Toxic epidermal necrolysis in Singapore, 1989 through 1993: incidence and antecedent drug exposure

Chan, H. L.

doi:10.1001/archderm.131.10.1212

Cited by 6 publications

(9 citation statements)

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“…In Europe, TEN and SJS joint incidence is 2 cases per million inhabitants per year [13]. In Asia, it is estimated at 1.4 cases per million inhabitants per year [14]. TEN incidences in our study was 5 cases/year similar to the ones reported in several other series in sub-Saharan Africa [2,5].…”

Section: Discussionsupporting

confidence: 85%

Toxic Epidermal Necrolysis in Senegal, 2005 Through 2015: Epidemiological and Drug Etiology

Diallo¹,

Diop²,

Diadié³

et al. 2017

Dermatol Case Rep

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Introduction: The aim of this study was to determine the epidemiological and drug etiology of the toxic epidermal necrosis (TEN) or Lyell's syndrome in our Department. Patients and Methodology: Medical records of all admitted patients for TEN over an eleven-year period were analysed retrospectively. Findings: We collected 251 cases of drug-induced skin reactions, representing 0.3% of medical visits and 0.7% of admissions. On average, 5 patients suffering from TEN were hospitalized every year. They mostly consisted of young women with a mean age of 35 ± 19.71 years and a sex-ratio of 0.5. About half of patients have been evacuated by road from the various provinces of the country, sometimes over 500 km away. The culprit drug was prescribed by a nurse of an infirmary in 35% of the cases. A self-medication with a drug bought in the street or in a pharmacy was found in 24 patients (40%). There was poly-medication in 17 patients (28%). The inducing drugs were mostly sulphonamides, neuroleptics, paracetamol, allopurinol and NSAI. An oral phytotherapy (Momordica charantia and Guiera senegalensis) induced the TEN in 2 patients. Death occurred in 18 patients (30%). Discussion: Lyell syndrome is still frequent in sub-Saharan Africa where its prevalence even seems to be increased. Its incidence is probably favorised by self-medication especially with street medicines, unregulated access to drugs, inappropriate prescriptions, the circulation of counterfeit medicines, as well as the high prevalence of HIV. The remoteness of patients from dermatological department and the lack of sanitary evacuation systems explain its still poor prognosis in our regions.

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Section: Discussionsupporting

confidence: 85%

Toxic Epidermal Necrolysis in Senegal, 2005 Through 2015: Epidemiological and Drug Etiology

Diallo¹,

Diop²,

Diadié³

et al. 2017

Dermatol Case Rep

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“…La Grenade et al report similar results, with 1.9 cases of TEN per million inhabitants per year based on all cases reported to the FDA AERS database in the USA [6]. Lower incidence rates were reported by Chan et al in Singapore [7]. Certain infectious diseases may have an impact on the incidence of TEN, and this is clearly the case for HIV where the annual incidence is approximately 1000-fold higher than in the general population, with approximately 1 case per thousand per year in the HIV-positive population ([8].…”

Section: Epidemiologymentioning

confidence: 61%

Toxic epidermal necrolysis and Stevens-Johnson syndrome

Harr

French

2010

Orphanet J Rare Dis

504

556

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Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Currently, TEN and SJS are considered to be two ends of a spectrum of severe epidermolytic adverse cutaneous drug reactions, differing only by their extent of skin detachment. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infections are well documented causes alongside rare cases in which the aetiology remains unknown. Several drugs are at "high" risk of inducing TEN/SJS including: Allopurinol, Trimethoprim-sulfamethoxazole and other sulfonamide-antibiotics, aminopenicillins, cephalosporins, quinolones, carbamazepine, phenytoin, phenobarbital and NSAID's of the oxicam-type. Genetic susceptibility to SJS and TEN is likely as exemplified by the strong association observed in Han Chinese between a genetic marker, the human leukocyte antigen HLA-B*1502, and SJS induced by carbamazepine. Diagnosis relies mainly on clinical signs together with the histological analysis of a skin biopsy showing typical full-thickness epidermal necrolysis due to extensive keratinocyte apoptosis. Differential diagnosis includes linear IgA dermatosis and paraneoplastic pemphigus, pemphigus vulgaris and bullous pemphigoid, acute generalized exanthematous pustulosis (AGEP), disseminated fixed bullous drug eruption and staphyloccocal scalded skin syndrome (SSSS). Due to the high risk of mortality, management of patients with SJS/TEN requires rapid diagnosis, evaluation of the prognosis using SCORTEN, identification and interruption of the culprit drug, specialized supportive care ideally in an intensive care unit, and consideration of immunomodulating agents such as high-dose intravenous immunoglobulin therapy. SJS and TEN are severe and life-threatening. The average reported mortality rate of SJS is 1-5%, and of TEN is 25-35%; it can be even higher in elderly patients and those with a large surface area of epidermal detachment. More than 50% of patients surviving TEN suffer from long-term sequelae of the disease.

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“…Although carbamazepine is the leading cause of SJS/TEN in our series, there is only one ARF case in this group. Carbamazepine and allopurinol are the major causes of SJS/TEN in Asian patients, accounting for 25–33 and 25–37% cases, respectively, which might be related to specific HLA typing in the Chinese population [16,17,18]. Despite their similarity in frequency and genetic predisposition, they show differences in ARF susceptibility.…”

Section: Discussionmentioning

confidence: 99%

Acute Renal Failure and Its Risk Factors in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Hung¹,

Liu²,

Kuo³

et al. 2009

Am J Nephrol

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Background: Skin lesion is the most frequent manifestation of adverse drug reactions. Drug-induced cutaneous hypersensitivity and drug-induced acute interstitial nephritis might share a similar mechanism involving drug-specific T cells. We thus investigated the renal outcome of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the most severe drug-induced cutaneous hypersensitivity, and hypothesize that skin detachment in SJS/TEN might be associated with acute renal failure (ARF). Methods: 234 hospitalized patients were retrospectively classified into an SJS/TEN group (skin detachment) or an erythematous multiforme majus group (target-like exanthema alone). Results: Both drugs and chronic kidney disease (CKD) are associated with SJS/TEN. The SJS/TEN group was more likely to develop ARF than the erythematous multiforme majus group (18.8 vs. 4.3%, p < 0.05) despite similar initial creatinine clearance. In the ARF patients, RIFLE-F class, dialysis and long-term dialysis were 25, 15 and 5%, respectively. The offending drugs in ARF were also associated with CKD. Hyponatremia and late hypokalemia were more frequently in the SJS/TEN group (15.6 vs. 2.9%, 7.3 vs. 0.7%, respectively, p < 0.05). Sepsis, allopurinol, antibiotics, NSAIDs, CKD and hypoalbuminemia (OR: 18.8, 9.8, 10.1, 9.0, 5.3 and 3.3, respectively, p < 0.05) were the risk factors of developing ARF. Conclusion: ARF, the need for dialysis, and late hypokalemia could be the consequences of SJS/TEN. Skin detachment after certain medication might implicate the associated ARF, especially in CKD patients.

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Toxic epidermal necrolysis in Singapore, 1989 through 1993: incidence and antecedent drug exposure

Cited by 6 publications

References 0 publications

Toxic Epidermal Necrolysis in Senegal, 2005 Through 2015: Epidemiological and Drug Etiology

Toxic Epidermal Necrolysis in Senegal, 2005 Through 2015: Epidemiological and Drug Etiology

Toxic epidermal necrolysis and Stevens-Johnson syndrome

Acute Renal Failure and Its Risk Factors in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

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