Stevens–Johnson Syndrome and toxic epidermalnecrolysis: a multi-aspect comparative 7-year study from the People’s Republic of China

Abstract

Jie Sun,1 Jin Liu,2 Qing-Li Gong,1 Gao-Zhong Ding,1 Li-Wen Ma,1 Li-Chao Zhang,1 Yan Lu1 1Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, 2Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China Background: Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous drug reactions. They are differentiated based on the fraction of the body surface area affected. Optimal therapy for SJS and TEN is a controversial issue.Objective: We compared the treatments given to and the clinical outcomes of 39 cases of SJS and 48 cases of TEN seen at a single institution between January 2007 and December 2013 for better understanding of the clinical characteristics and development of the two conditions.Methods: Demographic data, clinical characteristics, treatments given, and therapeutic responses observed were retrospectively collected.Results: The incidence rates of hypoproteinemia and secondary infections are significantly higher in TEN than in SJS (P=0.001 and P=0.002, respectively). The corticosteroid dose did not influence the time from the initiation of therapy to control of the lesions in SJS, but increasing the dosage of corticosteroids progressively decreased the time from the initiation of therapy to control of the lesions in TEN. With increases in the utilization ratio of intravenous immunoglobulin (IVIG), the length of the hospital stay became shorter, whereas the time from the initiation of therapy to control of the lesions remained the same in SJS. However, for TEN, both the length of the hospital stay and the time from the initiation of therapy to control of the lesions became shorter with increases in the utilization ratio of IVIG.Conclusion: SJS and TEN are two variants of the same spectrum, and they differ from each other not only in the severity of epidermal detachment but also in other clinical parameters and their distinct clinical courses. Thus, differential treatment of both conditions may have benefits for their prognosis. Keywords: corticosteroids, intravenous immunoglobulin, Stevens–Johnson Syndrome, toxic epidermal necrolysis, cutaneous drug reaction