Ann Dermatol.  2019 Oct;31(5):545-554. 10.5021/ad.2019.31.5.545.

Severe Cutaneous Adverse Reactions: A Single-Center Retrospective Study of 173 Patients in China

• Xu Z
• Shen J
• Yang Y
• Yuan R
• Xiang LF
• Zhang C

• KMID: 2456232
• DOI: http://doi.org/10.5021/ad.2019.31.5.545

Abstract

BACKGROUND
Severe cutaneous adverse reactions (SCAR) to drugs are a crucial public health issue and the use of systemic corticosteroids in SCAR has been controversial.
OBJECTIVE
To analyze clinical features, causative drugs, treatment, outcomes, and prognostic factors of SCAR in the case-series of 173 patients, and add more information to the debate of using systemic corticosteroids in SCAR management.
METHODS
A retrospective study of 173 SCAR patients diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) or acute generalized exanthematous pustulosis (AGEP) at a tertiary care institution in China between January 2014 and December 2017 was conducted.
RESULTS
Of 173 patients, allopurinol, carbamazepine, and antibiotics are the most frequently implicated drugs for DRESS (40.4%), SJS/TEN (26.0%), and AGEP (40.0%) respectively. Moreover, there is a strongly negative correlation between early corticosteroids use and the progression (p=0.000) and severity (p=0.01) of skin lesions. However, there is no association between early corticosteroids use and the mortality of SCAR (odds ratio: 1.01, 95% confidence interval: 0.95~1.08). In addition, lymphadenopathy, eosinophilia, and interval from onset to corticosteroids treatment were correlated with SCAR prognosis.
CONCLUSION
Prompt short-course systemic corticosteroids use is associated with early-stage skin lesions remission without influencing the disease mortality. Lymphadenopathy and eosinophilia were the independent poor prognostic factors of SCAR.

Keyword

Acute generalized exanthematous pustulosis; Drug reaction with eosinophilia and systemic symptoms; Stevens-Johnson syndrome; Systemic corticosteroids treatment; Toxic epidermal necrolysis

MeSH Terms

Acute Generalized Exanthematous Pustulosis
Adrenal Cortex Hormones
Allopurinol
Anti-Bacterial Agents
Carbamazepine
China*
Cicatrix
Drug Hypersensitivity Syndrome
Eosinophilia
Humans
Lymphatic Diseases
Mortality
Prognosis
Public Health
Retrospective Studies*
Skin
Stevens-Johnson Syndrome
Tertiary Healthcare
Adrenal Cortex Hormones
Allopurinol
Anti-Bacterial Agents
Carbamazepine

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