Treating Stevens-Johnson Syndrome and toxic epidermal necrolysis with high dose of glucocorticosteroids: report of seven cases and review of the literature
Keywords:
Stevens Johnson syndrome, toxic epidermal necrolysis, corticosteroids, cutaneous eruptionsAbstract
Introduction: Stevens- Johnson (SJS) and Toxic Epidermal Necrolysis (TEN) are considered to be the same diseases but of different severities across a spectrum; they are severe drug reactions characterized by a progressive involvement of skin and mucous membranes, caused by alterations in the immune response. Despite multiples advances in knowledge of the physiopathology of this disease, to date there is no pharmacological treatment with enough clinical evidence to be called a standard treatment. Glucocorticosteroids are one of the treatments used for SJS and TEN with different results among the published literature.This paper pretends to describe our experience with high dose of glucocorticosteroids for the treatment of SJS and TEN.
Methods: We performed a retrospective review of all medical charts of patients with diagnosis of SJS or TEN hospitalized in our clinic, between January 1 of 2006 and May 31 of 2010. Clinical information, epidemiological data and laboratory tests were analyzed. Patients younger than 18 years or with more than 10 days of evolution previous to the admission were excluded.
Results: Seven patients were included, with an average age of 44 years (27 – 57 years), five were woman, six cases had diagnoses of SJS and one of TEN. 5 patients had a generalized skin disease and 1 patient had only mucous membranes involvement. Corticosteroids were initiated in average 4,4 days after the onset of symptoms, with an average in the duration of treatment of 3,7 days (3 to 5 days), and an average of 10,2 days of hospitalization (4 to 19 days). Side effects were mild hypokalemia in 6 of the 7 patients, 1 patient presented bradycardia and hyperglycemia at the third day of treatment with methylprednisolone. Two patients had sepsis without isolation of any microorganism; one of the patients with sepsis required a longer hospitalization.
Conclusion: In our series, the use of high dose of corticosteroids was associated with a prompt clearance of lesions; mild hypokalemia was the most frequent side effect.
Author Biographies
Juan Carlos Díaz
Servicio de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
Diego Bonilla
Servicio de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
Ana Francisca Ramírez
Servicio de Dermatología, Fundación Valle del Lili, Cali, Colombia
Melba Cristina Herrera
Servicio de Dermatología, Fundación Valle del Lili, Cali, Colombia
Luis Fernando Ramírez
Servicio de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
Carlos Daniel Serrano
Servicio de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
Unidad de Alergia, Fundación Valle del Lili, Cali, Colombia
References
2. Inachi S, Mizutani H, Shimizu M. Epidermal apoptotic cell death in erythema multiforme and Stevens-Johnson syndrome. Arch Dermatol. 1997;133:845-9.
3. Miyauchi H, Losokawa H, Akaeda T, Iba H, Asada Y. et al. Tcell subsets in drug-induced toxic epidermal necrolysis. Arch DermatoI. 1991;127:851-5.
4. Abe R, Shimizu T, Shibaki A, Nakamura H, Watanabe H, Shimizu H. Toxic epidermal necrolysis and Stevens-Johnson syndrome are induced by soluble Fas ligand. Am J Pathol. 2003;162:1515-20.
5. Caproni M, Torchia D, Schincaglia E, Volpi W, Frezzolini A, Schena D et al. Expression of cytokines and chemokine receptors in the cutaneous lesions of erythema multiforme and Stevens-Johnson syndrome –toxic epidermal necrolysis. Br J Dermatol. 2006;155:722-8.
6. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331:1272-85.
7. Patterson R, Tripathi A. Stevens-Johnson syndrome: Getting ready for the year 2000 and beyond. Ann All Asthma Immunol. 1999;83:339-40.
8. Beltrani VS. Counterpoint to the use of systemic corticosteroids in the Stevens-Johnson syndrome. Ann Allergy Asthma Immunol. 2000;85:422-3.
9. Charlesworth E. Counterpoint to the use of systemic corticosteroids in the Stevens-Johnson syndrome. Ann Allergy Asthma Immunol. 2000;85:422-3.
10. Halebian PH, Corder VJ, Madden MR, Finklestein JL, Shires GT. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg. 1986;204:512-3.
11. Paul C, Wolkenstein P, Adle H, Wechsler J, Garchon HJ, Revus J et al. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol. 1996;134:710-4.
12. Kardaun S, Jonkman M. Dexamethasone pulse therapy for Stevens-Johnson Syndrome/toxic epidermal necrolysis. Acta Derm Venereol. 2007;87:144-8.
13. Yamane Y, Aihara M, Ikezawa Z. Analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan from 2000 to 2006. Allergol Int. 2007;56:419-25.
14. Tripathi A, Ditto A, Grammer L, Greenberger P, McGrath K, Zeiss R, et al. Corticosteroid therapy in an additional 13 cases of Stevens-Johnson syndrome: A total series of 67 cases. Allergy and Asthma Proc. 2000;21:101-5.
15. Araki Y, Sotozono C, Inatomi T, Ueta M, Yokoi N, Ueda E, et al. Successful treatment of Stevens-Johnson syndrome with steroid pulse therapy at disease onset. Am J Ophthalmol. 2009;147:1004-11.
16. Yang Y, Xu J, Li F, Zhu X. Combination therapy of intravenous immunoglobulin and corticosteroid in the treatment of toxic epidermal necrolysis and Stevens-Johnson syndrome: A retrospective comparative study in China. Int J Dermatol. 2009;481122-8.
17. 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.
18. Kakourou T, Klontza D, Soteropoulou F, Kattamis C. Corticosteroid treatment of erythema multiforme major (StevensJohnson syndrome) in children. Eur J Pediatr. 1997;156:90-3.
19. Halevy S, Ghislain PD, Mockenhaupt M, Fagot JP, Bouwes Bavinck JN, Sidoroff A, Naldi L, Dunant A, Viboud C, Roujeau JC; EuroSCAR Study Group. Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol. 2008;58:25-32.
20. Hung SI, Chung WH, Liou LB, Chu CC, Lin M, Huang HP, et al. HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Proc Natl Acad Sci USA. 2005;102:4134-9.
21. van der Meer J, Schuttelaar M, Toth G, Kardaun S, Beerthuizen G, de Jong M, et al. Successful dexamethasone pulse therapy in a toxic epidermal necrolysis (TEN) patient featuring recurrent TEN to oxazepam. Clin and Exp Derm. 2001;26:654-6.
22. Paice BJ, Paterson KR, Onyanga-Omara F, Donnelly T, Gray JMB, Lawson DH. Record linkage study of hypokalemia in hospitalized patients. Postgrad Med J. 1986;62:187-91.
23. Tvede N, Nielsen LP, Andersen V. Bradycardia after high-dose intravenous methylprednisolone therapy. Scand J Rheumatol. 1986;15:302-4.
24. Horeyseck G, Thämer V. Methylprednisolone-induced inhibition of the sympathetic vasomotor tonus in hemorrhagic shock. Chir Forum Exp Klin Forsch. 1978;65-8. (no tiene volume dejalo asi)
25. Guillén EL, Ruiz AM, Bugallo JB. Hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient. Am J Kidney Dis. 1998;32:E4.
How to Cite
Downloads
Downloads
Published
How to Cite
Issue
Section
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
