title: Effectiveness, safety and tolerability of cyclosporine versus supportive treatment in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A record-based study.
abstract: BACKGROUND
  Toxic epidermal necrolysis and Stevens-Johnson syndrome comprise life-threatening, drug-induced mucocutaneous disease spectrum. Interest in cyclosporine, a calcineurin inhibitor that can block the function of T-cells, has increased with the discovery of the importance of granulysin in apoptosis in toxic epidermal necrolysis. In our hospital, cyclosporine is given to Stevens-Johnson syndrome/toxic epidermal necrolysis patients as an adjunctive therapy.
  
  
  OBJECTIVE
  This study is an observational, record-based study comparing the effectiveness and safety of patients receiving cyclosporine versus only supportive therapy.
  
  
  METHODS
  Medical records as bed-head tickets and laboratory investigation reports of Stevens-Johnson syndrome/toxic epidermal necrolysis patients admitted in the hospital over a period of 1 year were collected. Data regarding clinico-demographic profile, suspected drug causing Stevens-Johnson's syndrome/toxic epidermal necrolysis, SCORTEN, body surface area involved, treatment received and outcome were obtained.
  
  
  RESULTS
  Twenty-eight patients were analyzed. Nineteen belonged to the cyclosporine group (supportive treatment + cyclosporine), nine to supportive treatment only group. Among the suspected drugs, antiepileptics formed the major group (28.6%). Five patients in the supportive only group and one in the cyclosporine group died. Time for stabilization and reepithelialization and duration of recovery were significantly lower in the cyclosporine group (P < 0.001, P= 0.007, P= 0.01, respectively). The standardized mortality ratio was 0.32 in cyclosporine group which is nearly 3.3 times lower than the only supportive treatment.
  
  
  CONCLUSIONS
  As it was a record-based study, certain confounding factors (serum blood urea nitrogen) could not be adjusted.
  
  
  CONCLUSIONS
  Cyclosporine (5 mg/kg/day) for 10 days from onset of Stevens-Johnson syndrome/toxic epidermal necrolysis may decrease the risk of dying, may provide faster healing of lesions and might lead to early discharge from hospital.
authors.affiliation: Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Swosti
authors.initials: S
authors.lastname: Mohanty
authors.affiliation: Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Anupam
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Anupama
authors.initials: A
authors.lastname: Ghosh
authors.affiliation: Department of Pharmacology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sil
authors.affiliation: Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Ramesh Chandra
authors.initials: RC
authors.lastname: Gharami
authors.affiliation: Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Bandyopadhyay
authors.affiliation: Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Nilay Kanti
authors.initials: NK
authors.lastname: Das
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D016572:Cyclosporine