflammatory agents (38%), and even corticosteroids (14%) have been suspected of causing the disease process. [11][12][13] The underlying pathophysiologic mechanism is unclear. The histologic characteristics of TEN include dermoepidermal separation resembling a blistering scald burn, followed by necrosis and shedding of the epidermis.…”

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confidence: 99%

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Treatment of Extensive Toxic Epidermal Necrolysis in Children

et al. 2001

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ABSTRACT. Objective. Toxic epidermal necrolysis (TEN) is a rare but life-threatening disease of the skin and mucous membranes. We report our experience in the treatment of pediatric TEN patients with early debridement of necrotic skin and coverage with human allograft skin.Methods. From 1984 to 2000, 15 children (6 girls, 9 boys, 7.2 ؎ 1.5 years) with a histologic diagnosis of TEN and involvement of >30% total body surface area were treated at the Shriners Hospitals for Children in Galveston. All were treated in a specialized pediatric burn intensive care unit after our standard treatment protocol, including operative debridement of sloughing skin and allografting within 24 hours of admission. Outcome parameters were mortality, length of hospital stay, wound healing, clinical complications, causative drugs, corticosteroid use, and delay in referral to a burn center. Results. Taking a new medication (antibiotics, anticonvulsive drugs) was associated with all cases of TEN.Patients who were treated with early debridement and coverage with allograft skin showed no wound infection, and overall mortality was 7%. Total length of hospital stay was 26 ؎ 3 days. Long-term sequelae were changes in skin pigmentation (100%), ophthalmologic problems (40%), and diffuse itching early after wound healing (53%).Conclusion. Although a rare disease in children, TEN was managed successfully in a burn center environment, using early debridement and wound coverage with allograft skin as a biological dressing. The use of corticosteroids and referral patterns seems unchanged during the past 2 decades, indicating an additional need for information and education about the disease. Pediatrics 2001; 108:1162-1168; toxic epidermal necrolysis, children, burn center, mortality, biological dressing.

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Section: Discussionsupporting

confidence: 94%

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confidence: 99%

Treatment of Extensive Toxic Epidermal Necrolysis in Children

et al. 2001

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“…11,14 A score of 0 to 4 was attributed to each drug that was taken by the patient during the month before the first cutaneous sign of TEN or SJS. This score was related to the timing of drug administration and the onset of disease.…”

Section: Causative Drugmentioning

confidence: 99%

“…Previous investigations have been unable to find a relationship between causative drugs and prognosis. 11 From a practical viewpoint, a drug eruption often starts as a morbilliform rash. Most often it has a benign course and does not progress.…”

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confidence: 99%

Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome

García‐Doval¹,

Lecleach²,

Bocquet³

et al. 2000

Arch Dermatol

392

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“…Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lye11 syndrome) are severe albeit rare adverse drug reactions (ADRs) to several antiepileptic drugs (AEDs) such as phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), and valproate (VPA) (1)(2)(3)(4)(5)(6). A recent cohort study indicated that the risks for severe cutaneous reactions in first-time users of PHT and CBZ are 9110,000 and 6.2/10,000, respectively (7).…”

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confidence: 99%

Lamotrighe‐Induced Severe Cutaneous Adverse Reactions

1998

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Summary: Purpose:We systematically reviewed and analyzed published and unpublished cases of Stevens-Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN) associated with lamotrigine (LTG) therapy to identify characteristics of these reactions.Methods: We performed a MEDLINE search (January 1985 to April 1998) and citation tracking for published reports. In addition, reports were requested from the Uppsala Monitoring Centre of the World Health Organization (WHO). Published and WHO cases of LTG-associated SJS or TEN were included if the causal relationship was assessed as either possible, probable, or definite.Results: We identified a total of 57 cases (43 cases of SJS, 14 cases of TEN), of which 13 (23%) were published. Cases in the SJS group were significantly younger-than in the TEN group (21 years vs. 31 years). The median time to onset (17 days for SJS and TEN) and the median dosage at onset (50 mg vs. 87.5 mg) for SJS and TEN did not differ significantly. Concomitant use of valproate (VPA) was reported in 74% of the SJS cases and 64% of the TEN cases. In three cases, TEN was the cutaneous manifestation of the antiepileptic drug hypersensitivity syndrome (AHS).Conclusions: The main features of severe cutaneous drug reactions, such as dosage, onset, and concomitant VPA use, do not differ in patients with LTG-induced SJS or TEN. SJS or TEN may also be the cutaneous manifestations of LTG-induced AHS. Further epidemiologic studies are needed to identify the incidence of severe LTG-induced cutaneous adverse reactions and the relative risk compared with other AEDs. Key Words: Lamotrigine-Antiepileptic drugs-Stevens-Johnson syndrome-Toxic epidermal necrolysis-Hypersensitivity .Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lye11 syndrome) are severe albeit rare adverse drug reactions (ADRs) to several antiepileptic drugs (AEDs) such as phenytoin (PHT), carbamazepine (CBZ), phenobarbital (PB), and valproate (VPA) (1-6). A recent cohort study indicated that the risks for severe cutaneous reactions in first-time users of PHT and CBZ are 9110,000 and 6.2/10,000, respectively (7). Severe cutaneous adverse reactions (SCARS) such as erythema multiforme (EM), SJS, or TEN may also represent the cutaneous manifestation of the antiepileptic drug hypersensitivity syndrome (AHS), which is defined by the triad of fever, a cutaneous reaction, and internal organ involvement (3,8).Lamotrigine (LTG), a phenyltriazine, is chemically unrelated to existing AEDs (9). It is extensively metabolized, predominantly by N-glucuronidation, whereas only minor fractions undergo N-oxidation and N-methylation

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The culprit drugs in 87 cases of toxic epidermal necrolysis (Lyell's syndrome)

Cited by 80 publications

References 0 publications

Treatment of Extensive Toxic Epidermal Necrolysis in Children

Treatment of Extensive Toxic Epidermal Necrolysis in Children

Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome

Lamotrighe‐Induced Severe Cutaneous Adverse Reactions

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