Stevens Johnson Syndrome Treatment

 

 

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2012 Jun;87(3):477-81.

Treatment of toxic epidermal necrolysis with intravenous immunoglobulin: a series of three cases.

Source

Department of Dermatology, Teaching Hospital, University of Mato Grosso do Sul, Campo Grande, MS, Brazil.

Abstract

Stevens-Johnson's syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatoses, that lead to keratinocyte apoptosis induced by interactions between Fas (cell death receptor) and soluble Fas-ligand, present in serum of Stevens-Johnson's syndrome / toxic epidermal necrolysis patients. Anti-Fas antibodies in intravenous immunoglobulin (IVIG) would block the apoptosis cascade. Three cases of toxic epidermal necrolysis occurred in one male and two female patients, after use of allopurinol, leprosy multidrug therapy concomitant with dipyrone, and diclofenac. The cases were treated with intravenous immunoglobulin 2-3 mg/kg and prednisone 20-50 mg/day. The interruption of new lesions outbreak and reepithelization were extremely fast after the use of intravenous immunoglobulin, without adverse effects. Controlled studies are needed to confirm the efficacy of intravenous immunoglobulin in Stevens-Johnson's syndrome / toxic epidermal necrolysis, but the results seem promising.

PMID:
22714769
[PubMed - in process]
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STEVENS JOHNSON SYNDROME TREATMENT

Treatment of severe drug reactions: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis and Hypersensitivity syndrome

Pierre-Dominique Ghislain M.D., Jean-Claude Roujeau, M.D. Dermatology Online Journal 8(1): 5 Department of Dermatology, Hospital Henri Mondor, Universite Paris XII, Creteil, France

Abstract: Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30-35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5-15%)...

 


Ophthalmology. 2009 Apr;116(4):685-90. Epub 2009 Feb 25.

Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications.

Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z, Hashimoto K, Kinoshita S. Source Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. csotozon@koto.kpu-m.ac.jp

Abstract PURPOSE: To present a detailed clarification of the symptoms at disease onset of Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), with ocular complications and to clarify the relationship between topical steroid use and visual prognosis.

DESIGN: Cross-sectional study.

PARTICIPANTS: Ninety-four patients with Stevens Johnson Syndrome SJS and Toxic Epidermal Necrolysis TEN with ocular complications.

METHODS: A structured interview, examination of the patient medical records, or both addressing clinical manifestations at disease onset were conducted for 94 patients seen at Kyoto Prefectural University of Medicine. Any topical steroid use during the first week at the acute stage also was investigated...

CONCLUSIONS: Acute conjunctivitis occurring before or simultaneously with skin eruptions accompanied by extremely high fever and oral and nail involvement indicate the initiation of Stevens Johnson Syndrome SJS or Toxic Epidermal Necrolysis TEN. Topical steroid treatment from disease onset seems to be important for the improvement of visual prognosis. PMID: 19243825 [PubMed - indexed for MEDLINE]


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

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...

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...

Conclusions

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



An Bras Dermatol. 2012 Jun;87(3):477-81.
Treatment of toxic epidermal necrolysis with intravenous immunoglobulin: a series of three cases.
Comparin C, Hans Filho G, Takita LC, Costa Nde C, Nascimento RA, Nanni Lde O.


Department of Dermatology, Teaching Hospital, University of Mato Grosso do Sul, Campo Grande, MS, Brazil.


Stevens-Johnson's syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatoses, that lead to keratinocyte apoptosis induced by interactions between Fas (cell death receptor) and soluble Fas-ligand, present in serum of Stevens-Johnson's syndrome / toxic epidermal necrolysis patients. Anti-Fas antibodies in intravenous immunoglobulin (IVIG) would block the apoptosis cascade. Three cases of toxic epidermal necrolysis occurred in one male and two female patients, after use of allopurinol, leprosy multidrug therapy concomitant with dipyrone, and diclofenac. The cases were treated with intravenous immunoglobulin 2-3 mg/kg and prednisone 20-50 mg/day. The interruption of new lesions outbreak and reepithelization were extremely fast after the use of intravenous immunoglobulin, without adverse effects. Controlled studies are needed to confirm the efficacy of intravenous immunoglobulin in Stevens-Johnson's syndrome / toxic epidermal necrolysis, but the results seem promising.

PMID:
22714769
[PubMed - in process]