371 Retrospective Analysis of Ocular Involvement and Outcomes following a Novel Approach to Application of Amniotic Membrane Graft in the Management of Stevens - Johnson Syndrome and Toxic Epidermal Necrolysis at a Level One Burn Center

Abstract An 18-year-old woman developed Stevens-Johnson syndrome (SJS) with ocular involvement after taking ibuprofen. She was admitted to another hospital, received saline flushes and bacitracin ophthalmic ointment to the eyes, and became unable to open them. Upon transfer to this burn center 3 weeks after symptom onset, there was complete fusion of both eyelids with no visible cornea or sclera. She underwent bilateral operative scar release. After opening the lids, meticulous debridement of cicatricial membranes and release of symblephara were performed with subsequent placement of amniotic membrane grafts. Her vision slowly improved, though her long-term visual prognosis remains guarded. Early recognition and treatment of SJS or toxic epidermal necrolysis (TEN) with ocular involvement is imperative. Even mild cases may require intensive topical lubrication, steroids, and antibiotics, with early placement of amniotic membrane grafts in severe cases. Prompt intervention and daily evaluation are paramount in preventing lifelong visual disability.

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A multicentric, prospective and retrospective analysis of Stevens–Johnson syndrome, toxic epidermal necrolysis and Stevens–Johnson syndrome/toxic epidermal necrolysis overlap: An Indian perspective

Indian Journal of Drugs in Dermatology ◽

10.4103/ijdd.ijdd_63_19 ◽

2021 ◽

Vol 7 (1) ◽

pp. 24

Author(s):

Jyothi Jayaraman ◽

RameshMarne Bhat ◽

Navyashree Suresha ◽

Sukumar Dandekeri ◽

MyfanwyJoanne D'souza

Keyword(s):

Toxic Epidermal Necrolysis ◽

Retrospective Analysis ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Indian Perspective

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Differences in Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis at Burn Centers and Nonburn Centers

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa082 ◽

2020 ◽

Vol 41 (5) ◽

pp. 945-950

Author(s):

Rachel M Nygaard ◽

Frederick W Endorf

Keyword(s):

Toxic Epidermal Necrolysis ◽

Severe Disease ◽

Definitive Treatment ◽

Stevens Johnson Syndrome ◽

Skin Disorders ◽

National Inpatient Sample ◽

Term Care ◽

Burn Centers ◽

Burn Center ◽

Johnson Syndrome

Abstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and Stevens–Johnson/TEN overlap syndrome (SJS/TEN) are severe exfoliative skin disorders resulting primarily from allergic drug reactions and sometimes from viral causes. Because of the significant epidermal loss in many of these patients, many of them end up receiving treatment at a burn center for expertise in the care of large wounds. Previous work on the treatment of this disease focused only on the differences in care of the same patients treated at nonburn centers and then transferred to burn centers. We wanted to explore whether patients had any differences in care or outcomes when they received definitive treatment at burn centers and nonburn centers. We queried the National Inpatient Sample database from 2016 for patients with SJS, SJS/TEN, and TEN diagnoses. We considered burn centers as those with greater than 10 burn transfers to their center and fewer than 5 burn transfers out of their center in a year. Multivariable logistic regression assessed factors associated with treatment at a burn center and mortality. Using the National Inpatient Sample, a total of 1164 patients were identified. These were divided into two groups, nonburn centers vs burn centers, and those groups were compared for demographic characteristics as well as variables in their hospital course and outcome. Patients treated at nonburn centers were more likely to have SJS and patients treated at burn centers were more likely to have both SJS/TEN and TEN. Demographics were similar between treatment locations, though African-Americans were more likely to be treated at a burn center. Burn centers had higher rates of patients with extreme severity and mortality risks and a longer length of stay. However, burn centers had similar actual mortality compared to nonburn centers. Patients treated at burn centers had higher charges and were more likely to be transferred to long-term care after their hospital stay. The majority of patients with exfoliative skin disorders are still treated at nonburn centers. Patients with SJS/TEN and TEN were more likely to be treated at a burn center. Patients treated at burn centers appear to have more severe disease but similar mortality to those treated at nonburn centers. Further study is needed to determine whether patients with these disorders do indeed benefit from transfer to a burn center.

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Burn Center Care of Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Clinics in Plastic Surgery ◽

10.1016/j.cps.2017.02.016 ◽

2017 ◽

Vol 44 (3) ◽

pp. 583-595 ◽

Cited By ~ 8

Author(s):

Robert Cartotto

Keyword(s):

Toxic Epidermal Necrolysis ◽

Stevens Johnson Syndrome ◽

Burn Center ◽

Johnson Syndrome ◽

Center Care

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MANAGEMENT OF ACUTE STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS USING AMNIOTIC MEMBRANE AND TOPICAL CORTICOSTEROIDS

Evidence-Based Ophthalmology ◽

10.1097/ieb.0b013e3181e472fa ◽

2010 ◽

Vol 11 (4) ◽

pp. 202-203

Author(s):

Hall F. Chew

Keyword(s):

Toxic Epidermal Necrolysis ◽

Amniotic Membrane ◽

Stevens Johnson Syndrome ◽

Topical Corticosteroids ◽

Johnson Syndrome

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Cyclosporine treatment for Stevens-Johnson syndrome/toxic epidermal necrolysis: Retrospective analysis of a cohort treated in a specialized referral center

Journal of the American Academy of Dermatology ◽

10.1016/j.jaad.2016.07.048 ◽

2017 ◽

Vol 76 (1) ◽

pp. 106-113 ◽

Cited By ~ 45

Author(s):

Haur Yueh Lee ◽

Stephanie Fook-Chong ◽

Hong Yi Koh ◽

Tharmotharampillai Thirumoorthy ◽

Shiu Ming Pang

Keyword(s):

Toxic Epidermal Necrolysis ◽

Retrospective Analysis ◽

Stevens Johnson Syndrome ◽

Referral Center ◽

Johnson Syndrome

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Management of ocular involvement in the acute phase of Stevens-Johnson syndrome and toxic epidermal necrolysis: french national audit of practices, literature review, and consensus agreement

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-020-01538-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

D. Thorel ◽

S. Ingen-Housz-Oro ◽

G. Royer ◽

A. Delcampe ◽

N. Bellon ◽

...

Keyword(s):

Corticosteroid Therapy ◽

Acute Phase ◽

Amniotic Membrane ◽

Systemic Corticosteroid ◽

Stevens Johnson Syndrome ◽

Amniotic Membrane Transplantation ◽

Ocular Involvement ◽

Eye Drops ◽

Johnson Syndrome ◽

Systemic Corticosteroid Therapy

Abstract Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) can lead to severe ophthalmologic sequelae. The main risk factor is the severity of the initial ocular involvement. There are no recommendations for ocular management during acute phase. We conducted a national audit of current practice in the 11 sites of the French reference center for toxic bullous dermatoses and a review of the literature to establish therapeutic consensus guidelines. We sent a questionnaire on ocular management practices in SJS/ TEN during acute phase to ophthalmologists and dermatologists. The survey focused on ophthalmologist opinion, pseudomembrane removal, topical ocular treatment (i.e. corticosteroids, antibiotics, antiseptics, artificial tear eye drops, vitamin A ointment application), amniotic membrane transplantation, symblepharon ring use, and systemic corticosteroid therapy for ophthalmologic indication. Nine of 11 centers responded. All requested prompt ophthalmologist consultation. The majority performed pseudomembrane removal, used artificial tears, and vitamin A ointment (8/9, 90%). Combined antibiotic-corticosteroid or corticosteroid eye drops were used in 6 centers (67%), antibiotics alone and antiseptics in 3 centers (33%). Symblepharon ring was used in 5 centers (55%) if necessary. Amniotic membrane transplantation was never performed systematically and only according to the clinical course. Systemic corticosteroid therapy was occasionally used (3/9, 33%) and discussed on a case-by-case basis. The literature about ocular management practice in SJS/ TEN during acute phase is relatively poor. The role of specific treatments such as local or systemic corticosteroid therapy is not consensual. The use of preservatives, often present in eye drops and deleterious to the ocular surface, is to be restricted. Early amniotic membrane transplantation seems to be promising.

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