Stevens-Johnson syndrome and toxic epidermal necrolysis-challenges of recognition and management.
Skin adverse drug reactions (ADRs) generally present as transient erythematous macular/papular rashes. However these can many a times be the initial presentation of serious muco-cutaneous ADRs such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). The incidence of SJS varies from 1.2 to 6 per million patient-years and that of TEN to be 0.4 to 1.2 per million patient-years. The pathophysiological mechanism of SJS and TEN have not been fully elucidated. The aetiological factors of SJS and TEN are diverse; drugs being the cause in more than 80% cases of TEN and about 40-50% cases of SJS. Mucous membranes are affected in nearly all cases. The extent of epidermal sloughing may vary and forms a basis for the classification of an individual case as SJS or TEN. Prognosis of SJS is better than that of TEN; mortality rates being about 5% and 30%-40% respectively. Specific therapy for these conditions is yet not available. The use of systemic corticosteroids has been controversial. Early diagnoses can prevent/reduce the morbidity of such serious ADRs. This article provides a brief review of the clinical presentation and management of SJS and TEN.
Sane
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Novartis India Limited, Medical Department, Khetan Bhavan, 198, J Tata Road, Churchgate, Mumbai-400 020.
Bhatt
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D004342:Drug Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*