Anti-inflammatory treatment in adults with Stevens Johnson Syndrome and toxic epidermal necrolysis: a systematic review
DOI:
https://doi.org/10.29176/2590843X.246Keywords:
Stevens-Johnson syndrome, toxic epidermal necrolysis, drug therapyAbstract
Background: There is no specific treatment approved for toxic epidermal necrolysis and Stevens Johnson syndrome. Patients must be treated mainly by eliminating the triggering factor and general support. Our aim was to perform a systematic review to evaluate the effect of anti-inflammatory treatment in adults with Stevens Johnson syndrome or toxic epidermal necrolysis.
Methods: Systematic, objective, exhaustive and reproducible search of original research was conducted in electronic databases (Cochrane Skin Group Specialized Register, the Cochrane Controlled Trials and CDSR, Trip database, MEDLINE, EMBASE, CINAHL, Biomed, NCBI, HINARI and LILACS using “StevensJohnson Syndrome / drug therapy” or “Stevens-Johnson Syndrome / therapy” or “Toxic epidermal necrolysis / drug therapy” or “Toxic epidermal necrolysis / therapy” as key words with restriction to open trials and phase III clinical trials from 1998 to December 30, 2011 in Spanish or English languages. Grey literature was not included. Title or abstract were reviewed to identify clinical trials.
Results: Only one randomized, double-blind, placebo-controlled study with thalidomide was identified, and 7 open clinical trials without a control group or historical control were included. The drug therapy used was immunoglobulin in four studies, cyclosporine in two, and methylprednisolone in one. Although the extensive skin detachment of more than 50%, mortality was 0% in two studies with cyclosporine, one death in the methylprednisolone group and one death in the immunoglobulin group. Mortality in the thalidomide group was 83%. In one study with high-dose of immunoglobulin, the observed mortality was 32% vs. 21% of predicted mortality and in the low-dose of immunoglobulin, predicted mortality was 32% compared to 10% of observed mortality.
Conclusion: There seems to be some benefit from therapy with methylprednisolone, immunoglobulin and cyclosporine but randomized controlled clinical trials are needed to determine the efficacy of these therapies available. Thalidomide increased mortality in toxic epidermal necrolysis.
Author Biographies
Diana Carrillo
Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
Luz Zárate
Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
Ana Ramírez
Departamento de Dermatología, Fundación Valle del Lili, Cali, Colombia
Carlos Serrano
Unidad de Alergia, Fundación Valle del Lili, Cali, Colombia
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