Etiologies and effect of systemic corticosteroids on the outcome of Stevens Johnson syndrome, Toxic Epidermal Necrolysis and Erythema Multiforme in Ramathibodi Hospital

Sinijchaya Sahawatwong; Natta Rajatanavin

Authors

Sinijchaya Sahawatwong DERMATOLOGY CLINIC SAMITIVEJ SUKHUMVIT HOSPITAL, BANGKOK, THAILAND
Natta Rajatanavin DIVISION OF DERMATOLOGY, DEPARTMENT OF MEDICINE, FACULTY OF MEDICINE RAMATHIBODI HOSPITAL, MAHIDOL UNIVERSITY, BANGKOK, THAILAND

Keywords:

Corticosteroids, Stevens-Johnson syndrome, Toxic epidermal necrolysis

Abstract

Background: : Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS) and Erythema multiforme (EM) are immune-complex–mediated hypersensitivity reaction to drugs and certain infection with high mortality and morbidity. To date, no sufficient evidence of any benefit from specific treatment was shown.

Objectives: To evaluate etiologies and association between treatment outcome and systemic corticosteroids in Toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS) and Erythema multiforme (EM).

Methods: Retrospective reviewed of the SJS, overlapping SJS/TEN, TEN and EM patients admitted to Ramathibodi Hospital from January 2002 to October 2009.

Results: There were 87 cases which consisted of 15 TEN patients (17.2%), 9 SJS/TEN patients (10.3%), 52 SJS patients (59.8%) and 11 EM patients (12.6%). Further analysis was performed in severe cutaneous reaction group (SJS, SJS/TEN and TEN patients). The 3 most common causative drugs were carbamazepine(11%), co-trimoxazole(9%) and allopurinol(8%) respectively. In addition to cessation of culprit drug and supportive care, systemic corticosteroids, either with or without intravenous immunoglobulin(IVIG), were given to 72% of patients. The mortality rate was 13.15%, which occurred in 3, 4 and 3 cases of TEN, overlapping SJS/TEN and SJS respectively. The patients who received systemic corticosteroids without IVIg had superior survival than those who received supportive treatment only. There was no significant association between systemic corticosteroids and prolonged hospitalization. The correlation between systemic corticosteroids and infection rate was inconclusive.

Conclusion: SJS, overlapping SJS/TEN and TEN are mainly caused by drugs and lead to high mortality and morbidity rate. Our study show that systemic corticosteroids may have positive effects on these life-threatening dermatologic conditions.

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