Treating Stevens-Johnson syndrome and toxic epidermal necrolysis with high doses of glucocorticosteroids
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis are drug-induced diseases with a low incidence but high mortality. Numbers come mainly from large cohorts such as the European Registry of Severe Cutaneous Adverse Reactions (EuroSCAR study, http:// regiscar.uni-freiburg.de) and others. Thus, the annual incidences of Stevens-Johnson syndrome and toxic epidermal necrolysis are estimated to be between 1.2 to 6 and 0.5 to 1.2 cases per million inhabitants, respectively1 . Mortality rate has been estimated as high as 30-50% for toxic epidermal necrolysis and lower in Stevens-Johnson syndrome patients (5%). The most commonly associated drugs include antimicrobial sulphonamides, betalactams, anticonvulsants (except valproic acid), allopurinol, nevirapine, and oxicam-NSAIDS (such as piroxicam)1,2. Most, but not all, cases occur within the first 8 weeks of drug exposure.
Author Biographies
Luis Fernando Ramírez
Allergy Unit, Inserm U657, University Hospital of Montpellier; Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, 34295 Montpellier cedex 05, France
Pascal Demoly
Allergy Unit, Inserm U657, University Hospital of Montpellier; Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, 34295 Montpellier cedex 05, France
References
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3. Díaz J, Bonilla D, Ramírez AF, Herrera M, Ramírez LF, Serrano C. Dosis altas de corticoides sistémicos en pacientes con síndrome de Stevens-Johnson y necrolisis epidérmica tóxica: descripción de siete casos y revisión de la literatura. Rev Col Dermatol. 2011;19: 13-19
4. Sekula P, Liss Y, Davidovici B, Dunant A, Roujeau JC, Kardaun S, Naldi et al. Evaluation of SCORTEN on a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis included in the RegiSCAR Study. J Burn Care Res. 2011;32:237-45.
5. Hung SI, Chung WH, Liu ZS, Chen CH, Hsih MS, Hui RC, et al. Common risk allele in aromatic antiepileptic-drug induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Han Chinese. Pharmacogenomics. 2010;11:349-56.
6. Harr T, French LE. Toxic epidermal necrolysis and StevensJohnson syndrome. Orphanet J Rare Dis. 2010;5:39.
7. Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol. 2007;87:144-8.
8. Schneck J, Fagot JP, Sekula P, Sassolas B, Roujeau JC, Mockenhaupt M. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR Study. J Am Acad Dermatol. 2008;58:33-40
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