Nine years of a single referral center management of Stevens–Johnson syndrome and toxic epidermal necrolysis (Lyell’s syndrome)

Abstract

Context: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) corresponds to a rare and acute life-threatening mucocutaneous reactions characterized by extensive necrosis and epidermal detachment. There are no efficacious pharmaceutical interventions proven through large clinical trials.

Objective: We sought to study clinical cases admitted in our institution in order to determine which drugs and medical comorbidities or treatments impacted the mortality.

Material and methods: In a retrospective study over 9 years we evaluated all patients presenting biopsy-proven SJS or TEN for age, gender, total body surface area involved, causing agents, SCORTEN score, blood transfusion, steroid administration, intubation, length of intensive care stay and death rate. Statistical analysis was done using SPSS statistical software.

Results: The highest incidence of SJS and TEN was in age group of 71–80 years. Of the 30 patients, 30% died from SJS/TEN, mainly due sepsis. For each subgroup SJS/TEN overlap had the highest mortality. The highest mortality was from antibiotic treatment as causing agent. Step-wise regression analysis identified mechanical ventilation requirement and age over 65 years as mortality high-risk factors.

Discussion: The most crucial interventions are discontinuation of the offending drug and prompt referral to a burn unit, which helps in early diagnosis and decrease mortality in these diseases.

Conclusion: When SJS/TEN is caused by antibiotics suspicion of developing fatal sepsis should be high, independently of patients’ medical condition.

Keywords:

• Stevens–Johnson’s syndrome
• toxic epidermal necrolysis
• Lyell’s disease
• SCORTEN
• burn unity

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.