Stevens Johnson Syndrome Review
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Abstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are dermatologic emergencies that are distinguished by extensive epidermal necrolysis and sloughing. The incidence rates are location-dependent. Mortality rates vary from 4.8-9% to 14.8-48%, with females being more frequently affected than males.
Supportive care, infection control, wound care, and fluid and electrolyte management comprise nonpharmacologic treatment for SJS/TEN patients. The identification and cessation of the causative substance are the most critical components. The management of fluid, electrolytes, and nutrition is essential for SJS/TEN patients, as they have lower fluid requirements than burn patients.
Prophylactic antibiotics do not improve outcomes; however, infection prevention necessitates appropriate wound care and antiseptic handling. The decision to pursue surgical debridement is contingent upon the location of care, and the function of this treatment option has been a subject of controversy. Anti-shear therapy, which entails the preservation of denuded epidermis and the aspiration of blister fluid, has been demonstrated to be effective in decreasing mortality rates.
The disease's rarity has resulted in a scarcity of prospective studies on pharmacologic treatment for SJS/TEN. There have been reports of a variety of treatment regimens that involve corticosteroids, IVIg, cyclosporine, and TNF-alpha inhibitors. However, it is difficult to ascertain whether the disease's remission was caused by a specific treatment or the natural course of the disease.
Studies have demonstrated that supportive care and cyclosporine have the potential to serve as alternative treatments for SJS/TEN. A meta-analysis of 10 studies revealed that patients who received cyclosporine had a survival advantage, while a meta-analysis of 67 studies revealed that the combination of corticosteroids and IVIg resulted in statistically significant improvements in outcomes. The severity of illness scores in patients with SJS/TEN overlap or TEN was reduced by plasmapheresis, which entails plasmapheresis and corticosteroids. In 86.8% of patients, TNF-alpha inhibitors have also demonstrated positive outcomes, despite their immunosuppressive properties. Nevertheless, the most effective pharmacological treatment for SJS/TEN must be determined by taking into account practical factors, such as cost. There is a lack of consensus regarding the most effective treatment, and additional research is required to ascertain the most effective treatment.
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References
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