Evaluation of causative drugs and types of treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis during 2010-2015 at Shahid Faghihi Hospital, Shiraz, Iran

Background and Objective: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two ends of the spectrum of severe immunobullous state characterized by keratinocyte apoptosis. In TEN, epidermal loss influences more than 30% of the total body surface, while SJS involves less than 10% of the body surface area. SJS/TEN overlap is characterized by epidermal detachment and the detachable skin between 10%-30%. A substantial amount of research has been published on different epidemiologic aspects of them. However, epidemiologic studies in Iran are scarce. Therefore, the present study aimed to draw attention to various epidemiological features of SJS and TEN diseases such as causative drugs and types of treatment in Iran. Materials and Methods: In this cross-sectional study, the records of all patients with the diagnosis of SJS, TEN, and SJS/TEN overlap during 2010-2015 were retrospectively reviewed. The patients were admitted to the Dermatology Tertiary Referral Center of Shahid Faghihi Hospital affiliated to the Shiraz University of Medical Sciences, Shiraz, Iran. The study was approved by the Ethics Committee of Shiraz University of Medical Sciences (code: ir.sums.med. rec.1395.s154). The diagnosis of these patients was mainly based on clinical signs and symptoms, and in a few cases, a skin biopsy was done to rule out any other conditions. From the records, patients’ admission and progress notes, charts, examination results, and treatments were retrospectively evaluated.Descriptive statistics were reported as mean±SD or frequency (%) for quantitative and qualitative data, respectively. The association between the two categorical variables was assessed using the chi-square or the Fisher s exact test, where appropriate, and non-parametric Kruskal-Wallis test was used to test quantitative variables among the three types of disorders. Statistical analysis was performed using the SPSS software (version18.0) and P<0.05 was considered statistically significant. Findings:From a total of 97 patients with such skin disorders, we identified SJS in 89 (91.8 %), TEN in 5 (5.1%), and SJS/TEN overlap in 3 (3.1%) patients. The most commonly consumed drug was Lamotrigine (21.6%) and the most common drug category was anticonvulsants (46.4%). Patients with SJS/TEN overlap or TEN were treated with combination therapy, whereas SJS patients received systemic corticosteroids. (P-value<0.001) Conclusion:There are some differences between the epidemiological features of SJS and TEN diseases. In line with many studies, particularly in Iran, lamotrigine and anticonvulsants were the most common causative drugs. Also, patients with SJS/TEN overlap or TEN were treated with combination therapy, whereas SJS patients received systemic corticosteroids. To the best of our knowledge, this is one of the most large-scale investigations in Iran on various epidemiological features of SJS and TEN diseases.

کلیدواژه ها:

Stevens-Johnson Syndrome ، Drug Eruptions ، Epidemiology