Usefulness of case report literature in determining drugs responsible for toxic epidermal necrolysis

Toxic epidermal necrolysis is skin deterioration resulting from reaction to certain drugs. Although it is rare, with an estimated incidence of two or fewer cases per million people per year, toxic epidermal necrolysis is associated with a high death rate. Because of the low incidence of the disease, it is difficult to obtain information about causative agents, diagnostic criteria, and clinical prognosis. The usefulness of case report literature concerning toxic epidermal necrolysis was evaluated by survey of English-language reports, published from January 1966 to April 1987, stored in the MEDLINE database. Of the 345 articles identified using the key words epidermal necrolysis, 59 were available for review; they represented 73 cases of drug-related toxic epidermal necrolysis. These cases accounted for only five percent of the total number of cases occurring between January 1966 and April 1987. In 62 percent of the 73 cases, the purpose of the published study was to show a relation between the development of toxic epidermal necrolysis and a drug. The drugs most commonly associated with the disease were allopurinol, the nonsteroidal anti-inflammatory agents, phenytoin (dilantin), and the sulfonamide antibiotics. The contribution these few case reports is limited in providing an estimate of risk for drug-related toxic epidermal necrolysis. Specific diagnostic criteria are required for more uniform reporting of signs, symptoms, and therapy of this disease. (Consumer Summary produced by Reliance Medical Information, Inc.)