Severe Cutaneous Adverse Reactions: A Single-Center Retrospective Study of 173 Patients in China
- Author:
Zhongyi XU
1
;
Jie SHEN
;
Yiwen YANG
;
Ruoyue YUAN
;
Leihong Flora XIANG
;
Chengfeng ZHANG
Author Information
- Publication Type:Original Article
- Keywords: Acute generalized exanthematous pustulosis; Drug reaction with eosinophilia and systemic symptoms; Stevens-Johnson syndrome; Systemic corticosteroids treatment; Toxic epidermal necrolysis
- MeSH: Acute Generalized Exanthematous Pustulosis; Adrenal Cortex Hormones; Allopurinol; Anti-Bacterial Agents; Carbamazepine; China; Cicatrix; Drug Hypersensitivity Syndrome; Eosinophilia; Humans; Lymphatic Diseases; Mortality; Prognosis; Public Health; Retrospective Studies; Skin; Stevens-Johnson Syndrome; Tertiary Healthcare
- From:Annals of Dermatology 2019;31(5):545-554
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND: Severe cutaneous adverse reactions (SCAR) to drugs are a crucial public health issue and the use of systemic corticosteroids in SCAR has been controversial. OBJECTIVE: To analyze clinical features, causative drugs, treatment, outcomes, and prognostic factors of SCAR in the case-series of 173 patients, and add more information to the debate of using systemic corticosteroids in SCAR management. METHODS: A retrospective study of 173 SCAR patients diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) or acute generalized exanthematous pustulosis (AGEP) at a tertiary care institution in China between January 2014 and December 2017 was conducted. RESULTS: Of 173 patients, allopurinol, carbamazepine, and antibiotics are the most frequently implicated drugs for DRESS (40.4%), SJS/TEN (26.0%), and AGEP (40.0%) respectively. Moreover, there is a strongly negative correlation between early corticosteroids use and the progression (p=0.000) and severity (p=0.01) of skin lesions. However, there is no association between early corticosteroids use and the mortality of SCAR (odds ratio: 1.01, 95% confidence interval: 0.95~1.08). In addition, lymphadenopathy, eosinophilia, and interval from onset to corticosteroids treatment were correlated with SCAR prognosis. CONCLUSION: Prompt short-course systemic corticosteroids use is associated with early-stage skin lesions remission without influencing the disease mortality. Lymphadenopathy and eosinophilia were the independent poor prognostic factors of SCAR.
