Successful treatment of Stevens-Johnson syndrome with steroid pulse therapy at disease onset.
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.
Araki
Yayoi
Y
Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Sotozono
Chie
C
Inatomi
Tsutomu
T
Ueta
Mayumi
M
Yokoi
Norihiko
N
Ueda
Eiichiro
E
Kishimoto
Saburo
S
Kinoshita
Shigeru
S
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
D005938:Glucocorticoids; D001623:Betamethasone; D008775:Methylprednisolone