title: A retrospective analysis of Stevens-Johnson syndrome/toxic epidermal necrolysis treated with corticosteroids.
abstract: BACKGROUND
  Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are severe mucocutaneous reactions that incur high mortality, and in which the systemic application of corticosteroids remains controversial.
  
  
  OBJECTIVE
  This study aimed to determine the optimal protocols for the use of corticosteroids and treatment measures.
  
  
  METHODS
  We performed a retrospective analysis of 70 patients with SJS/TEN who were hospitalized between January 2008 and May 2015 in the Department of Dermatology, Shandong Provincial Hospital, and treated with corticosteroids. Expected and actual mortality rates in patients treated with different doses of corticosteroids, according to SCORTEN, were compared.
  
  
  RESULTS
  The diagnoses associated with initial corticosteroid use differed significantly between the low- and high-dose groups (P = 0.041). There were significant differences between expected and actual mortality rates according to the use of corticosteroid therapy (P = 0.0168, standardized mortality ratio [SMR] = 0.30). There was a statistical difference between expected and actual mortality rates in the low-dose group (P = 0.0145, SMR = 0.20). Serum albumin levels were significantly lower in patients administered corticosteroids additive therapy (31.12 ± 8.32 g/l vs. 35.54 ± 5.82 g/l; P = 0.016), and the rate of use of antibiotics was higher among patients in the additive therapy group than in the non-additive group (94.7% vs. 60.8%).
  
  
  CONCLUSIONS
  Our research supports the use of corticosteroids for the systemic treatment of SJS/TEN. Corticosteroids should be used in a timely manner and in accordance with disease severity, age, underlying diseases, serum albumin level, and concurrent treatment with antimicrobial therapy.
authors.affiliation: Department of Dermatology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Wenmin
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Dermatology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Nie
authors.affiliation: Department of Dermatology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China. zhangliwenzhe@medmail.com.cn.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000097:blood / Q000188:drug therapy* / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D012709:Serum Albumin