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OBJECTIVES: To determine the frequency of pharmacodermias in the Hospital Ángeles Metropolitano, Mexico City, as well as to examine the clinical characteristics and etiological agents. MATERIALS AND METHODS: An observational, descriptive, cross-sectional and retrospective study was carried out from March 2022 to June 2023. Patients hospitalized at the Hospital Ángeles Metropolitano, Mexico City, over 18 years of age, with a diagnosis of mucocutaneous adverse drug reactions were included. RESULTS: Of the 16,651 hospitalized patients in the period of study, 104 were selected for diagnosis of mucocutaneous adverse drug reaction. The prevalence was of 6.24/1000 hospitalized patients, with a predominance of female sex (62.5%). The most frequent pharmacodermia was maculopapular exanthema, followed by urticaria with or without angioedema. Serious adverse drug reactions, such as Stevens-Johnson syndrome, accounted for 1%. The most related drugs were antibiotics, followed by nonsteroidal anti-inflammatory drugs. CONCLUSIONS: The results of this study agree with those reported in the national and international literature; however, epidemiological studies on pharmacodermias in Mexico should be continued in order to establish a more realistic national incidence. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the prevalence of severe cutaneous adverse reactions to medications in hospitalized patients of two hospitals of Bogota, Colombia. MATERIALS AND METHODS: An exploratory cross-sectional observational study conducted in two hospitals in Bogota, Colombia, from 2010 to 2020 of patients diagnosed with severe cutaneous adverse reactions to medications collected by reviewing medical records. RESULTS: A total of 42 cases were found with a mean age of 40.8 years and a male predominance. The acute generalized exanthematous pustulosis was the most frequently reported reaction in 15 patients, followed by drug-induced hypersensitivity syndrome (DRESS syndrome): 11, Stevens-Johnson syndrome: 7, toxic epidermal necrolysis: 5 and generalized bullous fixed pigmented erythema: 4. The main triggering drugs were antibiotics in 19 cases and anticonvulsants in 9. Systemic corticosteroids were the main treatment received by 26 patients. Three patients died. CONCLUSIONS: Future pharmacogenetic studies are needed to determine susceptibility to different drugs in the Colombian population. [ABSTRACT FROM AUTHOR]

Copyright of Revista Pediatría de Atención Primaria is the property of LUA Ediciones 3.0 S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Toxic epidermal necrolysis is a serious dermatological entity associated with multiple organ failure and high mortality. The most frequent etiology is related to the use of drugs. It begins with a prodromal picture, followed by a rash consisting of erythematous or erythematous-violaceous macules and plaques that progress to multiple blisters, leaving extensive denuded areas and mucosal involvement. It requires multidisciplinary management in the intensive care unit that includes the services of Dermatology, Internal Medicine, Critical Medicine, Plastic Surgery, Emergencies and Anesthesiology. The management of this disease is based on life support measures and targeted pharmacological treatment. Avoiding complications is a priority to improve survival. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a severe skin disorder that prompts extensive necrosis and skin peeling. SJS/TEN can affect from 10 to 30% of total epidermis. Despite the knowledge that it often results in lengthy and costly hospitalization, there is limited pediatric research data on the condition; scant information exists on general mortality and long-term side effects in children. CLINICAL CASE: A 7-year-old male patient whose clinical symptoms corresponded to Stevens-Johnson syndrome/toxic epidermal necrolysis brought on by adverse reaction to polymedication, including recent introduction of levetiracetam. CONCLUSIONS: Research has discovered few adverse reactions to medications in the pediatric population. Short-term treatment of choice is usually a combination of large doses of immunoglobulin and corticosteroids; however, these therapies do not affect length of treatment period or of hospital stay. Proper diagnosis and treatment are essential in preventing systemic complications, as well as long-term adverse cosmetic and psychological outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Drug reactions are frequent, resulting a wide spectrum of manifestations in different organs and systems. One of the most frequent reactions is found at the tegumentary level, which could vary from localized to generalized. Acute generalized exanthematous pustulosis, Stevens-Johnson’s syndrome and toxic epidermal necrolysis are part of the adverse reactions that present a generalized dermatosis. Acute generalized exanthematous pustulosis is a rare and poorly understood adverse reaction. CLINICAL CASE: A 35-year-old female patient, with a history of self-medication, who manifested generalized dermatosis, with no affection of palms, soles and mucous membranes, characterized by multiple 1-2 mm pinpoint pustules with an erythematous base that tended to converge; the biopsy report described a rare variety of toxicoderma. CONCLUSIONS: Reports of acute generalized exanthematous pustulosis are scarce, mostly associated with drugs. Differential diagnoses can lead us to the erroneous administration of other drugs, which could worsen the reaction. [ABSTRACT FROM AUTHOR]

Erythema multiforme (EM) also known as polymorph erythema is an acute skin disease of immunological nature with or without mucous membrane involvement, which may behave as chronic recurrent. It presents with distinctive targets like skin lesions, often together with ulcers or bullae in mucous membranes (oral, genital or ocular). Among its clinical forms are: a minor form characterized by a mild skin syndrome and its major form that manifests as a skin disease with marked mucosal damage. Among its main differential diagnoses are Stevens-Johnson Syndrome (SJS) and Lyell Syndrome (Toxic Epidermal Necrolysis (TEC)). It has an estimated incidence < 1%, with its major form being slightly more frequent than its minor form (0. 8-6 per million/year). It can occur at any age, presenting a peak incidence at the age between 20 and 30 years, with a slight predominance of males with a 3:2 ratio, without racial predilection. Its presentation in pediatric age is rare, even more so in early childhood. Minor recurrent EM is more common in this population. This paper reports a case of EM in the pediatric population as a rare form of exanthematic presentation, addressed at the Department of Pediatrics of the Complejo Asistencial Victor Rios Ruiz (CAVRR) in the city of Los Angeles, Chile this year. [ABSTRACT FROM AUTHOR]

Background: The severe pharmacodermias (SF) are associated with high morbidity and mortality. Chronic kidney failure (CKD) related with dialysis is one of the main factors associated with higher mortality. ABCD-10 is a predictive mortality scale that includes the history of dialysis. Case report: Male 2 years old with a history of CKD on peritoneal dialysis and Lennox-Gastaut syndrome, admitted to the hospital due to acute peritonitis and developed SJS-NET secondary to phenytoin administration. He was treated with immunoglobulin and systemic steroid without improvement. Septic shock was added, presenting a fatal outcome. Conclusions: In the case presented, the ABCD-10 scale was applied, reporting a greater prediction of mortality compared to SCORTEN due to a history of dialysis. In children with SF there are no validated predictive mortality. Future initiatives should search for risk factors for mortality in children who develop SF for the creation of a predictive mortality scale. [ABSTRACT FROM AUTHOR]

Background: Stevens-Johnson syndrome is a severe drug reaction. Sulfonamides have been associated with drug reactions, complications, sequelae, even death. Case report: A 40-year-old female patient with a medical history of endometriosis and recently diagnosed chronic inflammatory ulcerative colitis. She was treated at the Allergology service of the San Juan de Dios Hospital of the Costa Rican Social Security Fund, and after 20 days of treatment with sulfasalazine she had a severe drug reaction on the skin, compatible with Stevens-Johnson syndrome. The lymphocyte transformation test was positive, confirming sulfasalazine as the causative agent. Conclusions: The lymphocyte transformation test is a useful method that can confirm the causative agent and prevent important complications in the future. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the epidemiological characteristics of hospitalized patients with Stevens-Johnson syndrome/toxic epidermal necrolysis in Mexico from 2010 to 2020. MATERIALS AND METHODS: An observational, cross-sectional and retrospective study analyzing hospitalizations nationwide in Mexico secondary to Stevens-Johnson syndrome (ICD-10: L51.1) and toxic epidermal necrolysis (ICD-10: L51.2) from 2010 to 2020. The data was obtained from the Open Data portal of the General Directorate of Health Information belonging to the National Health System. RESULTS: One thousand four hundred twenty-five hospitalizations secondary to Stevens-Johnson syndrome-toxic epidermal necrolysis were recorded, with an incidence of 10.8 cases per million inhabitants in our study period. Of the total, 51% (n = 728) were women. The median age was 24 years with a mean of 29.6 years; 96 deaths were registered, with a lethality due to Stevens-Johnson syndrome of 5.8% and of 10.4% due to toxic epidermal necrolysis. CONCLUSIONS: About 1000 hospitalizations per year for Stevens-Johnson syndrome/toxic epidermal necrolysis were recorded, representing 10.8 cases per million inhabitants. The clinical importance and hospital mortality observed in the period, despite its low frequency, makes manifest the importance of prevention, pharmacovigilance, and public health measures for the communication of risks and behaviors to be taken to avoid fatal complications. [ABSTRACT FROM AUTHOR]

Skin eruptions are among the most common drug adverse reactions; therefore, it is usual to face them in medical practice. A systematic approach based on early identification of the possible etiologic agent, the chronology of the exposure and the clinical characteristics of the reaction, allows the clinician to categorize the severity of the disease. With a high index of suspicion, it is possible to choose the appropriate laboratory tests, to optimize medical care and take the pertinent therapeutic and preventive measures for each case. The following narrative review is intended to cover the key aspects of the most serious drug eruptions and propose a simple approach for these in the emergency department. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered a continuum of the same process. Toxic epidermal necrolysis or Lyell syndrome is the most severe form. Both entities involve an acute mucocutaneous blistering reaction associated with systemic inflammation. CLINICAL CASE: A 16-year-old female patient who developed toxic epidermal necrolysis following concomitant treatment with valproate, lamotrigine, and phenobarbital. Despite the extensive mucocutaneous detachment (over 90%), prognostic evaluation was favorable (SCORTEN score 2; probability of survival: 88%), and patient evolved satisfactorily. Five days after arrival, valproate was reinitiated without any subsequent adverse reaction. Causality evaluation identified both lamotrigine and phenobarbital as "very probable" (ALDEN score 6) causes and valproate as "very unlikely" (ALDEN score 0) cause of toxic epidermal necrolysis. CONCLUSIONS: Stevens-Johnson syndrome and toxic epidermal necrolysis are true life-threatening medical emergencies. Therefore, an early recognition and appropriate management is critical for the patient survival. [ABSTRACT FROM AUTHOR]

Copyright of INSPILIP. Revista Ecuatoriana de Ciencia, Tecnología e Innovacion en Salud Pública is the property of Instituto Nacional de Investigacion en Salud Publica (INSPI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Stevens-Johnson syndrome is a rare and life-threatening mucocutaneous disease. Its main etiology is hypersensitivity secondary to drug intake, where carbamazepine, allopurinol and sulfonamides stand out. Paracetamol as a causal agent has been described in only a few reports and case series, predominantly in Asian population. CLINICAL CASE: A 3-years-old male patient with a history of penicillin allergy. He presented erythematous-violaceous macules on the trunk secondary to the administration of paracetamol to relieve abdominal and testicular pain. He went to the emergency room where he received antihistamines and the dose of paracetamol was increased. After this, he began to exhibit blisters and areas of detached skin with systemic affection. Due to this, he was hospitalized in the pediatric intensive care unit where the diagnosis of Stevens-Johnson syndrome was established. His main treatment was focused on immunoglobulin and steroids, with which he presented progressive clinical improvement. CONCLUSIONS: Although most of drug hypersensitivity reactions are limited to mild skin conditions, it is important to recognize that even seemingly innocuous medications, such as paracetamol, can cause severe side reactions like Stevens-Johnson syndrome. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Stevens-Johnson syndrome and toxic epidermal necrolysis are rare diseases characterized by mucocutaneous involvement, considered late hypersensitivity mainly associated with drugs. Other less frequent causes include infections, vaccines, systemic diseases and botanical medicine. CLINICAL CASE: A 20-year-old male patient with clinical and histopathological characteristics compatible with Stevens-Johnson syndrome and whose only antecedent was the application of the Ad26.COV2 (Janssen/Johnson & Johnson) 11 days prior to the start of the disease. CONCLUSIONS: Although the information regarding the adverse effects of the new vaccines against COVID-19 is still limited, there is the possibility of a direct association between the Ad26.COV2 vaccine and a Stevens-Johnson syndrome. [ABSTRACT FROM AUTHOR]

BACKGROUND: Generalized bullous medicated fixed erythema is a rare variant of pigmented fixed erythema that presents with generalized blisters and erosions. It was first described in 1985 by Kauppinen in the British Journal of Dermatology. It is characterized by multiple erythematous plaques due to the exposure to a drug. The most involved pharmacological groups are antimicrobials and non-steroidal anti-inflammatory drugs. It is usually diagnosed from minutes to 24 hours after the exposure to the causal drug. Generalized bullous medicated fixed erythema, especially with extensive mucosal involvement, it can be confused with Stevens-Johnson syndrome or toxic epidermal necrolysis. The history of recurrent lesions in the same places is pathognomonic of the generalized bullous-fixed drug erythema. The treatment is symptomatic with oral antihistamines and topical corticosteroids. Systemic corticosteroids are reserved in select cases. CLINICAL CASE: A 25-year-old male patient who presented generalized erythema and blisters in the axillary region, trunk, inguinal and scrotal region secondary to the administration of intramuscular ceftriaxone simulating a Stevens-Johnson syndrome or toxic epidermal necrolysis picture. CONCLUSIONS: Generalized bullous-fixed drug erythema has a low prevalence; differential diagnosis should be done with other pharmacodermias life-threatening, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. [ABSTRACT FROM AUTHOR]

Copyright of CES Odontología is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of INSPILIP. Revista Ecuatoriana de Ciencia, Tecnología e Innovacion en Salud Pública is the property of Instituto Nacional de Investigacion en Salud Publica (INSPI) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lamotrigine is an antiepileptic drug that has been widely used for epilepsy, as a mood stabilizer (for type 1 bipolar disorder) and in the management of neuropathic pain, it is used both in monotherapy and in complementary therapy. Considered relatively new, approved by the Food and Drug Administration in 1994, its benefits include a greater margin of safety compared to other anticonvulsants. However, although in a lower percentage, it causes severe adverse skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. A review is made about the probable pathways that trigger this delayed hypersensitivity immune response. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Toxicología is the property of Asociacion Espanola de Toxicologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Most cases of toxic epidermal necrolysis and Stevens-Johnson syndrome have presentations with mucosal and skin involvement, derived from the reaction to certain drugs, which clinically constitute the same disease spectrum, although with a different degree of epidermolysis. Case presentation: Male patient of 11 years of age, admitted to the adolescent medicine service, who developed a severe presentation with cutaneous lesions, conjunctivitis and oral lesions after the ingestion of lamotrigine; treatment was conservative, although slow, the patient progressed satisfactorily. Conclusion: In the present case, isolation, minimal invasion and early initiation of enteral nutrition were appropriate to achieve recovery. [ABSTRACT FROM AUTHOR]

Cutaneous diseases triggered by medications are common and usually harmless, but some of the less frequent variations can be life threatening. Some of the diseases in this category are the spectrum of Stevens-Johnson syndrome/toxic epidermal necrolysis and drug reaction with eosinophilia and systemic symptoms syndrome. The rare occurrence of these diseases has led to low levels of knowledge on its clinical presentation, diagnosis and treatment by medical staff on intensive care units, which can be associated with attention delays and negative impact on morbimortality. This article reviews the above conditions, and describes its association with medications frequently used on intensive care units, as well as its pathophysiology, clinical presentation and treatment. [ABSTRACT FROM AUTHOR]

Adverse cutaneous reactions to drugs are any undesirable change in the structure or function of the skin. These are among the adverse side effects to common drugs. The most commonly implicated drugs are antibiotics and anticonvulsants. Cutaneous clinical manifestations are diverse ranging from mild or moderate reactions, such as urticaria and maculopapular rash, to severe cutaneous adverse reactions (SCAR), which are known due to their high morbidity and mortality (among these: Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS). The clinical pattern, etiology, prognosis and treatment differ among these skin reactions, which is why it is necessary a clear diagnosis based on a comprehensive clinical examination, skin biopsy, and specific laboratory tests. The therapeutic options depend on the clinical diagnosis. For all reactions, a symptomatic and adequate supportive therapy is necessary; in some cases, a systemic immunomodulatory therapy can be useful. [ABSTRACT FROM AUTHOR]

Copyright of CES Medicina is the property of Universidad CES and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Toxic epidermal necrolysis (TEN) or Lyell' syndrome and Stevens-Johnson's syndrome are variants of a same disease sharing pathogenic, histopathological and therapeutic approaches. TEN is an acute and rare presentation and it is considered the most severe dermatologic entity, characterized by blisters, necrosis and sloughing of the dermis. Systemic manifestations are basically respiratory, gastrointestinal and renal; mortality is 70%. TEN is usually drug-induced, especially by antiseizure medications including diphenylhydantoin. We present the case of a 60 year-old male treated with diphenylhydantoin for seizures that developed a bullous rash whose clinical presentation; body distribution; systemic involvement and temporal association supported the diagnosis of TEN. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) defines an adverse drug reaction (ADRs) as "any response to a drug that is harmful, unintended and which occurs at usual doses for the prevention, diagnosis or treatment." The ADRs are classified into groups: type A, non-immunologic dose-dependent explained by the pharmacological action of the drug and Type B, immunological, independent dose and they may be at the same time idiosyncratic or hypersensitivity reactions. In Type B, the Pharmacodermies are found, a group of dermatoses caused by drugs, which penetrate through various channels, and depend on factors such as age, route of administration and genetic predisposition. In the United States, the frequency of eruptions for drugs occurs in approximately 2-5% of inpatients and more than 1% of outpatients. The pathogenesis includes four types of reactions: mediated by Ig G, cytotoxic reactions mediated by immune complexes and delayed hypersensitivity reactions. It is regarded as one of the great simulators, due to the wide range of injuries that can occur, finding within them Exanthematous reactions, acute generalized exanthematous pustulosis, erythema Fixed Pigment, Stevens-Johnson syndrome, among others. Its diagnosis is given by the clinic mainly to a drug association and its correlation with histopathologic findings. The cornerstone of the treatment is the identification and early withdrawal of the suspect drug, considering that most of these patients are polypharmacy. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medicina is the property of Revista Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Adverse drug reactions have different clinical expressions. The skin is an organ directly involved in the processes of pharmacokinetics and pharmacodynamics and is capable of expressing multiple reactions in response to different stimuli medicated. Objectives: To determine the prevalence of adverse drug reactions, to identify and to establish the associated morbidity and mortality as well as the most frequent reactions in hospitalized patients in the Dermatology service of the Specialties Hospital, West National Medical Center, Mexican Institute of Social Security. Material and method: A cross-sectional and retrospective analysis performed with patients hospitalized in the Dermatology service from January 1st, 2004 to December 31st, 2012 according to a non-probabilistic counting of consecutive cases. Results: Adverse drug reactions corresponded to 34.4% of patients hospitalized in the Dermatology service; 63% were female. The most common reaction was Brocq-Lyell syndrome (32%), followed by Stevens-Johnson syndrome (14%). The most frequent comorbidity was epilepsy (16.1%) and diabetes mellitus (15%); 24% of the patients died. Conclusions: Stevens-Johnson and Brocq-Lyell syndrome were found more frequently related with adverse drug reactions in Dermatology service of the Specialties Hospital, West National Medical Center, Mexican Institute of Social Security. [ABSTRACT FROM AUTHOR]

Adverse drug reaction (ADR) is defined by WHO as a response to a drug which is noxious and unexpected, which occurs at doses normally used in man for prophylaxis, diagnosis, therapy of disease or for modification of physiological function. When ADR committed to the skin is called farmacodermtoxicoderma, which occurred in 1% of outpatients and 2-5 % of hospitalized patients. WHO accepts that 2% of all adverse drug reactions (ADRs) are severe. They are more common in women, the elderly and AIDS patients. Most toxicodermas are mild, but they can be severe reactions. 1 in 1.000 hospitalized patients suffer a severe toxicoderma (ST), within which are included Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Stevens Johnson's Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe skin reactions with the potential for morbidity and mortality, that occurs in 0.4 to 2 cases per million inhabitants per year for SJS and 1.2 to 6.0 cases per million inhabitants in the year for TEN. It occurs in patients of all ages, races and sex. These conditions constitute a true emergency dermatology, where the care and management should be multidisciplinary. [ABSTRACT FROM AUTHOR]

The Stevens-Johnson syndrome and the toxic epidermal necrolysis are very severe cutaneous drug reactions and constitute a spectrum of the same disease, sharing etiological, pathogenic, histological and therapeutic aspects. Objectives: To describe the cases of toxic epidermal necrolysis and Stevens-Johnson syndrome over a nine year period at the Hospital Universitario del Valle, the treatments used in these patients and their mortality. Methodology: A medical history review was carried out retrospectively of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis diagnosed and managed from February, 2003, until April, 2012, at the Hospital Universitario del Valle. We analyzed clinical characteristics, frequency, mortality, medications as possible triggers, treatments used and response to them. Results: Out of 29 cases, 13 (44.8%) had diagnosis of toxic epidermal necrolysis, 13 (44.8%) had Stevens-Johnson syndrome and the remaining 3 (10.3%), overlapping Stevens-Johnson syndrometoxic epidermal necrolysis. In 16 patients (55%) a single drug could be the trigger. In 12 patients (41%) two or more drugs were found as possible triggers. Drugs were identified only in one. Antibiotics, anticonvulsants, NSAIDs and allopurinol were the most frequently associated drugs. All patients received supporting measures. Twenty patients (68%) received antibiotic therapy due to an associated infection. Twenty three patients (79.3%) received pentoxifylline as part of their treatment; six (20.6%) received gammaglobulin (two of them associated with oral pentoxifylline). One patient died (3.4%). Conclusions: The supporting measures are essential in the management of patients with toxic epidermal necrolysis and Stevens-Johnson syndrome independent of the affected body area, as well as the timely management of complications as superinfection. Pentoxifylline may be considered an alternative in the treatment of these pathologies. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome is considered one of the most severe reactions to medications, and carbamazepine is associated with greater frequency. This is related with HLA-B*1502 allele in Asiatic populations. Pharmacogenomics is dedicated, among other things, to the analysis of the genetic profile of the patient to determine his susceptibility to adverse drug effects. In populations at increased risk should be screening of genetic markers routinely, before prescribing a drug that can induce this syndrome. [ABSTRACT FROM AUTHOR]

Background: There is no specific treatment approved for toxic epidermal necrolysis and Stevens Johnson syndrome. Patients must be treated mainly by eliminating the triggering factor and general support. Our aim was to perform a systematic review to evaluate the effect of anti-inflammatory treatment in adults with Stevens Johnson syndrome or toxic epidermal necrolysis. Methods: Systematic, objective, exhaustive and reproducible search of original research was conducted in electronic databases (Cochrane Skin Group Specialized Register, the Cochrane Controlled Trials and CDSR, Trip database, MEDUNE, EMBASE, CINAHL, Biomed, NCBI, HINARI and LILACS using "Stevens- Johnson Syndrome / drug therapy" or "Stevens-Johnson Syndrome / therapy" or "Toxic epidermal necrolysis I drug therapy" or "Toxic epidermal necrolysis I therapy" as key words with restriction to open trials and phase III clinical trials from 1998 to December 30, 2011 in Spanish or English languages. Grey literature was not included. Title or abstract were reviewed to identify clinical trials. Results: Only one randomized, double-blind, placebo-controlled study with thalidomide was identified, and 7 open clinical trials without a control group or historical control were included. The drug therapy used was immunoglobulin in four studies, cyclosporine in two, and methylprednisolone in one. Although the extensive skin detachment of more than 50%, mortality was 0% in two studies with cyclosporine, one death in the methylprednisolone group and one death in the immunoglobulin group. Mortality in the thalidomide group was 83%. In one study with high-dose of immunoglobulin, the observed mortality was 32% vs. 21% of predicted mortality and in the low-dose of immunoglobulin, predicted mortality was 32% compared to 10% of observed mortality. Conclusion: There seems to be some benefit from therapy with methyipredni- solone, immunoglobulin and cyclosporine but randomized controlled clinical trials are needed to determine the efficacy of these therapies available. Thalidomide increased mortality in toxic epidermal necrolysis. [ABSTRACT FROM AUTHOR]

Copyright of Médicas UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Toxic epidermal necrolysis and Stevens Johnson syndrome are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. We report a case of 43 year old female with 75% body surface area affected, treated with intravenous immunoglobulin who presented favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Drug prescription is a common practice in Medicine; however, this is not risk free. Any drug can produce adverse reactions. Most of them are present in the skin. Objective: To define epidemiologic data of adverse cutaneous drug reactions in a dermatologic outpatient clinic in Mexico. Patients and method: The study was performed from December the first 2003 to August 31th 2004. Every patient who came to the out-patient clinic was revised. Those with clinical diagnosis of adverse drug reaction were included. An epidemiologic study was done in order to find those characteristics of affected patients and their clinical manifestations. In some cases were clinical diagnosis was not definitive punch biopsies were done. Results: 8,322 patients came to the clinic at that time. 56 patients were diagnosed with adverse drug reaction (0.6%). 34% of them had no previous illness, 28.5% were hypertensive and 12.5% were diabetics. There was a slight preference for women 1.43:1. Trimetoprim plus sulfametoxazol (12.3%), piroxicam (10.7%) and carbamazepin (7.6%) were the most related drugs. Most frequent clinical diagnoses were: morbilliform exantema 25%, fixed drug eruption 16%, and photosensitivity 16%. There were five severe adverse reactions, two cases of Stevens-Johnson syndrome, one case of hypersensitivity syndrome, one of erythroderma and one of vasculitis. Four of them required hospitalization. There was no mortality in this study group. Conclusion: Adverse drug reactions had a low incidence in our outpatient clinic. We found a higher frequency of photosensitivity, fixed drug eruptions and "dishydrosis like" eruptions above those reported in the literature. It is very important to continue the surveillance of these reactions in order to determine risk factors in this population and related drugs. [ABSTRACT FROM AUTHOR]

Stevens Johnson Syndrome/toxic epidermal necrolysis is a rare acute condition with high morbidity and mortality. The incidence is estimated at 1 to 1.4 cases per million inhabitants per year. Despite its low frequency, the importance of these reactions because they can cause serious consequences or even lead to death. Mortality is estimated between 5 and 40%. Dermatitis is usually widespread and dominates the face, neck, trunk and limbs (may include the entire body, including palms and soles). The percentage of skin surface affected is forecast and it dermatoses classifi ed into three groups: a) Stevens Johnson, when it affects less than 10% body surface. b) Overlap Stevens-Johnson syndrome / toxic epidermal necrolysis 10 to 30%. c) necrolysis toxic epidermal skin detachment greater than 30%. It has been shown that early referral before the seven days at a burn center reduces the incidence of bacteremia and sepsis mortality reduction to 4%. By contrast, mortality rises to 83% in patients referred after the seventh day. The theoretical basis on which to support the use of antiapoptotic drugs suggest the use of corticosteroids, immunosuppressant's, plasmapheresis, drugs modulating effects of cytokines and immunoglobulins. However, the use of corticosteroids is not recommended, in our case the denudapatient was operated on admission with high doses of steroids, showing no adverse effects or deterioration in its evolution. The longterm squeal include skin changes, mucosal, eye and lung, it is important to integrate the Department of Ophthalmology in patient care, as ocular squeal have an impact, social, psychological and economic value. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome and toxic epidermal necrolisis are severe skin drug reactions that form part of the same entity. Despite its low frequency, they are associated with high morbidity and mortality rates. Although their physiopathology, classification and management are controversial, it is known that massive apoptosis of keratinocytes plays a role through different pathways. It should not be confused with erythema multiforme and there is not enough evidence to support the effectiveness of any treatment except support measures that are the mainstay of treatment. We present a literature revision of Stevens-Johnson syndrome and toxic epidermal necrolisis. [ABSTRACT FROM AUTHOR]

Introduction: Stevens- Johnson (SJS) and Toxic Epidermal Necrolysis (TEN) are considered to be the same diseases but of different severities across a spectrum; they are severe drug reactions characterized by a progressive involvement of skin and mucous membranes, caused by alterations in the immune response. Despite multiples advances in knowledge of the physiopathology of this disease, to date there is no pharmacological treatment with enough clinical evidence to be called a standard treatment. Glucocorticosteroids are one of the treatments used for SJS and TEN with different results among the published literature.This paper pretends to describe our experience with high dose of glucocorticosteroids for the treatment of SJS and TEN. Methods: We performed a retrospective review of all medical charts of patients with diagnosis of SJS or TEN hospitalized in our clinic, between January 1 of 2006 and May 31 of 2010. Clinical information, epidemiological data and laboratory tests were analyzed. Patients younger than 18 years or with more than 10 days of evolution previous to the admission were excluded. Results: Seven patients were included, with an average age of 44 years (27 - 57 years), five were woman, six cases had diagnoses of SJS and one of TEN. 5 patients had a generalized skin disease and 1 patient had only mucous membranes involvement. Corticosteroids were initiated in average 4,4 days after the onset of symptoms, with an average in the duration of treatment of 3,7 days (3 to 5 days), and an average of 10,2 days of hospitalization (4 to 19 days). Side effects were mild hypokalemia in 6 of the 7 patients, 1 patient presented bradycardia and hyperglycemia at the third day of treatment with methylprednisolone. Two patients had sepsis without isolation of any microorganism; one of the patients with sepsis required a longer hospitalization. Conclusion: In our series, the use of high dose of corticosteroids was associated with a prompt clearance of lesions; mild hypokalemia was the most frequent side effect. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome, overlap syndrome Stevens-Johnson-toxic epidermal necrolysis and toxic epidermal necrolysis or Brocq-Lyell syndrome are uncommon diseases caused by drugs in the most of cases. Toxic epidermal necrolysis is a potentially fatal illness, which is characterized by extensive epidermal detachment combined with severe inflammation and denudation of the mucosal surfaces. Because of low incidence of toxic epidermal necrolysis, the treatment is controversial, however, withdrawing causal medication, nutritional and electrolytic balance support and control of infections are the key to better evolution of the patients. Intravenous immunoglobulin and cyclosporine A can be effective therapies when there are no contraindications for its use. [ABSTRACT FROM AUTHOR]

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The Stevens-Johnson syndrome is a muco-cutaneous disorder related to pharmacological agents. The most frequent cause is sulphonamides in 30% of cases. The incidence rate of severe cutaneous reactions secondary to amifostine is <1%; Stevens-Johnson syndrome being one of them. We report a case of Stevens-Johnson syndrome probably related to amifostine administration during radiation therapy. [ABSTRACT FROM AUTHOR]