J Korean Surg Soc.  2010 Mar;78(3):133-139. 10.4174/jkss.2010.78.3.133.

A Clinical Study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Efficacy of Treatment in Burn Intensive Care Unit

• Yim H
• Park JM
• Cho YS
• Kim D
• Hur J
• Chun W
• Kim JH
• Seo DK

• KMID: 2211940
• DOI: http://doi.org/10.4174/jkss.2010.78.3.133

Abstract

PURPOSE
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), potentially life-threatening skin diseases with organ failures caused by drugs, require specialized intensive care. However, SJS and TEN have usually been managed in general wards and intensive care units by most doctors. This study describes the efficacy of treatment in the burn intensive care unit (BICU) compared to previous general treatments.
METHODS
To investigate the clinical features, outcomes and benefits of 11 patients with SJS and TEN treated in our burn intensive care unit. Data on 11 patients who were treated between January 2004 and December 2008 were collected via a retrospective chart review. Also, the data were reviewed with previous literatures on SJS and TEN treatments.
RESULTS
Patients were classified with overlap SJS/TEN (n=4, 36.36%) or TEN (n=7, 63.64%). Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most common causative agents. Hepatitis was the most common organ involvement in both overlap SJS/TEN (n=1, 9.1%) and TEN (n=4, 36.36%). Renal dysfunction (n=4, 36.36%) and respiratory disorders (n=3, 27.27%) were seen in some cases. Mean time of total reepithelization was 9 days and mean hospital day was 14.66 days. Two patients with TEN died from sepsis with multi-organ failure, and the mortality rate was 18.18%.
CONCLUSION
Adequate treatment of SJS and TEN in the BICU supports efficacy with a low mortality rate, short healing time, short hospitalization and fewer complications.

Keyword

Burn intensive care unit; Stevens-Johnson syndrome; Toxic epidermal necrolysis

MeSH Terms

Burns
Critical Care
Epidermal Necrolysis, Toxic
Hepatitis
Hospitalization
Humans
Intensive Care Units
Patients' Rooms
Retrospective Studies
Sepsis
Skin Diseases
Stevens-Johnson Syndrome

Reference

1. Lee JY, Oh MJ, Lee BJ, Choi DC. Comparison of clinical characteristics according to infection in Stevens-Johnson syndrome and toxic epidermal necrolysis. J Asthma Allergy Clin Immunol. 2006. 26:277–281.

2. Revuz J, Penso D, Roujeau JC, Guillaume JC, Payne CR, Wechsler J, et al. Toxic epidermal necrolysis. Clinical findings and prognosis factors in 87 patients. Arch Dermatol. 1987. 123:1160–1165.

3. McGee T, Munster A. Toxic epidermal necrolysis syndrome: mortality rate reduced with early referral to regional burn center. Plast Reconstr Surg. 1998. 102:1018–1022.

4. Ruiz-Maldonado R. Acute disseminated epidermal necrosis types 1, 2, and 3: study of sixty cases. J Am Acad Dermatol. 1985. 13:623–635.

5. Kim JW, Kim ST, Song DH. A clinical observation of the patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in Jeju island. Korean J Dermatol. 2004. 42:579–591.

6. Kim EJ, Lee JB, Kwon YH, Yun SJ, Kim SJ, Lee SC, et al. A clinical study of Stevens-Johnson syndrome and toxic epidermal necrolysis over the last five-year period in the Gwangju-Chonnam area. Korean J Dermatol. 2006. 44:574–578.

7. Kim YG, Cho KH, Chung JH. A comparative clinical study of toxic epidermal necrolysis and Stevens-Johnson syndrome. Korean J Dermatol. 1991. 29:602–609.

8. Halebian P, Corder V, Herndon D, Shires GT. Clinical management: a burn center experience with toxic epidermal necrolysis. J Burn Care Rehabil. 1983. 4:176–183.

9. Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993. 129:92–96.

10. Pereira FA, Mudgil AV, Rosmarin DM. Toxic epidermal necrolysis. J Am Acad Dermatol. 2007. 56:181–200.

11. Kim KJ, Jee MS, Han MH, Choi JH, Sung KJ, Moon KC, et al. The effect of high-dose intravenous immunoglobulin for the treatment of toxic epidermal necrolysis. Korean J Dermatol. 2002. 40:766–771.

12. Wolkenstein P, Latarjet J, Roujeau JC, Duguet JC, Boudeau S, Vaillant L, et al. Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis. Lancet. 1998. 352:1586–1589.

13. Lohmeier K, Megahed M, Schulte KW, Stannigel H, Mayatepek E, Schroten H. Toxic epidermal necrolysis in a premature infant of 27 weeks' gestational age. Br J Dermatol. 2005. 152:150–151.

14. Chan HL, Stern RS, Arndt KA, Langlois J, Jick SS, Jick H, et al. The incidence of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A population-based study with particular reference to reactions caused by drugs among outpatients. Arch Dermatol. 1990. 126:43–47.

15. Roujeau JC, Guillaume JC, Fabre JP, Penso D, Flechet ML, Girre JP. Toxic epidermal necrolysis (Lyell syndrome). Incidence and drug etiology in France, 1981-1985. Arch Dermatol. 1990. 126:37–42.

16. Strom BL, Carson JL, Halpern AC, Schinnar R, Snyder ES, Shaw M, et al. A population-based study of Stevens-Johnson syndrome. Incidence and antecedent drug exposures. Arch Dermatol. 1991. 127:831–838.

17. McKenna JK, Leiferman KM. Dermatologic drug reactions. Immunol Allergy Clin North Am. 2004. 24:399–423. vi

18. Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med. 1995. 333:1600–1607.

19. Fritsch PO, Ruiz-Maldonado R. Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Fitzpatrick's Dermatology in General Medicine. 2003. 6th ed. New York: McGraw-Hill;543–557.

20. Schopf E, Stuhmer A, Rzany B, Victor N, Zentgraf R, Kapp JF. Toxic epidermal necrolysis and Stevens-Johnson syndrome. An epidemiologic study from West Germany. Arch Dermatol. 1991. 127:839–842.

21. Viard I, Wehrli P, Bullani R, Schneider P, Holler N, Salomon D, et al. Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin. Science. 1998. 282:490–493.

22. Kim PS, Goldfarb IW, Gaisford JC, Slater H. Burn rounds: Stevens-Johnson syndrome and toxic epidermal necrolysis: a pathophysiologic review with recommendations for a treatment protocol. J Burn Care Rehabil. 1983. 4:91–100.

23. Halebian PH, Corder VJ, Madden MR, Finklestein JL, Shires GT. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg. 1986. 204:503–512.

24. Choi SW, Suh MS, Park SJ, Lim YK. Burn care of toxic epidermal necrolysis using allevyn®: a report of two cases. J Korean Burn Soc. 2006. 9:74–78.