Long-Term Effect of a Treatment Protocol for Acute Ocular Involvement in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

Abstract Background Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening skin conditions with an etiology of drug exposure or infections. Objectives To determine the cause, treatments, complications, and outcomes of SJS/TEN in children admitted to Srinagrind Hospital during 1992–2012. Methods Retrospective chart review. A diagnosis of SJS and TEN was confirmed by pediatric dermatologists. Results A total of 38 patients was recorded. They consisted 31 (82%) SJS patients and 7 (18%) TEN patients. Mean age 6.6 years (range 1 to 14 years). Male to female was 1.1:1. Most cases (30 or 79%) were caused by drug exposure. Three cases (8%) by infection, and 5 cases (13%) were of unknown cause. The antiepileptic drug group was the most common cause. Systemic corticosteroids were used in 33 cases (87%). Intravenous immunoglobulin was used in one TEN patient (3%). There were 18 cases (47%) with acute complications. Ocular complications (7 cases, 39%), septicemia (4 cases, 22%), and secondary skin infections (3 cases, 17%) were the most common. Mean difference in length of hospital stay between those with and without acute complications was 12.3 days (P < 0.01, 95% CI 5.9–18.6). Ocular complications were the only long-term complications at 1-year follow up, and included symblepharon, corneal pannus, and dry eyes. Two patients (5%), both having cases of TEN, died. Conclusions Antiepileptic drugs were the most common causes of SJS/TEN in our study. Good ophthalmologic care of the prevalent acute eye complications in these patients is needed to prevent long-term ophthalmic complications.

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Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

AACN Advanced Critical Care ◽

10.4037/aacnacc2020634 ◽

2020 ◽

Vol 31 (3) ◽

pp. 281-295

Author(s):

Leah M. Hanson ◽

Amanda P Bettencourt

Keyword(s):

Toxic Epidermal Necrolysis ◽

Nursing Care ◽

Psychosocial Support ◽

Wound Care ◽

Stevens Johnson Syndrome ◽

Care Needs ◽

Current State ◽

Johnson Syndrome ◽

State Of The Science

Nurses are central to the care of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients with these conditions present with nuanced symptoms and have complex nursing care needs. Although much of the exact pathophysiology of these diseases is not known, all nurses benefit from a fundamental understanding of the genesis of skin manifestations, associated pharmacology, and prognosis. The care of patients hospitalized with Stevens-Johnson syndrome and toxic epidermal necrolysis consists of wound care, infection prevention, comfort management, hydration and nutrition, psychosocial support, and the prevention of long-term complications. This article provides an overview of these diseases, including clinical diagnosis, history and physical assessment, related pharmacology, and nursing care priorities. A description of the current state of the science in clinical management for nurses at all levels is provided, with an emphasis on nursing’s contribution to the best possible patient outcomes.

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Acute and Chronic Management of Ocular Disease in Stevens Johnson Syndrome/Toxic Epidermal Necrolysis in the USA

Frontiers in Medicine ◽

10.3389/fmed.2021.662897 ◽

2021 ◽

Vol 8 ◽

Author(s):

Derek Metcalfe ◽

Omer Iqbal ◽

James Chodosh ◽

Charles S. Bouchard ◽

Hajirah N. Saeed

Keyword(s):

Chronic Disease ◽

Toxic Epidermal Necrolysis ◽

Acute Treatment ◽

Management Strategies ◽

Ocular Disease ◽

Stevens Johnson Syndrome ◽

Amniotic Membrane Transplantation ◽

Ocular Involvement ◽

Johnson Syndrome ◽

The Usa

Stevens Johnson syndrome and toxic epidermal necrolysis are on a spectrum of a severe, immune-mediated, mucocutaneous disease. Ocular involvement occurs in the vast majority of cases and severe involvement can lead to corneal blindness. Treatment in the acute phase is imperative in mitigating the severity of chronic disease. Advances in acute treatment such as amniotic membrane transplantation have shown to significantly reduce the severity of chronic disease. However, AMT is not a panacea and severe chronic ocular disease can and does still occur even with aggressive acute treatment. Management of chronic disease is equally critical as timely intervention can prevent worsening of disease and preserve vision. This mini-review describes the acute and chronic findings in SJS/TEN and discusses medical and surgical management strategies.

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The possibility of application of endocrowns in prosthetic treatment

Nowa Stomatologia ◽

10.25121/ns.2018.23.3.116 ◽

2018 ◽

Vol 23 (3) ◽

Author(s):

Magda Sobczyk ◽

Tomasz Godlewski

Keyword(s):

Simple Procedure ◽

Treatment Protocol ◽

Glass Ceramics ◽

Good Alternative ◽

Minimal Invasive ◽

Term Effect ◽

Prosthetic Reconstruction ◽

Root Canals ◽

Long Term Effect

After root canal treatment, teeth are weakened and more prone to failure. Prosthetic reconstruction of these teeth should strengthen the remaining structure and ensure the long-term effect of the treatment. An endocrown is a monolithic restoration, which use adhesion and mechanical retention. Most often, it is used during the reconstruction of the non-vital molars. It is debatable whether the premolars due to its structure should be rebuilt without the use of post. An endocrown is also used in reconstruction of teeth with low crowns and with short, obliterated root canals. The main advantages of it are a simple procedure, shorter treatment protocol compared to the classic reconstruction, lower costs, satisfactory aesthetics, reduction of stress, minimal invasive preparation or a smaller number of complications. Most frequently mentioned drawbacks are the possibility of fracture of the tooth and debonding of reconstruction. Most commonly used materials in performing endocrowns are composite and glass ceramics. According to the advantages and clinical trials, endocrowns seem to be a good alternative to the classic restorations after endodontic treatment using posts and crowns.

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