The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China

Abstract

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI) and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5%) and anticonvulsants (24.1%). Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%). Chinese patent medicines accounted for 5.4%. There were 76 (45.8%) patients receiving systemic steroid and intravenous immunoglobulin (IVIG) in combination therapy, especially for TEN (80.3%), and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.

Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in vietnamese spontaneous adverse drug reaction database: A subgroup approach to disproportionality analysis

“…Our finding was in accordance with results from China or South‐East Asian countries in which carbamazepine, allopurinol and antibiotics were the most commonly implicated drugs to cause SJS/TEN . However, among antibiotic‐induced SJS/TEN, the third‐generation cephalosporins were the most reported in our study instead of penicillins as the predominant group in those studies.…”

“…22 Our finding was in accordance with results from China or South-East Asian countries in which carbamazepine, allopurinol and antibiotics were the most commonly implicated drugs to cause SJS/ TEN. 27,42 However, among antibiotic-induced SJS/TEN, the thirdgeneration cephalosporins were the most reported in our study instead of penicillins as the predominant group in those studies. In fact, the tendency of overuse of antibiotics in Vietnam, especially third-generation cephalosporins, is an important health issue in the country and greatly influences the structure of drug-induced MLOSCAR.…”

“…As traditional or herbal medicines (THMs) are widely used in the population, our study highlighted a large number of SJS/TEN reports with positive signals. These signals merit attention, especially in countries where traditional and herbal medicines are relatively popular . The causal relationship is both complex and challenging given the cocktail of herbs frequently used in THM products.…”

“…4,7,24. Several studies conducted in Japan, China, India and Malaysia also highlight the risk of using these drugs in the Asian population 9,[25][26][27][28]. Adopting the pharmacogenetic approach, Lim et al29 pointed out that the HLA-B*1502 allele accounted for more than 10% of the Vietnamese population and the highest proportion of HLA-B*5801 was found in South-East Asians 30.…”

A Case Report: Toxic Epidermal Necrolysis in Children

“…16 Another study reviewed case reports of patients with SJS/TEN from 2006 to 2016 and found 94/166 cases of TEN, 29.5% of which were caused by antibiotics. 17 No current consensus exists on how this disease should be treated. There are only health care protocols established by local hospitals.…”