http://www.annallergy.org/article/S1081-1206(10)61112-X/abstract

 

Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature

 

To perform a comprehensive review of Stevens-Johnson syndrome and toxic epidermal necrolysis

 

Skin Amiss

Subsequent to have taken a 10-day antibiotic course of drug Bactrim for treating of sinus infection, Californian Sarah Yeargain was in a state of utter shock on noticing her skin starting to slough off her body.

She began getting slight swell up & discolouring in her facial area & it advanced to blisters on her lip area & swollen eyes. The blister formations spread throughout her facial, trunk & arm areas.

Forty-eight hours later, skin loss over her complete body occurred – this included even her inner organs & membrane on her oral, throat & eye areas. Physicians believed that her chances of surviving were poor, though on swathing her complete body with a synthetic skin substitution, transcyte, & several medicines for controlling inner bleeding, Sarah showed miraculous recovery.

Within seven days anon, re-growth of her skin occurred. The reason for her drastic skin loss has been believed to be due to toxic epidermal necrolysis which is essentially an acute allergic response to the antibiotic medicine she had taken.

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A MEDLINE search was performed for the years 1975 to 2003 using the keywords Stevens-Johnson syndrome and toxic epidermal necrolysis to identify relevant articles published in English in peer-reviewed journals.

Study Selection

All clinical studies that reported on 4 or more patients, review articles, and experimental studies that concerned disease mechanisms were selected and further analyzed. Clinical reports that included fewer than 4 patients were selected only if they were believed to carry a significant message about disease mechanism or therapy.

 

All clinical studies that reported on 4 or more patients, review articles, and experimental studies that concerned disease mechanisms were selected and further analyzed. Clinical reports that included fewer than 4 patients were selected only if they were believed to carry a significant message about disease mechanism or therapy.

Results

Stevens-Johnson syndrome and toxic epidermal necrolysis seem to be variants of the same disease with differing severities. A widely accepted consensus regarding diagnostic criteria and therapy does not exist at present.

Despite the recent experimental studies, the pathogenic mechanisms of these diseases remain unknown. Although progress in survival through early hospitalization in specialized burn units has been made, the prevalence of life-long disability from the ocular morbidity of Stevens-Johnson syndrome and toxic epidermal necrolysis has remained unchanged for the past 35 years.

Further progress depends on modification of the acute phase of the disease rather than continuation of supportive care. The available published evidence indicates that a principal problem in the pathogenesis is immunologic and that immunomodulatory intervention with short-term, high-dose intravenous steroids or intravenous immunoglobulin holds the most promise for effective change in survival and long-term morbidity.

Conclusions

The results of this review call for a widely accepted consensus on diagnostic criteria for Stevens-Johnson and toxic epidermal necrolysis and multicenter collaboration in experimental studies and clinical trials that investigate disease mechanisms and novel therapeutic interventions, respectively.

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* Department of Ophthalmology, Uveitis and Immunology Service, The Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts

Department of Medicine, New England Baptist Hospital, and Department of Oral Medicine and Diagnostic Sciences, Harvard School of Dental Medicine, Boston, Massachusetts

Requests for reprints should be addressed to: C. Stephen Foster, MD Immunology and Uveitis Service Massachusetts Eye and Ear Infirmary 243 Charles St Boston, MA 02114

Dr Foster is currently with The Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institute, Boston, MA. None of the authors have financial interests in any of the medications or products mentioned in this article.

Yassine J. Daoud is the recipient of the Doris Duke Charitable Foundation and Harvard Medical School PASTEUR Clinical Research Fellowship.

This feature is supported by an unrestricted educational grant from AstraZeneca LP

PII: S1081-1206(10)61112-X

doi:10.1016/S1081-1206(10)61112-X