title: Prognosis of generalized bullous fixed drug eruption: comparison with Stevens-Johnson syndrome and toxic epidermal necrolysis.
abstract: BACKGROUND
  Generalized bullous fixed drug eruption (GBFDE) is a rare cutaneous adverse reaction to drugs, and may resemble Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), but is usually considered less severe.
  
  
  OBJECTIVE
  To compare the severity and mortality rate in cases of GBFDE and control cases of SJS or TEN of similar extent of skin detachment.
  
  
  METHODS
  This was a case-control analysis of 58 patients with GBFDE matched by age and extent of skin detachment to 170 control patients with a validated diagnosis of SJS or SJS/TEN overlap. Data for cases and controls were extracted from the EuroSCAR and RegiSCAR databases resulting from two population-based studies of severe cutaneous adverse reactions conducted in Europe. Preselected outcome criteria were death (primary), and fever, duration of hospitalization and transfer to an intensive care or burn unit (secondary).
  
  
  RESULTS
  GBFDE affected mainly older patients (median age 78 years, interquartile range 68-84 years); 13 of 58 cases died (22%). The mortality rate was slightly but not significantly lower for patients with GBFDE than controls [28%, multivariate odds ratio 0·6 (95% confidence interval 0·30-1·4)]. Patients with GBFDE and controls did not differ in other preselected criteria for severity.
  
  
  CONCLUSIONS
  Although our study featured limited statistical power, we were not able to confirm that GBFDE had better prognosis than SJS or SJS/TEN of similar disease extent in older patients. Severe cases of GBFDE deserve the attention and active management given to patients with SJS or TEN.
authors: Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est-Créteil, Créteil, France.
authors: S
authors: S
authors: Lipowicz
authors: P
authors: P
authors: Sekula
authors: S
authors: S
authors: Ingen-Housz-Oro
authors: Y
authors: Y
authors: Liss
authors: B
authors: B
authors: Sassolas
authors: A
authors: A
authors: Dunant
authors: J-C
authors: JC
authors: Roujeau
authors: M
authors: M
authors: Mockenhaupt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003875:Drug Eruptions / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013262:Stevens-Johnson Syndrome / Q000401:mortality*; D055815:Young Adult