ABSTRACT
Background: Stevens–Johnson syndrome and toxic epidermal necrolysis are severe, life‑threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor‑α inhibitors. Aim: The ideal therapy of Stevens– Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. The aim of this article is to comprehensively review the published medical literature and frame management guidelines suitable in the Indian perspective. Methods: The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) assigned the task of preparing these guidelines to its special interest group on cutaneous adverse drug reactions. The group performed a comprehensive English language literature search for management options in Stevens–Johnson syndrome/toxic epidermal necrolysis across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for keywords (alone and in combination) and MeSH items such as “guidelines,” “Stevens–Johnson syndrome,” “toxic epidermal necrolysis,” “corticosteroids,” “intravenous immunoglobulin,” “cyclosporine” and “management.” The available evidence was evaluated using the strength of recommendation taxonomy and graded using a three‑point scale. A draft of clinical recommendations was developed on the best available evidence which was also scrutinized and critically evaluated by the IADVL Academy of Dermatology. Based on the inputs received, this final consensus statement was prepared. Results: A total of 104 articles (meta‑analyses, prospective and retrospective studies, reviews [including chapters in books], previous guidelines [including Indian guidelines of 2006] and case series) were critically evaluated and the evidence thus gathered was used in the preparation of these guidelines. Recommendations: This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1‑2 mg/kg/day or equivalent), tapered rapidly within 7‑10 days. Cyclosporine (3‑5 mg/kg/day) for 10‑14 days may also be used either alone, or in combination with corticosteroids. Owing to the systemic nature of the disease, a multidisciplinary approach in the management of these patients is helpful.
ABSTRACT
Background: Beetle dermatitis is a common condition seen in regions with warm and tropical climate. The condition causes significant morbidity and can be misdiagnosed. Aim: The study was conducted to know the clinical profile of beetle dermatitis and to increase awareness among nondermatologist physicians about this condition. Methods: All clinically diagnosed cases of beetle dermatitis were included in the study. Detailed history was taken and a thorough clinical examination was conducted in all the cases. Clinical photographs were taken in all the cases. Results: A total of 70 cases comprising of 46 males and 24 females were studied. The age of the patients ranged from 5 to 60 years. Majority of the cases presented during the post monsoon months (September-November), indicating a distinct seasonal trend. Morphology of lesions was mainly linear, but kissing and bizarre lesions were also observed. Head, neck and upper extremities were the most commonly involved sites. Fever and malaise was observed in a few cases. Conclusion: Beetle dermatitis should be included in differential diagnosis while examining erythematous vesicular lesions of sudden onset, especially on exposed parts during rainy and post rainy season. Awareness of this condition and its clinical features among the physicians will prevent misdiagnosis. Preventive measures can be undertaken based on the behavioral pattern of this beetle.