The Profiles of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Patients in Tertiary Hospital
Downloads
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe eruptive skin reactions that can cause death. The incidence of SJS and TEN cases in the United States is 1.5–9.6 per 1,000,000 per year. Drugs are the primary etiology of SJS and TEN. Some drugs are at high risk and used frequently. The SJS and TEN mortality rates were relatively high, with SJS 4.8%, SJS / TEN overlap 19.8%, and TEN 14.8%. In Indonesia, there are lack of studies on the SJS and TEN. This study is needed to determine the epidemiological profile of SJS and TEN. Purpose: This study aimed to describe SJS and TEN patients' profiles. Methods: Drug-induced SJS and TEN cases from January 2016 to December 2019 were evaluated from the medical records patients' profile, incidence, suspected drugs, risk factors, and comorbidities of SJS and TEN were described. Result: There were 28 SJS and TEN patients, comprising of 24 SJS patients (85.7%), 3 TEN patients (10.7%), and 1 SJS overlapping TEN patients (3.5%). The most common suspected drugs were paracetamol (22.2%), carbamazepine (20.4%), cefadroxil (8.8%), and ciprofloxacin (8.8%). Women (53.5%) experienced more severe drug eruptions than men (46.4%). The largest age group was 25–44 years (35.7%). Most comorbidities were epilepsy (21%), diabetes (15.7%), hypertension (15.7%), and stroke (15.7%). Conclusion: The most common manifestation was SJS with paracetamol as the most common suspected drug, followed by carbamazepine.
Mockenhaupt M, Roujeau JC. Epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis). In: Kang S, Amagai M, Bruckner A, Enk AH, Margolis DJ, McMichael AJ, et al., editors. Fitzpatrick’s Dermatology. New York: McGraw-Hill Education; 2019.p.733-45.
Hsu DY, Brieva J, Silverberg NB, Silverberg JI. Morbidity and mortality of Stevens-Johnson Syndrome and toxic epidermal necrolysis in United States adults. J Invest Dermatol 2016;136(7):1387-97.
Chaby G, Maldini C, Haddad C, Lebrun-Vignes B, Hemery F, Ingen-Housz-Oro S, et al. Incidence of and mortality from epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) in France during 2003–16: a four-source capture–recapture estimate. Br J Dermatol 2020;182(3):618-24.
Wong SX, Tham MY, Goh CL, Cheong HH, Chan SY. Spontaneous cutaneous adverse drug reaction reports—An analysis of a 10-year dataset in Singapore. Pharmacol Res Perspect 2019;7(2):e00469.
Damayanti D, Umborowati MA, Anggraeni S, Prakoeswa CR, Hutomo M, Sukanto H. Clinicoepidemiological profile of severe cutaneous adverse drug reaction: A retrospective study. Berkala Ilmu Kesehatan Kulit dan Kelamin. 2019;31(1):1-6.
Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bavinck JN, Sidoroff A, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: Assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 2008;128(1):35-44.
Lee HY, Martanto W, Thirumoorthy T. Epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in Southeast Asia. Dermatol Sin 2013;4(31):217-20.
Sousa-Pinto B, Araújo L, Freitas A, Correia O, Delgado L. Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug-related hospitalisations in a national administrative database. Clin transl allergy. 2018;8(1):1-0.
Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S. Adverse cutaneous drug reactions: Eight year assessment in hospitalized patients. J Res Med Sci 2014;19(8):720.
Carrasquillo OY, Santiago-Vazquez M, Cardona R, Cruz-Manzano M, Figueroa LD. Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective descriptive study. Int J Dermatol 2019;58(11):1293-9.
Park CS, Kang DY, Kang MG, Kim S, Ye YM, Kim SH, et al. Severe cutaneous adverse reactions to antiepileptic drugs: A nationwide registry-based study in Korea. Allergy Asthma Immunol Res 2019;11(5):709.
Miliszewski MA, Kirchhof MG, Sikora S, Papp A, Dutz JP. Stevens-Johnson syndrome and toxic epidermal necrolysis: An analysis of triggers and implications for improving prevention. Am J Med 2016;129(11):1221-5.
Damayanti D, Anggraeni S, Prakoeswa CRS, Hutomo M, Sukanto H. Epidemiologic study: severe cutaneous adverse drug reaction. Berkala Ilmu Kesehatan Kulit dan Kelamin 2017;29(2):151–7.
Lebrun-Vignes B, Guy C, Jean-Pastor MJ, Gras-Champel V, Zenut M, French Network of Regional Centres of Pharmacovigilance and the French Investigators for Adverse Skin Reactions to Drugs. Is acetaminophen associated with a risk of Stevens–Johnson syndrome and toxic epidermal necrolysis? Analysis of the French Pharmacovigilance Database. Br J Clin Pharmacol 2018;84(2):331-8.
Damayanti D. Konsep Patomekanisme Obat Terkini. Berkala Ilmu Kesehatan Kulit dan Kelamin. 2019;31(3):136-41.
Nguyen D van, Chu HC, Nguyen D van, Phan MH, Craig T, Baumgart K, et al. HLA-B*1502 and carbamazepine-induced severe cutaneous adverse drug reactions in Vietnamese. Asia Pac Allergy 2015;5(2):68-77.
Yuliwulandari R, Kristin E, Prayuni K, Sachrowardi Q, Suyatna FD, Menaldi SL, et al. Association of the HLA-B alleles with carbamazepine-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in the Javanese and Sundanese population of Indonesia: the important role of the HLA-B75 serotype. Pharmacogenomics 2017;18(18):1643-8.
Lin YF, Yang CH, Sindy H, Lin JY, Hui CYR, Tsai YC, et al. Severe cutaneous adverse reactions related to systemic antibiotics. Clin Infect Dis 2014;58(10):1377-85.
Oshikoya KA, Ogunyinka IA, Ogar CK, Abiola A, Ibrahim A, Oreagba IA. Severe cutaneous adverse drug reactions manifesting as Stevens-Johnson syndrome and toxic epidermal necrolysis reported to the national pharmacovigilance center in Nigeria: a database review from 2004 to 2017. Ther Adv Drug Saf 2020;11:1-18.
Khan DA, Banerji A, Bernstein JA, Bilgicer B, Blumenthal K, Castells M, et al. Cephalosporin allergy: current understanding and future challenges. J Allergy Clin Immunol 2019;7(7):2105-14.
Wang L, Mei XL. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 88 Chinese patients. Chin Med J 2017;130(9):1062.
Lavan AH, Gallagher P. Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf 2016;7(1):11-22.
Barvaliya M, Sanmukhani J, Patel T, Paliwal N, Shah H, Tripathi C. Drug-induced Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS-TEN overlap: A multicentric retrospective study. J Postgrad Med 2011;57(2):115.
Schwartz JB. The influence of sex on pharmacokinetics. Clin Pharmacokinet 2003;42(2):107-21.
Patel S, Shah R, Behbahani, S, Lambert WC. Effect of diabetes mellitus on hospital complications of Stevens-Johnson syndrome and toxic epidermal necrolysis patients. J Am Acad Dermatol 2019;81(4):196.
- Copyright of the article is transferred to the journal, by the knowledge of the author, whilst the moral right of the publication belongs to the author.
- The legal formal aspect of journal publication accessibility refers to Creative Commons Atribusi-Non Commercial-Share alike (CC BY-NC-SA), (https://creativecommons.org/licenses/by-nc-sa/4.0/)
- The articles published in the journal are open access and can be used for non-commercial purposes. Other than the aims mentioned above, the editorial board is not responsible for copyright violation
The manuscript authentic and copyright statement submission can be downloaded ON THIS FORM.
