Skip to main content Skip to main navigation menu Skip to site footer

Topical Treatment for Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis: A Review

  • Schandra Purnamawati ,
  • Sri Awalia Febriana ,
  • Retno Danarti ,
  • Tatan Saefuddin ,


Abstract

Background: Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are currently regarded to be same disease entity which differs only in the extent and severity of epidermal sloughing. Both are potentially life-threatening mucocutaneous immunologic reaction, which are most frequently induced by drug consumption. The epithelial destruction of skin and mucosal membrane can cause both acute as well as chronic/ long term outcomes in term of  late sequelae during the course of the disease. Sequelae often occur during the late phase of SJS/TEN and become a significant problem due its chronicity and severe degree of impairment, which leads to deterioration of quality of life for the patients. This may prevented or decreased in terms of intensity if the patient’s received prompt and sufficient topical therapy, particularly in managing lesions on the mucosa of the eye, oral, and genital. Objective : This review underlines topical therapies which could be delivered for management of mucocutaneous lesions from SJS/ TEN, aimed to prevent late sequelae due to SJS – TEN in order to improve the life quality of SJS – TEN survivors. Conclusion: SJS/ TEN frequently lead to late sequeale which includes skin, ocular, oral, and genital involvement. These sequelaes are often severe and chonic. Thus, may cause significant decrease in quality of life of SJS/TEN survivors. It is therefore most important to detect them early in order to manage them adequately. To date, we still have an impression that the specific sequelae of SJS – TEN are often late diagnosed and insufficiently treated. Finally, we want to emphasize that for mucosal involvement in particular, such as ocular, genital and oral involvement, a careful topical treatment have to be taken into special consideration in order to prevent severe late sequelae. 

Keywords: Stevens Johnson Syndrome (SJS) Toxic Epidermal necrolysis (TEN) topical therapy

References

  1. Allanore LV, Rojeau JC. Epidemal necrolysis (Stevens Johnson Syndrome and Toxic Epidermal Necrolysis). Fitzpatrick Dermatology in General Medicine. 8th ed. Mc Graw Hill. 2010:439-49.
  2. Lyell A. Toxic epidermal necrolysis: an eruption resembling scalding of the skin. Br J Dermatol. 1956;68:355-361 http://dx.doi: 10.1111/j.1365-2133.1956. tb12766.x
  3. Roujeau JC, Kelly JP, Naldi L, et.al. Medication use and risk of Stevens- Johnson syndrome or Toxic epidermal necrolysis. N Engl J Med 1995;333:1600-1607 http://dx.doi:10.1056/NEJM199512143332404
  4. Ardern-Jones MR, Friedmann PS. Skin manifestations of drug allergy. Br J Clin Pharmacol. 2011;71(5):672-83 http://dx.doi: 10.1111/j.1365-2125.2010.03703.x.
  5. Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bavinck JNB, Sidoroff A, Schneck J, Roujeau JC, Flahault A. Stevens-Johnson syndrome and Toxic Epidermal Necrolysis: Assessment of medication Risks with emphasis on recently Marketed Drugs. The EuroSCAR-study. Journal of Investigative Dermatology. 2008;128:35-44 http://dx.doi:10.1038/sj.jid.5701033
  6. Locharernkul C, Loplumlert J, Limotai C, et al. Carbamazepine and phenytoin-induced Stevens-Johnson syndrome is associated with HLA-B*1502 allele in Thai population. Epilepsia. 2008;49:2087-2091 http://dx.doi:10.1111/j.1528-1167.2008.01719.x.
  7. Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson Syndrome. Orphanet Journal of Rare diseases. 2010,5:39 http://dx.doi: 10.1186/1750-1172-5-39.
  8. Chung WH, Hung SI. Recent advances in genetics and immunology of Stevens-Johnson syndrome and toxic epidermal necrosis. J Dermatol Sci. 2012;66:190-196 http://dx.doi: 10.1016/j.jdermsci.2012.04.002.
  9. Fernando SL, Broadfoot AJ. Prevention of severe cutaneous adverse drug reactions: the emerging value of pharmacogenetic screening. CMAJ. 2009;182:476-480 http://dx.doi: 10.1503/cmaj.090401.
  10. Lonjou C, Borot N, Sekula P, et al. A European study of HLA-B in Stevens-Johnson syndrome and toxic epidermal necrolysis related to five high-risk drugs. Pharmacogenet Genomics. 2008;18:99-107 http://dx.doi: 10.1097/FPC. 0b013e3282f3ef9c.
  11. Hung SI, Chung WH, Liou LB, et al. HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. PNAS. 2005;102:4134-4139 http://dx.doi: 10.1073/pnas.0409500102
  12. Hershfield MS, Callaghan JT, Tassaneeyakul W, et al. Clinical Pharmacogenetics Implementation Consortium guidelines for human leukocyte antigen-B genotype and allopurinol dosing. Clin Pharmacol Ther. 2013;93:153-158 http://dx.doi: 10.1038/clpt.2012.209
  13. Chung WH, Hung SI, Yang JY, et al. Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis. Nat Med. 2008;14:1343-1350 http://dx.doi: 10.1038/nm.1884.
  14. Roujeau J. Chapter 39. Erythema multiforme. In: L Goldsmith LA, Katz SI, Gilchrest BA, et al, eds. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York, NY: McGraw-Hill; 2012
  15. Gerull R, Nelle M, Schaible T. Toxic epidermal necrolysis and Stevens-Johnson syndrome: a review. Crit Care Med. 2011;39:1521-1532 http://dx.doi: 10.1097/CCM.0b013e31821201ed.
  16. Mockenhaupt M. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol. 2011;7:803-815 http://dx.doi:10.1586/eci.11.66.
  17. Magina S, Lisboa C, Leal V, Palmares J, Mesquita-Guimaraes J. Dermatological and ophthalmological sequels in toxic epidermal necrolysis. Dermatology.2003; 207:33-36 http://dx.doi: 70938
  18. Yip LW, Thong BY, Lim J, Tan AW, Wong HB, Handa S, Heng WJ. Ocular manifestations and complications of Stevens-Johnson syndrome and toxic epidermal necrolysis: an Asian series. Allergy.2007; 62:527-531 http://dx.doi: 10.1111/j.1398-9995.2006.01295.x
  19. Roujeau JC, Guillaume JC, Revuz J, Touraine R. Reporting adverse drug reactions. Lancet.1985; 2:1244
  20. Sheridan RL, Schulz JT, Ryan CM, Schnitzer JJ, Lawlor D, Driscoll DN, Donelan MB, Tompkins RG: Long-term consequences of toxic epidermal necrolysis in children. Pediatrics. 2002; 109:74-78
  21. Oplatek A, Brown K, Sen S, Halerz M, Supple K, Gamelli RL: Long-term follow-up of patients treated for toxic epidermal necrolysis. J Burn Care Res.2006; 27:26-33 http://dx.doi: 10.1097/01.bcr.0000194268.01514.f8
  22. Mockenhaupt M. Severe drug-induced skin reactions: a clinical pattern, diagnostics and therapy. JDDG. 2009;7:142-62 http://dx.doi: 10.1111/j.1610-0387.2008.06878.x.
  23. Bastuji-Garin S, Fouchard N, Bertocchi M, Roujeau JC, Revuz J, Wolkenstein P. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol. 2000;115:149-153 http://dx.doi: 10.1046/j.1523-1747.2000.00061.x
  24. Tyagi S, Kumar S, Kumar A, Singla M, Singh A. Stevens-Johnson syndrome-A life threatening skin disorder. J. Chem. Pharm. Res. 2010; 2(2); 618-626
  25. Fu X, Shen Z, Chen Y, et.al. Randomised placebo-controlled trial of use of topical recombinant bovine basic fibroblast growth factor for second-degree burns. Lancet. 1998: 1661-1664 http://dx.doi: 10.1016/S0140-6736(98)01260-4
  26. Widgerow AD, Stevens-Johnson syndrome and toxic epidermal necrolysis: topical treatment influencing systemic response. Wound Healing Southern Africa. 2011;4(1):17-24
  27. Dalli RL, Kumar R, Kennedy P, et al. Toxic epidermal necrolysis/Stevens-Johnson syndrome: current trends in management. ANZ J Surg. 2007;77:671-676 http://dx.doi: 10.1111/j.1445-2197.2007.04184.x
  28. Asz J, Asz D, Moushey R, et al. Treatment of toxic epidermal necrolysis in a pediatric patient with a nanocrystalline silver dressing. J Pediatr Surg. 2006:41,E9-E12 http://dx.doi: 10.1016/j.jpedsurg.2006.08.043
  29. Alvarez-Diaz C, Cuenca-Pardo J, Sosa-Serrano A, Juarez-Aguilar E, Marsch-Moreno M, Kuri-Harcuch W.Controlled clinical study of deep partial-thickness burns treated with frozen cultured human allogeneic epidermal sheets. J Burn Care Rehabil. 2000;21:291–9
  30. Waymack P, Duff RG, Sabolinski M. The effect of a tissue engineered bilayered living skin analog, over meshed split-thickness autografts on the healing of excised burn wounds. The Apligraf Burn Study Group. Burns. 2000;26:609–19
  31. Lal S, Barrow RE, Wolf SE et al. Biobrane improves woundhealing in burned children without increased risk of infection. Shock. 2000;14:314–18 http://dx.doi: 10.1016/j.jpedsurg.2011.03.070
  32. Barret JP, Dziewulski P, Ramzy PI, Wolf SE, Desai MH, Herndon DN. Biobrane versus 1% silver sulfadiazine in second-degree pediatric burns. Plast Reconstr Surg. 2000;105:62–5
  33. Noordenbos J, Dore C, Hansbrough JF. Safety and efficacy of TransCyte for the treatment of partial-thickness burns. J Burn Care Rehabil 1999;20:275–81
  34. Wilken R, Li CS, Sharon VR, Kim K, Patel FB, Patel F, Maverakis E. topical clobetasol for treatment of toxic epidermal necrolysis: study protocol for randomized controlled trial. Biomed Central.2015:0879-7:1-10
  35. Decani S, Federighi V, Baruzzi E, Sardella A, Lodi G. Iatrogenic Cushing’s syndrome and topical steroid therapy: case series and review of the literature. J Dermatolog Treat. 2014;25(6):495–500 http://dx.doi: 10.3109/09546634.2012. 755252.
  36. Fromowitz JS, Ramos-Caro FA, Flowers FP, et al. Practical guidelines for the management of toxic epidermal necrolysis and Stevens-Johnson syndrome. Int J Dermatol.2007;46:1092-1094 http://dx.doi: 10.1111/j.1365-4632.2007.03277.x
  37. Shammas M, Edward C, Sarkar J, et al. Management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis utilizing amniotic membrane and topical corticosteroids. Am J Ophthalmol.2010;149:203-213 http://dx.doi: 10.1016/j.ajo. 2009.08.040.
  38. Romero-Rangel T, Stavrou P, Cotter J, Rosenthal P, Baltatzis S, Foster CS. Gas permeable scleral contact lens therapy in ocular surface disease. Am J Opthalmol. 2000; 130: 25-32
  39. Baudouin C. Allergic reaction to topical eyedrops. Curr Opin Allergy Clin Immunol. 2005;5:459–463
  40. Furrer P, Mayer JM, Gurny R. Ocular tolerance of preservatives and alternatives. Eur J Pharm Biopharm. 2002;53: 263–280
  41. Geerling G, Daniels JT, Dart JK, Cree IA, Khaw PT. Toxicity of natural tear substitutes in a fully defined culture model of human corneal epithelial cells. Invest Ophthalmol Vis Sci. 2001;42: 948–956
  42. Gregory GD. The opthalmologic management of acute Stevens Johnson Syndrome. The Ocular Surface. 2008; 6(2):87-95
  43. Robertson SM, Curtis MA, Schlech BA, et al. Ocular pharmaco kinetics of moxifloxacin after topical treatment of animals and humans. Surv Ophthalmol.2005;50:S32-45 http://dx.doi: 10.1016/j.survophthal.2005.07.001
  44. Wagner RS, Abelson MB, Shapiro A, Torkildsen G. Evaluation of moxifloxacin, ciprofloxacin, gatifloxacin, ofloxacin, and levofloxacin concentrations in human conjunctival tissue. Arch Ophthalmol. 2005;123:1282-3 http://dx.doi: 10.1001/archopht.123.9.1282
  45. Scheinfeld N. A review of deferasirox, bortezomib, dasatinib, and cyclosporine eye drops: possible uses and known side effects in cutaneous medicine. J Drugs Dermatol.2007;6:352-5
  46. Onaran Z, Usta G, Kocak M, Ornek K, Buyukkocak U. Topical Ophthalmic Cyclosporine in the Treatment of Toxic Epidermal Necrolysis. Hindawi Publishing Corporation. 2011; 416842 http://dx.doi.org/10.1155/2011/416842
  47. M. C. Shammas, E. C. Lai, J. S. Sarkar, J. Yang, C. E. Starr, K. C. Sippel. Management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis utilizing amniotic membrane and topical corticosteroids. American Journal of Ophthalmology. 2010;149(2):203–213 http://dx.doi: 10.1016/j.ajo.2009.08.040.
  48. Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z, et al. Diagnosis and treatment of Stevens–Johnson syndrome and toxic epidermal necrolysis with ocular complications. Ophthalmology. 2009;116(4):685–90 http://dx.doi: 10.1016/j.ophtha.2008.12.048.
  49. Chang YS, Huang FC, Tseng SH, Hsu CK, Ho CL, Sheu HM. Erythema multiforme, Stevens–Johnson syndrome, and toxic epidermal necrolysis: acute ocular manifestations, causes, and management. Cornea. 2007;26(2):123–9 http://dx.doi: 10.1097/ICO.0b013e31802eb264
  50. De Rojas MV, Dart JK, Saw VP. The natural history of Stevens–Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy. Br J Ophthalmol. 2007;91(8):1048–53 http://dx.doi: 10.1136/bjo.2006.109124
  51. Kano Y, Shiohara T. long term outcome of patients with severe cutaneous adverse reactions. Dermatologica sinica. 2013;31: 211-216 http://dx.doi: 10.1016/j.dsi.2013. 09.004

How to Cite

Purnamawati, S., Febriana, S. A., Danarti, R., & Saefuddin, T. (2016). Topical Treatment for Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis: A Review. Bali Medical Journal, 5(1), 82–90. https://doi.org/10.15562/bmj.v5i1.274
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
5

Total
1

Share

Search Panel

Schandra Purnamawati
Google Scholar
Pubmed
BMJ Journal

Sri Awalia Febriana
Google Scholar
Pubmed
BMJ Journal

Retno Danarti
Google Scholar
Pubmed
BMJ Journal

Tatan Saefuddin
Google Scholar
Pubmed
BMJ Journal