A clinicoetiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis

Abstract

Objectives To present the pattern of morbidity associated complications, and causative factors in individual cases of Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Patients and methods This case series descriptive study, using a convenience sampling technique, was carried out in the In-patients department of Dermatology Unit I, Mayo Hospital, King Edward Medical University, Lahore from January 2007 to September 2008. Thirty clinically diagnosed patients, suffering from SJS/TEN, fulfilling the inclusion criteria were included in the study. Patients’ demographic data, symptoms, signs and any relevant investigations were recorded and scored. Using an appropriately designed pro forma, symptoms/ and signs were categorized into thirteen variables. The severity of each variable was scored from1-3 (total score range 13 to 39). An association of these variables with patient outcome, in terms of either discharge from hospital or death, was calculated. Results Pain and gastrointestinal involvement were seen in all 30 (100%) patients. Mortality was found to be 13.3% and was significantly associated with infection, total morbidity score, area of epidermal involvement and respiratory system involvement. Similarly development of wound infection, area of epidermal involvement, fever and total score significantly affected the duration of hospital stay. While the causative drug/s remained unknown in 26.7% cases the most common identifiable drug was trimethoprim-sulphamethoxazole, causing disease in 13.3%. Conclusions Mortality in cases of SJS/TEN showed significant association with wound infection, area of skin involvement, total morbidity score and respiratory system involvement.