Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Causes, Treatment Investigated

Medication reaction was found to be the most frequent cause of SJS/TEN (89.7%)
Medication reaction was found to be the most frequent cause of SJS/TEN (89.7%)

Findings from a retrospective study involving a large cohort of US adults who developed Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) were published in the Journal of Investigative Dermatology.

The multicenter retrospective study (N=377) was conducted to investigate the causes, treatment protocols, and mortality rates of US adults with SJS/TEN. Patients included in the study were seen by inpatient consultative dermatologists at 18 medical centers in the country between January 1, 2000 and June 1, 2015. 

Medication reaction was found to be the most frequent cause of SJS/TEN (89.7%), with 27.2% of the cases involving trimethoprim/sulfamethoxazole. Most patients were treated either in a burn unit (41.0%) or in intensive care (27.2%). Pharmacologic therapy was administered to 70.7% of patients; treatments mostly consisted of corticosteroids (42.5%), intravenous immune globulin (35.3%), or both (20.3%). Nearly one-third of patients received only supportive care (29.3%). 

Seventy-eight in-hospital deaths were expected (21%) based on Day 1 SCORTEN, a severity-of-illness score for TEN, however observed mortality was significantly lower (54 deaths; 14.7%) (standardized mortality ratio [SMR] 0.70, 95% CI: 0.58, 0.79). The SMR was lowest among patients who received both corticosteroids and intravenous immune globulin (0.52, 95% CI: 0.21, 0.79). 

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"Mortality, while substantial, was significantly lower than predicted," the authors concluded. "While the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and [intravenous immune globulin), among other therapies, may warrant further study."

For more information visit jidonline.org.