Steven-Johnson Syndrome and toxic epidermal necrolysis at a tertiary care centre in South India: a 12 year retrospective analysis

Authors

  • Vidya Kuntoji
  • Chandramohan Kudligi
  • Pradeep Vittal Bhagwat
  • Ravi Munasingh Rathod
  • Suman Gurunathgouda Odugoudar
  • Mahesh Kurugodiyavar
  • Ranjan Jeevannavar
  • Dr. Arika

Keywords:

Steven-Johnson syndrome, toxic epidermal necrolysis, HIV, drugs

Abstract

Background Stevens-Johnson syndrome and Toxic epidermal necrolysis are life threatening mucocutaneous reactions with high mortality. Drugs are the major implicated etiologic agents; others include infections, immunisation, malignancies, radiotherapy and idiopathic. The knowledge on the drugs causing SJS/TEN in a given population can be ascertained by knowing the type of prescription and associated conditions of the patients. Aims 1-To study the demography, etiologic agents, associated conditions and mortality in patients with SJS/TEN. 2- To study the impact of HIV on SJS/TEN with respect to mortality. Materials and Methods A retrospective study was performed by analysing the medical records of patients with SJS, TEN, SJS/TEN overlap admitted in a tertiary care hospital over a period of 12 years. Results Out of 86 patients enrolled in the study, TEN constituted 69(80.23%), SJS 13(15.11%) and SJS/TEN overlap 4 (4.65%). Male to female ratio was 0.72. Maximum number of patients were in 4th decade (25.58%). Antimicrobials (50.00%), antiepileptics (22.91%) and NSAIDs (16.66%) were responsible in majority of patients. HIV (39.53%) and epilepsy (20.93%) were the most common associated conditions. Mortality was seen in 9 patients (10.0%) amongst which 4 patients had HIV infection. There was no statistically significant difference between mortality seen in HIV infected patients and those who did not have HIV (p-value=0.75). Conclusion Drugs constituted major causative agents. HIV infection had no significant impact on SJS/TEN with respect to mortality. However further studies are needed to substantiate this finding. 

References

Valayrie-Allanore L, Roujeau JC. Epidermal Necrolysis (Stevens - Johnson syndrome and Toxic Epidermal Necrolysis). In: Goldsith LA, Katz SI, Gilchrest BA, Paller AS. Leffell DJ. Wolff K, editors. Fitzpatrick’s Dermatology in General Medicine. 8th edition. McGraw Hill. p439.

Su Sc, Chung WH. Update on pathophysiology in Stevens-Johnson syndrome and toxic epidermal necrolysis. Dermatologica Sinica 2013; 175-180.

Mockenhaupt M. Severe drug-induced skin reactions: Clinical pattern, diagnostics and therapy. J Dtsch Dermatol Ges 2009; 7: 142-60.

Ordonez L, Salgueiro E, Jimeno FJ, Manso G. Spontaneous reporting of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with antiepileptic drugs. European Review for Medical and Pharmacological Sciences 2015; 19: 2732-37.

Kardaun SH, Jonkman MF. Dexamethasone Pulse Therapy for Stevens - Johnson syndrome/ Toxic Epidermal Necrolysis. Acta Derm Venereol 2007; 87: 144-8.

Hung SI, Chung WH, Liou LB, Chu CC, Lin M, Huang HP, Lin YL, Lan JL, Yang LC, Hong HS, 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.

Walsh S, Lee HY, Creamer D. Severe Cutaneous Adverse Reactions to Drugs. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook’s Textbook of Dermatology. 9th ed. Wiley Blackwell. 2016. p.119.14.

Roujeau JC. Epidermal necrolysis (Stevens - Johnson syndrome and toxic epidermal necrolysis): Historical considerations. Dermatologica Sinica 2013; 169-174.

Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet Journal of Rare Diseases 2010; 5: 39.

Anne A, Kosanam S, Prasanthi L. Steven Johnson syndrome and toxic epidermal necrolysis: A review. International Journal of Pharmacological Research 2014; 4(4): 158-165.

Elazzazy S, Hassan TA, Seid AE, Jacob CM. Toxic epidermal necrolysis associated with antiepileptic Drugs and Cranial Radiation Therapy. Case Reports in Oncological Medicine 2013 Article ID 415031, 3 pages.

Suwarsa O, Yuwita W, Dharmadji HP, Sutedja E. Stevens- Johnson syndrome and toxic epidermal necrolysis in Dr. HasanSadikin General Hospital Bandung, Indonesia from 2009-2013. Asia Pac Allergy 2016; 6: 43-7.

Gardezi SAA, Kazmi AH, Aman S, Nadeem M, Khan MS, Sohail M. A clinicoetiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis. J Pak Assoc of Dermatol 2015; 23(1): 5-13

Breathnach SM, Erythema multiforme, Stevens- Johnson syndrome and toxic epidermal necrolysis. In: Burns T, Breathnach S, Cox N, Griffith C, editors. Rook’s Textbook of Dermatology, 7th ed. Oxford: Blackwell Science; 2004. P. 53.1-53.47.

Yamane Y, Matsukura S, Watanabe Y, Yamaguchi Y, Nakamura K et al. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients-Treatment and outcome. Allergology International 2016: 74-81.

Kim HI, Kim SW, Park GY, Kwon EG, Kim HH et al. Causes and Treatment Outcomes of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 82 Adult Patients. Korean J Intern Med 2012; 27: 203-10.

Barvaliya M, Sanmukhani J, Patel T, Paliwal N, Shah H, Tripathi C. Drug –induced Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap: A multicentric retrospective study. J Postgrad Med 2011; 57(2): 115-9.

Knight L, Muloiwa R, Dlamini S, Lehloenya RJ. Factors Associated with Increased Mortality in a Predominantly HIV- Infected Population with Stevens Johnson Syndrome and Toxic Epidermal Nerolysis. PLoS ONE 2014: 9(4): e93543.

Jena M, Panda M, Mishra S, Patro N. A Clinicoepidemiological Study of Steven- Johnnson Syndrome and Toxic Epidermal necrolysis At A Tertiary Care Teaching Hospital. International Journal of Pharmaceutical Science and Health Care 2014: 4(2): 46-53.

Vaishampaiyan SS, Das AL, Verma R. SCORTEN: Does it need modification? Indian J Dermatol Venereol Leprol 2005; 71: 325-8.

Sharma VK, Sethuraman G, Kumar B. Cutaneous adverse drug reactions: Clinical pattern and causative agents- A 6 year series from Chandigarh, India. J Postgraduate Med 2001; 47: 95-9.

Sanmarkan AD, Sori T, Thappa DM, Jaisankar TJ. Retrospective analysis of Stevens - Johnson syndrome and Toxic epidermal necrolysis over a period of 10 years. Indian J Dermatol 2011: 56(1): 25-9.

Devi K, George S, Criton S, Suja V, Sridevi PK. 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.

Naveen KN, Pai VV, Rai V, Athanikar SB. Retrospective analysis of Steven Johnson syndrome and toxic epidermal necrolysis over a period of 5 years from northern Karnataka, India. Indian Journal of Pharmacology 2013; 45(1): 80-2.

Bhounsale SA, Bandodkar LV, Samuel LJ et al. Retrospective analysis of deaths due to drug-induced Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in inpatients admitted in the dermatology unit of a tertiary care hospital. IOSR Journal of Pharmacy and Biological Sciences 2015: 96-9.

Chantaphakul H, Sanon T, Klaewsongkram. Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis. Exp Ther Med 2015; 10(2): 519–24.

Kaniwa N, Ueta M, Nakamura R, Okamoto- Uchida Y, Sugiyama E et al. Drugs causing severe ocular surface involvements in Japanese patients with Stevens-Johnson syndrome/toxic epidermal necrolysis. Allergol Int. 2015; 64(4): 379-81.

Knight L, Todd G, Muliwa R, Matjila M, Lehloenya RJ. Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Maternal and Foetal Outcomes in Twenty-Two consecutive Pregnant HIV Infected Wome. PLoS One 2015; 10(8): e0135501.

Wolverton SE. Systemic Steroids. In: Wolverton SE. Comprehensive Dermatologic Drug Therapy. 3rd edition. Elsevier. 2013. p 151-152.

Downloads

Published

2019-09-01

Issue

Vol. 29 No. 1 (2019): January - March

Section

Original Articles

Most read articles by the same author(s)

1 2 > >>