A Clinical Observation of the Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Jeju Island / 대한피부과학회지

ABSTRACT

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, acute life-threatening, hypersensitivity reaction usually to certain medications. Although SJS and TEN occur at an estimated incidence of 0.4 and 1.2 cases per million per year, these conditions have occurred, not infrequently, on Jeju island. OBJECTIVE: We performed this study to evaluate the clinical characteristics of the 15 patients diagnosed as SJS and TEN in Jeju island. METHODS: The retrospective clinico-epidemiologic analysis of 10 months' data of 15 inpatients, including 5 SJS patients, 8 SJS/TEN overlap patients and 2 TEN patients, was conducted through the available medical records. RESULTS: 1. Mean time of onset of clinical disease following the institution of a new drug was 10.1 days. Mean duration of drug exposure was 9.3 days. There were 4 cases showing positive response to skin test. The most common culprit drugs were anti-glaucoma agents (26.7%) such as methazolamide or acetazolamide, and anti-convulsants (26.7%) including valproic acid. 2. The clinical outcome was as follows; recovery in 13 patients, transfer in one patient, and expire in one. Time from appearance of first skin lesions to the initiation of therapy (time to treat) in 15 patients was 3.5 days; time from start of hospital treatment to interruption of further progression (time to arrest), 4.1 days; time to heal, 14.1 days; length of hospital stay, 20.6 days. The four patients with delayed withdrawal of drugs represented a longer time to treat (4.8 days), time to arrest (4.5 days), time to heal(15 days), and length of hospital stay (26.5 days) than those in the 11 patients with early withdrawal. 3. The fraction of patients corresponding to risk factors of SJS or TEN was as follows; elder (>60 years old) (46.6%), widespread lesions (>10%) (66.6%), lymphopenia (66.6%), leukopenia (40%), neutropenia (26.7%), thrombocytopenia (20%), abnormal BUN/Cr (20%), abnormal liver function (46.7%), symptoms of respiratory tract (53.3%), sepsis (13.3%). There were conjunctivitis (66.6%), keratitis (60%), gastroenterologic complications (40%), anxiety disorder (13.3%), and urologic complications (13.3%) in the accompanied systemic complications at first visit. 4. The analysis of a medication history in 15 patients showed 10 cases of prescribed medication and 5 female cases of non-prescribed medication. The patients taking prescribed medication were younger (47.3 years old) than the cases of non-prescribed medication (68 years old). Four cases among the patients with non-prescribed medication at the pharmacy corresponded to the prescription drugs. CONCLUSION: In Jeju island, the incidence of SJS and TEN seems to be higher than that in the published literatures. Along with the habitual pattern of too frequent, prolonged medication by elder patients, the territorial trait of seeing a pharmacist for the disease care at first, and the pharmacists practicing medicine like a physician instead of dispensing a prescription, might contribute to this higher incidence. Anti-glaucoma ophthalmics and anti-convulsants might be the principal causative drugs leading to SJS or TEN in Jeju island.