title: A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population.
abstract: BACKGROUND
  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous drug reactions. No large scale epidemiological data are available for this disorder in India.
  
  
  OBJECTIVE
  To carry out a systematic review of the published evidence of the drug-induced SJS and TEN in Indian population.
  
  
  METHODS
  Publications from 1995 to 2011 describing SJS and TEN in Indian population were searched in PubMed, MEDLINE, EMBASE and UK PUBMED Central electronic databases. Data were collected for the causative drugs and other clinical characteristics of SJS and TEN from the selected studies.
  
  
  RESULTS
  From 225 references, 10 references were included as per selection criteria. The major causative drugs were antimicrobials (37.27%), anti-epileptics (35.73%) and non-steroidal anti-inflammatory drugs (15.93%). Carbamazepine (18.25%), phenytoin (13.37%), fluoroquinolones (8.48%) and paracetamol (6.17%) were most commonly implicated drugs. Regional differences were observed for fluoroquinolones, sulfa drugs and carbamazepine. Total 62.96% of patients showed systemic complications. Most common complications were ocular (40.29%) and septicemia (17.65%). Higher mortality was observed for TEN as compared to SJS (odd ratio-7.19; 95% confidence interval (CI) 1.62-31.92; p = 0.0023). Observed mortality is higher than expected as per SCORTEN score 3. Duration of hospital stay was significantly higher in TEN (20.6 days; 95% CI 14.4-26.8) as compared to SJS (9.7 days; 95% CI 5.8-13.6; p = 0.020). Cost of management was significantly higher in TEN (Rs. 7910; 95% CI 5672-10147; p < 0.0001) as compared to SJS (Rs 2460; 95% CI 1762-3158). No statistical data were described for steroid use in the studies included.
  
  
  CONCLUSIONS
  Carbamazepine, phenytoin, fluoroquinolones and paracetamol were the major causative drugs. TEN is showing higher mortality, morbidity and economic burden than SJS.
authors.affiliation: Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, India.
authors.forename: Tejas K
authors.initials: TK
authors.lastname: Patel
authors.forename: Manish J
authors.initials: MJ
authors.lastname: Barvaliya
authors.forename: Dineshchandra
authors.initials: D
authors.lastname: Sharma
authors.forename: Chandrabhanu
authors.initials: C
authors.lastname: Tripathi
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000927:Anticonvulsants / Q000009:adverse effects*; D024841:Fluoroquinolones / Q000009:adverse effects*; D006801:Humans; D007194:India / Q000453:epidemiology; D013262:Stevens-Johnson Syndrome / Q000209:etiology* / Q000401:mortality*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D024841:Fluoroquinolones