TOXIC EPIDERMAL NECROLYSIS / STEVENS JOHNSON SYNDROME: HOW EARLY DIAGNOSIS CAN IMPACT ON PROGNOSIS

Authors

DOI:

https://doi.org/10.47820/recima21.v2i9.747

Keywords:

Stevens-Johnson Syndrome, Necrosis, Epidermis, Diagnosis, Prognosis

Abstract

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are acute reactions that predominantly affect the skin and mucous membranes, mainly caused by the use of medications. They are rare pathologies, but they have a high mortality rate that is closely associated with late diagnosis. Therefore, the objective was to evaluate how early diagnosis of SJS/TEN can impact the prognosis. Thus, a systematic literature review was carried out, where the guiding question was defined from the acronym PICO. Searches were performed in the PubMed and ScienceDirect databases between February 2020 and March 2021, using the descriptors Toxic epidermal necrolysis, Stevens-Johnson Syndrome, early diagnosis and prognosis combined by the Boolean operators AND and OR. A total of 577 articles were identified and after an initial analysis of the title and abstract and a second more robust analysis from the full text and exclusion of duplicate articles, 24 articles were included in the review. It was demonstrated in our search that there are recently discovered markers that can help in the diagnosis such as the dosage of granulosin, TARC, IL-33 and IL-15. In addition, it is concluded that knowledge on the subject is essential for a quick and efficient diagnosis and that diagnostic speed is closely correlated with an improvement in the patient's prognosis.

Downloads

Download data is not yet available.

Author Biographies

Irla Carvalho Chaves Caminha

Graduanda do curso de Medicina, Instituto de Educação Superior do Vale do Parnaíba. Faculdade de Ciências Humana

Paulo Egildo Gomes de Carvalho, Faculdade de Ciências Humanas

Graduando do curso de Medicina, Instituto de Educação Superior do Vale do Parnaíba.

André Luca Araujo de Sousa

Graduando do curso de Odontologia, Universidade Estadual do Piauí. Parnaíba – PI, Brasil. Universidade Estadual do Piauí (UESPI

 

Antonione Santos Bezerra Pinto

Doutor em Ciências Morfofuncionais e Professor Titular do curso de Medicina, Instituto de Educação Superior do Vale do Parnaíba. Faculdade de Ciências Humanas

Camila Maila Fontinele Beltrão

Médica e Professora Auxiliar do curso de Medicina, Instituto de Educação Superior do Vale do Parnaíba. Faculdade de Ciências Humanas

References

Oliveira A, Sanches M, Selores M. [Stevens-Johnson syndrome and toxic epidermal necrolysis]. Acta Med Port. 2011;24 Suppl 4:995–1002.

White KD, Abe R, Ardern-Jones M, Beachkofsky T, Bouchard C, Carleton B, et al. SSJ/TEN 2017: Building Multidisciplinary Networks to Drive Science and Translation. J Allergy Clin Immunol Pract. 2018;6(1):38–69.

Ingen-Housz-Oro S, Duong T-A, Bensaid B, Bellon N, de Prost N, Lu D, et al. Epidermal necrolysis French national diagnosis and care protocol (PNDS; protocole national de diagnostic et de soins). Orphanet J Rare Dis. 2018;13(1):56.

Bulisani ACP, Sanches GD, Guimarães HP, Lopes RD, Vendrame LS, Lopes AC. Síndrome de Stevens-Johnson e necrólise epidérmica tóxica em medicina intensiva. Rev bras ter intensiva. 2006;18(3):292–7.

Oliveira, AF, Silva, ISN, Brito, LP, Pereira, RLA. Síndrome de Stevens-Johnson, aspectos fisiopatológicos: Uma revisão bibliográfica. Rev Cient Mult Nuc Conh. 2016, 8(6), 40-51.

Stocka-Labno E, Gabzdyl N, Misiak-galazka M, Pawlowska-Kisiel M, Lazowsk T, Rudnicka L. Stevens – johnson syndrome and toxic epidermal necrolysis in an academic hospital setting: A 5-year retrospective study. Our Dermatology Online. 2016; 7(4):381-4.

Rocha, D, Rafael, A, Sousa, S. Síndroma de Stevens-Johnson: a importância do reconhecimento pelo médico de família. Rev Port Med Ger Fam. 2017; 33(4): 284-8.

Roviello CF, Menezes Rodrigues FS, Bertolini Gonçalves JA, Ribeiro Nogueira Ferraz R. Manifestações e tratamento da necrólise epidérmica tóxica e da síndrome de Stevens Johnson. J Health NPEPS. 2019;4(1):319–29.

Arguijo MB, Blázquez Díaz G, Burguillo Gallego R, Cabezas Francés E, Cadavid García V, Toro Torrijos LD, et al. Cuidados enfermeros en paciente geriátrico con síndrome de Stevens-Johnson relacionado con levofloxacino: a propósito de un caso. Gerokomos. 2010;21(3).

Traikia C, Hua C, Le Cleach L, Prost N, Hemery F, Bettuzzi T, et al. Individual‐ and hospital‐level factors associated with epidermal necrolysis mortality: a nationwide multilevel study, France, 2012–2016. Br J Dermatol. 2020;182(4):900–6.

De Lara, VC; Mourão, MF; Fófano, GA. Nécrolise epidérmica tóxica no brasil: aspectos clínicos e epidemiológicos. Rev Cient fagoc saúde. 2020;4(2):45-50.

Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39.

Sekula P, Dunant A, Mockenhaupt M, Naldi L, Bouwes Bavinck JN, Halevy S, et al. Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Invest Dermatol. 2013;133(5):1197–204.

Misirlioglu ED, Guvenir H, Bahceci S, Haktanir Abul M, Can D, Usta Guc BE, et al. Severe Cutaneous Adverse Drug Reactions in Pediatric Patients: A Multicenter Study. J Allergy Clin Immunol Pract. 2017;5(3):757–63.

Laguna C, Martín B, Torrijos A, García-Melgares ML, Febrer I. Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica: experiencia clínica y revisión de la literatura especializada. Actas Dermosifiliogr. 2006; 97(3):177–85.

Emerick MFB, Rodrigues MMT, Pedrosa DMAS, Novaes MRCG, Gottems LBD. Síndrome de Stevens-Johnson e Necrólise Epidérmica Tóxica em um hospital do Distrito Federal. Rev Bras Enferm. 2014;67(6):898–904.

Pereira FA, Mudgil AV, Rosmarin DM. Toxic epidermal necrolysis. J Am Acad Dermatol. 2007;56(2):181–200.

Mitre V, Applebaum DS, Albahrani Y, Hsu S. Generalized bullous fixed drug eruption imitating toxic epidermal necrolysis: a case report and literature review. Dermatol Online J. 2017;23(7).

Chen C-B, Kuo K-L, Wang C-W, Lu C-W, Chung-Yee Hui R, Lu K-L, et al. Detecting Lesional Granulysin Levels for Rapid Diagnosis of Cytotoxic T lymphocyte–Mediated Bullous Skin Disorders. J Allergy Clin Immunol Pract. 2021; 9(3):1327-37.e3

Su SC, Mockenhaupt M, Wolkenstein P, Dunant A, Le Gouvello S, Chen CB, et al. Interleukin-15 Is Associated with Severity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. J Invest Dermatol. 2017;137(5):1065-73.

Adachi A, Komine M, Tsuda H, Nakajima S, Kabashima K, Ohtsuki M. Differential expression of alarmins: IL-33 as a candidate marker for early diagnosis of toxic epidermal necrolysis. J Allergy Clin Immunol Pract. 2019;7(1):325–7.

Gao X, Tang X, Ai L, Gao Q, Liao Q, Chen M, et al. Acute pancreatic injuries: A complication of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with cytotoxic immunocell activation. J Am Acad Dermatol. 2021;84(3):644–53.

Weinkle A, Pettit C, Jani A, Keller J, Lu Y, Malachowski S, et al. Distinguishing Stevens-Johnson syndrome/toxic epidermal necrolysis from clinical mimickers during inpatient dermatologic consultation—A retrospective chart review. . J Am Acad Dermatol. 2019;81(3):749–57.

Toussaint C, Sanchez-Pena P, Titier K, Castaing N, Molimard M, Milpied B. Toxicological screening reveals toxic epidermal necrolysis likely carbamazepine-induced rather than idiopathic. J Allergy Clin Immunol Pract. 2020;8(6):2075–6.

Chan F, Benson MD, Plemel DJA, Mahmood MN, Chan SM. A diagnosis of Stevens-Johnson Syndrome (SSJ) in a patient presenting with superficial keratitis. Am J Ophthalmol Case Rep. 2018;11:167–9.

Lim VM, Do A, Berger TG, Nguyen AH, DeWeese J, Malone JD, et al. A decade of burn unit experience with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical pathological diagnosis and risk factor awareness. Burns. 2016;42(4):836–43

Park HJ, Yun J, Kang DY, Park J-W, Koh Y-I, Kim S, et al. Unique Clinical Characteristics and Prognosis of Allopurinol-Induced Severe Cutaneous Adverse Reactions. J Allergy Clin Immunol Pract. 2019;7(8):2739-49.e3

Horcajada-Reales C, Pulido-Pérez A, Suárez-Fernández R. Severe Cutaneous Drug Reactions: Do Overlapping Forms Exist? Actas Dermosifiliogr (English Edition). 2016;107(1):23–33.

Zaouak A, Ben Salem F, Ben Jannet S, Hammami H, Fenniche S. Bullous fixed drug eruption: A potential diagnostic pitfall: a study of 18 cases. Therapies.2019;74(5):527–30.

Komatsu-Fujii T, Kaneko S, Chinuki Y, Suyama Y, Ohta M, Niihara H, et al. Serum TARC levels are strongly correlated with blood eosinophil count in patients with drug eruptions. Allergol Int. 2017;66(1):116–22.

Wang L, Mei X-L. Retrospective Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 88 Chinese Patients. Chin Med J. 2017;130(9):1062–8

Zhang Z, Li S, Zhang Z, Yu K, Duan X, Long L, et al. Clinical features, risk factors, and prognostic markers of drug-induced liver injury in patients with stevens-johnson syndrome/toxic epidermal necrolysis. Indian J Dermatol. 2020;65(4):274

Chan L, Cook DK. A 10-year retrospective cohort study of the management of toxic epidermal necrolysis and Stevens-Johnson syndrome in a New South Wales state referral hospital from 2006 to 2016. Int J Dermatol. 2019;58(10):1141-47.

Hama N, Nishimura K, Hasegawa A, Yuki A, Kume H, Adachi J, et al. Galectin-7 as a potential biomarker of Stevens-Johnson syndrome/toxic epidermal necrolysis: identification by targeted proteomics using causative drug-exposed peripheral blood cells. J Allergy Clin Immunol Pract. 2019;7(8):2894-97.e7.

Sunaga Y, Kurosawa M, Ochiai H, Watanabe H, Sueki H, Azukizawa H, et al. The nationwide epidemiological survey of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan, 2016-2018. J Dermatol Sci. 2020;100(3):175–82

Monteiro D, Egipto P, Barbosa J, Horta R, Amarante J, Silva P, et al. Nine years of a single referral center management of Stevens–Johnson syndrome and toxic epidermal necrolysis (Lyell’s syndrome). Cutan Ocul Toxicol. 2017;36(2):163–8

Noe MH, Rosenbach M, Hubbard RA, Mostaghimi A, Cardones AR, Chen JK, et al. Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis—ABCD-10. JAMA Dermatol. 2019;155(4):448.

Yang C, Cho Y, Chen K, Chen Y, Song H, Chu C. Long-term Sequelae of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Acta Derm Venerol. 2016; 96(4):525–9

Torres‐Navarro I, Briz‐Redón Á, Botella‐Casas G, Sahuquillo‐Torralba A, Calle‐Andrino A, Unamuno‐Bustos B, et al. Accuracy of SCORTEN and ABCD‐10 to predict mortality and the influence of renal function in Stevens–Johnson syndrome/toxic epidermal necrolysis. J Dermatol. 2020;47(10):1182–6.

Bastuji-Garin S, Ryzany B, Stern S, Shear NH, Nandi L, Roujeau JC. Clinical classification of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme, Arch. Dermatol. 1993; 129:92–6.

Published

25/10/2021

How to Cite

Caminha, I. C. C., Carvalho, P. E. G. de, Sousa, A. L. A. de, Pinto, A. S. B., & Beltrão, C. M. F. (2021). TOXIC EPIDERMAL NECROLYSIS / STEVENS JOHNSON SYNDROME: HOW EARLY DIAGNOSIS CAN IMPACT ON PROGNOSIS. RECIMA21 - Revista Científica Multidisciplinar - ISSN 2675-6218, 2(9), e29747. https://doi.org/10.47820/recima21.v2i9.747