title: Guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis: An Indian perspective.
abstract: BACKGROUND
  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor-α inhibitors.
  
  
  OBJECTIVE
  The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. The aim of this article is to comprehensively review the published medical literature and frame management guidelines suitable in the Indian perspective.
  
  
  METHODS
  The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these guidelines to its special interest group on cutaneous adverse drug reactions. The group performed a comprehensive English language literature search for management options in Stevens-Johnson syndrome/toxic epidermal necrolysis across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for keywords (alone and in combination) and MeSH items such as "guidelines," "Stevens-Johnson syndrome," "toxic epidermal necrolysis," "corticosteroids," "intravenous immunoglobulin," "cyclosporine" and "management." The available evidence was evaluated using the strength of recommendation taxonomy and graded using a three-point scale. A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared.
  
  
  RESULTS
  A total of 104 articles (meta-analyses, prospective and retrospective studies, reviews [including chapters in books], previous guidelines [including Indian guidelines of 2006] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these guidelines.
  
  
  CONCLUSIONS
  This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids. Owing to the systemic nature of the disease, a multidisciplinary approach in the management of these patients is helpful.
authors.affiliation: Department of Dermatology, RNT Medical College, Udaipur, Rajasthan, India.
authors.forename: Lalit Kumar
authors.initials: LK
authors.lastname: Gupta
authors.affiliation: Department of Dermatology, Baby Memorial Hospital, Kozhikode, Kerala, India.
authors.forename: Abhay Mani
authors.initials: AM
authors.lastname: Martin
authors.affiliation: Department of Dermatology, Geetanjali Medical College, Udaipur, Rajasthan, India.
authors.forename: Nidheesh
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Dermatology, ESI-PGIMSR, New Delhi, India.
authors.forename: Paschal
authors.initials: P
authors.lastname: D'Souza
authors.affiliation: Department of Dermatology, Medical College, Kolkata, West Bengal, India.
authors.forename: Sudip
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Dermatology, Grant Medical College, Mumbai, Maharashtra, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Dermatology, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India.
authors.forename: Sushil
authors.initials: S
authors.lastname: Pande
authors.affiliation: Department of Dermatology, Medical College, Kolkata, West Bengal, India.
authors.forename: Nilay Kanti
authors.initials: NK
authors.lastname: Das
authors.affiliation: Department of Dermatology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
authors.forename: Muthuvel
authors.initials: M
authors.lastname: Kumaresan
authors.affiliation: Department of Dermatology, Katihar Medical College, Katihar, Bihar, India.
authors.forename: Piyush
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Dermatology, Government Medical College, Gwalior, Madhya Pradesh, India.
authors.forename: Anubhav
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singh
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D019468:Disease Management; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007194:India / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards*; D011239:Prednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D016572:Cyclosporine; D011239:Prednisolone