Abstract
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Background : Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrosis (TEN) are rare but severe adverse drug cutaneous reactions associated with the use of several medications. Objective : To review the current medication use and the risk of stevens-johnson syndrome or toxic epidermal necrosis that is associated with the medicine Studymethod: All publications describing medication use and risk of SJS and TEN in adults and children were searched in Medline and The Cochrane collaboration. The search yielded 920 references, of which 896 were excluded, we couldn’t retrieve 11 case reports, hence 13 references were included, which consisted of 4 case-control studies in 1405 cases (5736 controls),a study of 82 retrospectively reviewed cases,7 case reports, a pooled analysis from 2 multicentre case-control studies in paediatric patients involving 80 cases and 216 controls and another study in children consisting of 29 sjs/ten cases. As a result totally 1414 adult cases and 135 paediatric cases of sjs/ten associated with drug use were included in the study. Results :The total number of patients of Stevens Johnson syndrome or toxic epidermal necrosis (associated with medication use) included in the reports are 1549 (which include 1414 adult patients and 135 pediatric patients).Among them 287 patients were associated with the use of antibiotics, which account for 18.53% of the total diseased. The use of antiepileptic’s was found in 274 patients which account for 17.69% of total. A total of 147 patients were associated with the use of allopurinol (An antigout agent) accounting for 9.49% of total. A total of 115 patients were associated with the use of NSAIDs, accounting for 7.42% of total. Around 96 were associated with the use of Analgesics (non NSAID), accounting for 6.20% of total. Rest of the medications used included Proton Pump Inhibitors(PPI) in 34 patients(2.19%),Antiviral drugs in 21 patients (1.36%),chlormezanone in 13(0.84%),Antihyperlipidemic in 12(0.77%) and chemotherapy as a cause in 2 patients accounting for 0.13%. |
Conclusion : Stevens Johnson syndrome and Toxic Epidermal necrosis are rare but potentially severe adverse drug reactions associated with the use of several medications. Mortality rate in children was found to be significantly lower than in adults. Antibiotics as a group dominated for both adults and children, followed by antiepileptic’s, oxicam NSAIDs, allopurinol, chlormezanone, and corticosteroids, which were associated with increased in the risk of Stevens–Johnson syndrome or toxic epidermal necrolysis. However, when individual drugs were considered, it was the antiepileptic, carbamazepine, that was associated with most of the SJS/TEN patients(both adult and children) encountered. But for no drug the risk exceeded five cases per million users per week. Our study also found that the risk associated is directly proportional to the exposure time for any drug.
