Efficacy of single-session plasmapheresis therapy alone for the treatment of toxic epidermal necrolysis in 17 cases: a clinical observation / 中华皮肤科杂志

Objective To evaluate the clinical efficacy of single-session plasmapheresis therapy alone for the treatment of toxic epidermal necrolysis (TEN),and to investigate its adverse reactions.Methods Patients with TEN receiving single-session plasmapheresis therapy alone were collected from the Second Affiliated Hospital of Xi'an Jiaotong University between September 2010 and December 2017.Clinical data on the disease severity,clinical efficacy,hospitalization duration and adverse reactions were analyzed.Results A total of 17 patients with TEN were enrolled into this study,including 9 males and 8 female,with an average age of 36.1 ± 25.4 years.Their initial SCORTEN and STENS scores were 2.1 ± 1.24 and 29.9 ± 6.6 respectively.After treatment,the STENS score decreased to 3.5 ± 1.8.Of the 17 patients,15 were cured after single-session plasmapheresis therapy,1 showed response to the treatment,and 1 died.The duration of intensive care unit stay was 6.4 ± 1.8 days,and the total hospitalization duration was 12.1 ± 5.7 days.There was no significant difference in the STENS score among the day 1,4,7,10 and 20 after hospital admission (F =18.569,P ＜ 0.05).No severe adverse reactions were observed,except 2 cases of plasma allergy.Conclusion Single-session plasmapheresis therapy alone is effective for the treatment of TEN without obvious adverse reactions.

Stevens-Johnson syndrome and toxic epidermal necrolysis at the University Hospital of the West Indies, Jamaica / El síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica en el Hospital Universitario de West Indies, Jamaica

OBJECTIVE: Stevens-Johnson syndrome and toxic epidermal necrolysis are uncommon acute dermatologic disorders. The purpose of this study was to examine the frequency, aetiology and outcome of cases of Stevens-Johnson syndrome and toxic epidermal necrolysis admitted to the dermatology ward at the University Hospital of the West Indies. METHODS: This was a retrospective study looking at all patients who were admitted with a diagnosis of Stevens-Johnson syndrome, Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome and toxic epidermal necrolysis over a nine-year period. RESULTS: The results showed almost equal numbers of males and females. The drugs most commonly implicated were phenytoin and cotrimoxazole. The most common complications were hepatic impairment and ophthalmic complications. CONCLUSION: Stevens-Johnson syndrome and toxic epidermal necrolysis contribute significantly to morbidity and mortality of patients on the dermatology ward although mortality was low compared to other studies.

OBJETIVO: El síndrome de Stevens-Johnson (SSJ) y la necrólisis epidérmica tóxica (NET) son trastornos dermatológicos agudos poco frecuentes. El propósito de este estudio fue examinar la frecuencia, la etiología y el resultado de casos de síndrome Stevens-Johnson y necrólisis epidérmica tóxica ingresados en la sala de dermatología del Hospital Universitario de West Indies. MÉTODOS: Se trata de un estudio retrospectivo con todos los pacientes que fueron ingresados con diagnóstico de síndrome de Stevens-Johnson, síndrome de solapamiento entre el síndrome de Stevens-Johnson y NET, y necrólisis epidérmica tóxica, por un período de nueve años. RESULTADOS: Los resultados mostraron casi igual número de varones y hembras. Los fármacos más comúnmente implicados fueron la fenitoína y el cotrimoxazol. Las complicaciones más frecuentes fueron deterioro hepático y complicaciones oftálmicas. CONCLUSIÓN: El síndrome Stevens-Johnson y la necrólisis epidérmica tóxica contribuyen significativamente a la morbilidad y mortalidad de los pacientes en la Sala de Dermatología, aunque la mortalidad fue baja en comparación con otros estudios.

Necrose epidérmica metabólica em cães / Metabolic epidermal necrosis in dogs

A necrose epidérmica metabólica é uma rara enfermidade endócrino-metabólica, com importantes manifestações cutâneas, possuindo paralelo clinicopatológico com o eritema necrolítico migratório em humanos. O presente estudo tem por objetivo relatar três casos clínicos de NEM em cães acometidos por dermatite eritematosa, crostosa e ulcerativa associada à hepatopatia. O diagnóstico definitivo foi alcançado a partir do exame dermatopatológico. O prognóstico é desfavorável e os três animais morreram, apesar do tratamento.

Metabolic epidermal necrosis is a rare endocrine metabolic disease, characterized by dermatological signs which has clinical and pathological similarity with necrolytic migratory erythema in humans. The present report describes three cases of MEN in dogs affected with erythematous ulcerative crusting dermatitis associated with hepatopathy. The diagnosis was based on cutaneous histopathology. The prognosis is poor and the three dogs died despite the treatment.

A Case of Allopurinol Hypersensitivity Syndrome in a Patient with Chronic Renal Failure / 대한신장학회잡지

Allopurinol hypersensitivity syndrome is a rare but life-threatening complication. We here report a case of allopurinol hypersensitivity syndrome manifested with irreVersible change of renal function and severe toxic epidermal necrolysis in a patient with chronic renal faiure. A 29-year-old male patient with chronic renal failure due to chronic glomerulonephritis presented with high fever and skin rash. He had been taking allopurinol for 6 weeks due to asymptomatic hyperuricemia. Blood chemistry showed severe hepatic dysfunction and aggrevated renal function. Skin biopsy revealed consistent findings with allopurinol hypersenstivity syndorme. Allopurinol was discontinued and steroid was instituted. His cutaneous lesion and high fever, and hepatic dysfunction improved but renal function irreversibly progressed in end stage renal failure requiring maintenance hemodialysis treatment.

Comparison of the Effect of Various Chemical Peeling Agents on the Skin Barrier / 대한피부과학회지

BACKGROUND: Among the various methods for chemical peeling, it is possible to select a wide range of peeling agents for particular patients. OBJECTIVES: The objective of present study was to investigate the effects of various chemical peeling agents on the epidermal permeability barrier of hairless mice skin and to clarify the histologic alteration in epidermal structure, thus to apply in the clinical practices. METHODS: We have applied 35% and 70% glycolic acid (GA) aqueous solutions, 30% of salicylic acid (SA) solution of PEG400, Jessner's solution and 15%, 30% and 50% of trichloroacetic acid (TCA) aqueous solution to the flank of hairless mice. TEWL (trans-epidermal water loss) values were measured before and immediately after the application and 3, 6, 12 and 24 hours following treatment. Biopsy specimens were evaluated with light and electron microscopy for epidermal structural changes. RESULTS: There were no significant changes in TEWL for the GA and SA solution treated skin, regardless of their concentration. For the TCA and Jessner's solution, TEWL increased immediately after treatment and recovered the basal levels about 90% after 24 hours for Jessner's solution and low concentrated TCA solution, but did not recovered for high concentrated TCA solution. On light and electron microscopic examination, exfoliating effect was seen in every case and as for SA and Jessner's solution treated skin, keratolysis at hair follicles was also seen. Slight epidermal necrosis was seen in every case, except in GA treated skin. CONCLUSION: The present results suggest that using topical agents such as glycolic acid can induce the change in the architecture of the epidermis without disrupting the skin barrier.