Stevens Johnson Syndrome

This paper reports the objective intervention of the Hospital Dentistry team of the Beneficent Association of Campo Grande Santa Casa, contemplating a multi-professional approach to present Low-Level Laser Therapy (LLLT) as a therapeutic alternative for the treatment of individuals with Stevens-Johnson Syndrome (SJS). Male patient, 13 years old, with an initial complaint of pain, edema and burning mouth was treated by in situ applications of LLLT - Aluminium Gallium Indium Phosphide - InGaAlP type diode Laser (Laser duo / DMC Therapy XT, São Carlos, SP, Brazil), to promote photobiomodulation and subsequent repair of the compromised mucosa. Monitoring the patient during four laser therapy sessions with 24-hour intervals between them revealed a favorable evolution of the clinical picture with tissue repair, decreased pain and consequent oropharyngeal homeostasis. The favorable results consolidate LLLT as an alternative to be adopted with considerable effectiveness in combating pain and tissue changes in the oral mucosa resulting from the SJS.

Our purpose is to comprehensively review the state of the art with regard to Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with particular attention to improving the management of associated ocular surface complications. SJS and TEN are two ends of a spectrum of immune-mediated disease, characterized in the acute phase by a febrile illness followed by skin and mucous membrane necrosis and detachment. Part I of this review focused on the systemic aspects of SJS/TEN and was published in the January 2016 issue of this journal. The purpose of Part II is to summarize the ocular manifestations and their management through all phases of SJS/TEN, from acute to chronic. We hope this effort will assist ophthalmologists in their management of SJS/TEN, so that patients with this complex and debilitating disease receive the best possible care and experience the most optimal outcomes in their vision and quality of life.

Lesi Vesikobulosa merupakan lesi berisi cairan jernih dan berada pada lapisan epitel, ruptur serta menimbulkan ulserasi. Lesi vesikobulosa dalam rongga mulut memiliki gambaran klinis, sehingga dibutuhkan pemeriksaan penunjang dalam menentukan diferensial diagnosis untuk tatalaksana perawatan yang tepat.

Advances in genetic research and molecular biology techniques have made it possible to begin to characterize the underlying genetic factors that predispose patients to serious forms of drug-induced skin injury (DISI). To facilitate research in this area, we have set out standardized phenotypic definitions for (i) Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), (ii) acute generalized exanthematous pustulosis (AGEP), and (iii) hypersensitivity syndrome (HSS; also known as drug reaction with eosinophilia and systemic symptoms (DRESS) and drug-induced hypersensitivity syndrome (DIHS)). A DISI Expert Working Group comprising participants with varied expertise reviewed and debated current terminology and diagnostic criteria for DISI and agreed on the minimum phenotypic criteria for selected forms of DISI (SJS/TEN, AGEP, and HSS). In addition, an algorithm has been developed to aid appropriate clinical categorization of patients with DISI. These standardized criteria will be important in facilitating adequate and accurate patient recruitment in order to advance research in pharmacogenomic, immunological, mechanistic, and epidemiological studies.Clinical Pharmacology & Therapeutics (2011) 89 6, 896–901. doi:10.1038/clpt.2011.79

Epidermal necrolysis (EN)--either Stevens-Johnson syndrome (SJS) or toxic EN (TEN)--is a severe drug reaction. We constructed and evaluated a specific algorithm, algorithm of drug causality for EN (ALDEN), in order to improve the individual assessment of drug causality in EN. ALDEN causality scores were compared with those from the French pharmacovigilance method in 100 cases and the case-control results of the EuroSCAR study. Scores attributed by ALDEN segregated widely. ALDEN pointed to a "probable" or "very probable" causality in 69/100 cases as compared to 23/100 with the French method (P < 0.001). It scored "very unlikely" causality for 64% of medications vs. none with the French method. Results of ALDEN scores were strongly correlated with those of the EuroSCAR case-control analysis for drugs associated with EN (r = 0.90, P < 0.0001), with probable causality being reported in 218/329 exposures. ALDEN excluded causality in 321 drugs that the ...

Most studies on drug-induced toxic epidermal necrolysis (TEN) report a high mortality rate. This has been attributed partly to the use of corticosteroids for its treatment. However, we consider corticosteroids to be the sheet anchor for saving the patients having TEN. Our approach to the treatment of this disease consists of administering a relatively high dose of corticosteroids to control the reaction at the earliest possible time and then withdrawing corticosteroids at the fastest possible rate. As illustrated by the five case reports, the reaction is controlled within 24 to 48 hours and the corticosteroids are withdrawn within the next 7 to 10 days. During this period, the skin also shows almost complete healing. With the confidence gained with this approach, we undertake the provocation test as a rule in every patient to find the actual drug responsible for the reaction.. Corticosteroids used in an appropriate dosage schedule constitute an important component of the treatment for TEN to ensure early recovery.

Dermatological emergencies include a number of clinical conditions usually accompanied by systemic symptoms that can lead to life-threatening complications. From the broad spectrum of life-threatening dermatoses, three cases are presented: a case of febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a case of pemphigus vulgaris mimicking Stevens-Johnson syndrome (SJS), and a case of toxic epidermal necrolysis (TEN). Those cases were considered extreme, and presented to illustrate the positive outcome of timely intensive dermatological care. An interdisciplinary approach is essential in the diagnosis, treatment, management, and follow up of patients with life-threatening dermatoses.