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Stevens Johnson Syndrome And Toxic Epidermal Necrolysis Pdf

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Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: a Review and Update

Supportive care remains the mainstay of treatment, and includes wound care, fluid and electrolyte management, management of medical co-morbidities, and infection control. The value of adjuvant therapy remains unclear, but new recent retrospective studies suggest that the combination therapies may be efficacious. Supportive care is the most universally accepted therapy, although specific strategies may vary among institutions. Adjuvant therapies include corticosteroids, IVIG, cyclosporine, TNF alpha inhibitors, and plasmapheresis but prospective data is still lacking. Clinical trials that may better elucidate their efficacy are currently under way.

Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: a Review and Update

Stevens-Johnson syndrome SJS and toxic epidermal necrolysis TEN , which can be considered a late-onset allergic reaction, can cause serious long-term sequelae. They have the same clinical manifestations and the only difference is in the extent of epidermal detachment. Infective agents are additional influencing factors. The usual treatment is mainly founded on the withdrawal of the suspected causative agent and supportive therapy. In pediatric patients, the specific therapeutic strategies are controversial and comprise systemic corticosteroids and the use of intravenous immunoglobulin IVIG. The Authors confirm that neither the manuscript nor any part of it has been published or is under consideration for publication elsewhere. The same Authors assign all rights, including but no limiteded to the copyright, for the present manuscript to Acta Biomedica upon its acceptance for publication.


Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis. (TEN or Lyell disease) are rare diseases that cause acute destruction of the epithelium of the.


2020, Number 01

Stevens-Johnson syndrome SJS and toxic epidermal necrolysis TEN are two of the most severe dermatologic conditions occurring in the inpatient setting. In addition, an interventional approach for the clinician is provided. PubMed was searched with the key words: corticosteroids, cyclosporine, etanercept, intravenous immunoglobulin, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The papers generated by the search, and their references, were reviewed. Specific guidelines differ from the care required for patients with thermal burns.

If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Toxic epidermal necrolysis TEN and Stevens—Johnson syndrome SJS are acute life-threatening mucocutaneous reactions characterized by extensive necrosis and detachment of the epidermis. Stevens and Johnson first reported two cases of disseminated cutaneous eruptions associated with an erosive stomatitis and severe ocular involvement. Because of the similarities in clinical and histopathologic findings, risk factors, drug causality, and mechanisms, these two conditions are now considered severity variants of an identical process that differs only in the final extent of body surface involved.

Clinical patterns and classification of the diseases included in the study. A, Erythema multiforme: typical targets, with regular round shape, well-defined borders, 3 different zones, predominant on the extremities. B, Stevens-Johnson syndrome: erythematous or purpuric macules with irregular shape and size.

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

Stevens—Johnson syndrome SJS and toxic epidermal necrolysis TEN are rare, potentially life-threatening, severe mucocutaneous adverse reactions characterized by extensive epidermal detachment, erosion of mucosae and severe constitutional symptoms. Based on the similar histologic findings, SJS and TEN were synonymously associated with erythema multiforme major since However, Bastuji-Garin et al. The present understanding of epidermal necrolysis is that it is an immune-driven pathway mediated by granulysin released by drug-specific cytotoxic CD8 T cells and natural killer cells. This is followed by the detachment of mucous membranes oropharyngeal, conjunctival, anogenital and nasal. Usually, more than two mucous membranes are involved. Typical raised target lesions, characteristic of the erythema multiforme spectrum, are usually absent.

If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Widespread apoptosis of keratinocytes is provoked by the activation of a cell-mediated cytotoxic reaction and amplified by cytokines, mainly granulysin. Confluent purpuric and erythematous macules evolving to flaccid blisters and epidermal detachment often start on the upper trunk and spread to the limbs associated with mucous membrane involvement. Histopathology shows full-thickness necrosis of epidermis associated with mild mononuclear cell infiltrate. Early identification and withdrawal of suspect medication in drug-induced cases are essential for good patient outcomes.

If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Widespread apoptosis of keratinocytes is provoked by the activation of a cell-mediated cytotoxic reaction and amplified by cytokines, mainly granulysin. Confluent purpuric and erythematous macules evolving to flaccid blisters and epidermal detachment often start on the upper trunk and spread to the limbs associated with mucous membrane involvement. Histopathology shows full-thickness necrosis of epidermis associated with mild mononuclear cell infiltrate.

1 Comments

Belmiro S. 18.05.2021 at 15:29

Erythema multiforme in its most extreme form has traditionally been divided between toxic epidermal necrolysis and Stevens-Johnson Syndrome.

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