title: Successful treatment of Stevens-Johnson syndrome with steroid pulse therapy at disease onset.
abstract: OBJECTIVE
  To evaluate the visual prognosis of patients with Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), followed by general and topical high-dose corticosteroids administration from disease onset.
  
  
  METHODS
  Prospective, observational case series.
  
  
  METHODS
  Between May 1, 2003 and June 30, 2005, we enrolled 5 patients with SJS or TEN with ocular complications at the acute stage. Intravenous pulse therapy with methylprednisolone (steroid pulse therapy; 500 or 1000 mg/day for 3 to 4 days) was initiated within 4 days from disease onset. Topically, 0.1% betamethasone was applied over 5 times daily for at least 2 weeks. Visual acuity (VA) and slit-lamp microscopic appearance 1 year from disease onset were evaluated.
  
  
  RESULTS
  At the first examination, corneal or conjunctival epithelial defects and pseudomembranous conjunctivitis were present in all cases. Skin eruptions dramatically improved after steroid pulse therapy. Although ocular inflammation increased for several days, pseudomembranes disappeared and corneal and conjunctival epithelium regenerated within 6 weeks. At the chronic stage, all eyes had clear corneas with the palisades of Vogt (POV), implying the presence of corneal epithelial stem cells. Best-corrected VA was 20/20 or better in all eyes. Five eyes showed superficial punctate keratopathy. No eye had cicatricial changes except for 1 with slight fornix shortening. No significant adverse effects of steroid occurred during all clinical courses.
  
  
  CONCLUSIONS
  Steroid pulse therapy at disease onset is of great therapeutic importance in preventing ocular complications. Topical betamethasone also shows great promise for preventing corneal epithelial stem cell loss in the limbal region and cicatricial changes.
authors.affiliation: Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Araki
authors.forename: Chie
authors.initials: C
authors.lastname: Sotozono
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inatomi
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ueta
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yokoi
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Ueda
authors.forename: Saburo
authors.initials: S
authors.lastname: Kishimoto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kinoshita
mesh_terms: D000208:Acute Disease; D000287:Administration, Topical; D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage; D003231:Conjunctivitis / Q000517:prevention & control*; D003316:Corneal Diseases / Q000517:prevention & control*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D020551:Pulse Therapy, Drug; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone; D008775:Methylprednisolone