Role of systemic steroids in the outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis
DOI:
https://doi.org/10.66344/jpad.v20i3.410Keywords:
Stevens-Johnson syndrome, toxic epidermal necrolysis, steroids, drug reactionAbstract
Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are cutaneous adverse reactions which usually develop as a result of drug therapy. The role of systemic steroids in the treatment of SJS and TEN is debatable.
Objective To see the clinical outcome of patients suffering from SJS or TEN, treated with or without steroids.
Patients and methods Forty patients of SJS and TEN were enrolled from the inpatient department of Jinnah Hospital Lahore. Clinical data were recorded on a pro forma. Clinical outcome of patients treated with or without steroids was recorded and analyzed.
Results A total of forty patients were enrolled in the study. Twenty nine patients were suffering from SJS and 11 were suffering from TEN. Twenty three patients of SJS (79.31%) were treated without steroids. Two patients died (8.7%) and twenty one (91.30%) recovered. Six patients were given steroids (20.68%), out of these 2 (33.3%) died and 4 (66.76%) recovered. There were eleven patients of TEN, four (36.37%) were managed without steroids, one expired (25%) and rest of the three (75%) patients recovered. Seven (63.63%) patients were given steroids, three (43.86%) patients expired while four (57.14%) recovered.
References
1. Roujeau JC, Kelly JP, Naidi L et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 1995; 333: 1600-7.
2. Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J 2002; 8(1): 5
3. Breathnach SM. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis In: Burns T, Breathnach S, Cox N, Griffiths C. Rook’s Textbook of Dermatology, 7th edn. London: Blackwell Science; 2004. P. 74:1-19.
4. Chosidow O, Deichier JC, Chaumette MT et al. Intestinal involvement in drug-induced toxic epidermal necrolysis. Lancet 1991; 337: 928.
5. Timsit JF, Mion G, Rouyer N et al. Bronchopulmonary distress associated with toxic epidermal necrolysis. Intensive Care Med 1992; 18: 42-4.
6. Chav TA, Mortimer NJ, Sladden MJ et al. Toxic epidermal necrolysis: Current evidence, practical management and future directions. Br J Dermatol 2005; 153: 241-53.
7. Kehren J, Devigines C, Krasteva M et al. Cytotoxicity is mandatory for CD 8(+) T cell mediated contact hypersensitivity. J Exp Med 1999; 189: 779-86.
8. Devi K, Sandhya G, Criton S et al. Carbamazepine - the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome. A study of 7 years. Indian J Dermatol Venereol Leprol 2005; 71: 325-8.
9. Cheriyan S, Patterson R, Greenberger PA et al. The outcome of Stevenson-Johnson treated with corticosteroids. Allergy Proc 1995; 16:151-5.
10. Halebian PH, Corder VJ, Madden MR et al. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg 1986; 204:
503-12.
11. Yapp FBB, Wahiduzzaman M, Pubalan M. Stevens-Johnson syndrome(SJS) and toxic epidermal necrolysis (TEN). In Sarawak: A four years review. Dermatol Online J 2008; 4: 1.
12. Saha K. Toxic epidermal necrolysis: Current concepts in pathogenesis and treatment. Indian J Dermatol Venereol Leprol 2000; 66: 10-17.
13. Chan HL, Stern RS, Arndt KA et al. The incidence of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol 1990; 126: 43-7.
14. Yamane Y, Aihara M, Tatewaki S et al. Analysis of treatments and deceased cases of severe drug reactions-analysis of 46 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis. Arerugi 2009; 58:537-47.
15. 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.
16. Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens-Johnson syndrome/ toxic epidermal necrolysis. Acta Derm Venereol 2007; 87: 144-8.
17. Tripathi A, Ditto AM, Gramner IC et al. Corticosteroids therapy in an additional 13 cases of Stevens-Johnson syndrome: A total series of 67 cases. Allergy Asthma Proc 2000; 21: 101-5.
18. Trautmann A, Akdis M, Schmid-Grendelmeier P et al. Targeting keratinocyte apoptosis in the treatment of apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. J Allergy Clin Immunol 2001; 108: 839-46.
19. Van Antmep DJ, Marlin SJ, Kafri T et al. Targeting keratinocyte apoptosis in the treatment of atopic dermatitis and allergic contact dermatitis. J Allergy Clin Immunol 2001; 108: 839-46.
20. Halebian PH, Corder VJ, Madden MR et al. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg 1986; 204:
503-12.
21. Kelemen JJ, Cioffii WG, McManus WF et al. Burn center care for patients of toxic epidermal necrolysis. J Am Coll Surg 1995; 180: 273-78.
22. Kim PS, Goldfarb, Gaisford JC, Slater H. Stevens-Johnson syndrome and toxic epidermal necrolysis: a pathophysiologic review with recommendations for a treatment protocol. J Burn Care Rehabil 1983; 4: 91-100.
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Copyright (c) 2016 Nadia Ali Azfar, Muhammad Ali Zia, Lamees Mahmood Malik, Abdur Rahim Khan, Muhammad Jahangir

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