ABSTRACT
Clear guidelines for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are lacking due to its infrequency and the absence of large controlled studies. Systemic corticosteroids and intravenous immunoglobulin (IVIG) have received considerable attention, though reports of the use of these agents have demonstrated mixed success rates in improving morbidity and mortality from SJS/TEN. We present a case series of 4 patients with SJS/TEN who rapidly responded to treatment with cyclosporin A (CsA). We discuss the proposed mechanism of action and the rationale for the use of cyclosporin based on the currently understood pathophysiologic mechanism of TEN.
Subject(s)
Cyclosporine/therapeutic use , Dermatologic Agents/therapeutic use , Stevens-Johnson Syndrome/drug therapy , Acetaminophen/adverse effects , Adult , Analgesics, Non-Narcotic/adverse effects , Anti-Infective Agents/adverse effects , Anticonvulsants/adverse effects , Drug Combinations , Female , Humans , Lamotrigine , Male , Stevens-Johnson Syndrome/chemically induced , Sulfamethizole/adverse effects , Triazines/adverse effects , Trimethoprim/adverse effectsABSTRACT
The proper nomenclature and classification of the group of diseases known as neutrophilic dermatoses is a topic of ongoing interest and study Specifically, the possible relationship between neutrophilic dermatosis of the dorsal hands (NDDH) and Sweet disease (SD), or their existence as separate and discrete entities, has been explored in the literature. We present the case of a 63-year-old woman with acute myelogenous leukemia (AML) who developed NDDH 4 weeks after undergoing chemotherapy. Results from a punch biopsy revealed leukocytoclasia and endothelial swelling around the dermal vessels, with no evidence of fibrinoid necrosis of the vessel walls. This case may lend support to the concept that NDDH is a variant of SD rather than a distinct clinical entity.
