Warning against long-acting sulphonamides

1966 ◽  
Vol 4 (4) ◽  
pp. 13-13
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Erythema Multiforme ◽  
The United States ◽  
Stevens Johnson Syndrome ◽  
Warning Letter ◽  
Johnson Syndrome ◽  
The Us ◽  
Mucous Membranes ◽  
Long Acting

Last month the US Food and Drug Administration required American manufacturers of long-acting sulphonamides (sulphamethoxypyridazine, Lederkyn - Lederle and Midicel - PD; sulphadimethoxine - Madribon - Roche) to warn prescribers that in rare cases the Stevens-Johnson syndrome may develop as a severe and sometimes fatal side effect. This syndrome is a type of erythema multiforme in which large blisters appear on the skin and especially on the mucous membranes. The manufacturers were also to advise doctors ‘to consider prescribing short-acting sulphonamides first because they are effective for most of the same conditions’. The three drug firms concerned accordingly sent a joint warning letter to all doctors, pointing out that the Stevens-Johnson syndrome is a serious complication with a mortality rate of about 25%. So far 116 cases of this syndrome have been reported in association with the use of long-acting sulphonamides, most of them in the United States. Almost two thirds of the patients were children.

Head and Neck Manifestations of Erythema Multiforme in Children

1994 ◽  
Vol 111 (3P1) ◽  
pp. 236-242 ◽  
Author(s):  
Michael G. Stewart ◽  
Newton O. Duncan ◽  
Daniel J. Franklin ◽  
Ellen M. Friedman ◽  
Marcelle Sulek
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Head And Neck ◽  
Erythema Multiforme ◽  
Medication Use ◽  
Stevens Johnson Syndrome ◽  
Striking Increase ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Mucous Membranes

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.

scholarly journals Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States

2017 ◽  
Vol 76 (5) ◽  
pp. 811-817.e4 ◽  
Author(s):  
Derek Y. Hsu ◽  
Joaquin Brieva ◽  
Nanette B. Silverberg ◽  
Amy S. Paller ◽  
Jonathan I. Silverberg
Keyword(s):  
United States ◽  
Toxic Epidermal Necrolysis ◽  
The United States ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

Comparing the Accuracy of ABCD-10 and SCORTEN in Predicting the In-Hospital Mortality of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multi-Institutional Study from Central China

Dermatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Huinan Suo ◽  
Biling Jiang ◽  
Xiaoyan Sun ◽  
Jing Dong ◽  
Mahin Alamgir ◽  
...  
Keyword(s):  
United States ◽  
Hospital Mortality ◽  
Prediction Model ◽  
Toxic Epidermal Necrolysis ◽  
Goodness Of Fit ◽  
The United States ◽  
Central China ◽  
Stevens Johnson Syndrome ◽  
Risk Of Death ◽  
Johnson Syndrome

<b><i>Background:</i></b> The newly described ABCD-10 (age, bicarbonate, cancer, dialysis, 10% body surface area [BSA]) is a 5-item mortality prediction model for patients with Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It was developed in the United States, has at present been externally tested only in the United States, Spain, and Singapore, and remains to be validated in resource-restricted settings. We sought to compare the accuracy of ABCD-10 and Score of Toxic Epidermal Necrolysis (SCORTEN) in predicting in-hospital mortality in a cohort from central China. Due to disease progression affecting the accuracy of the prediction model during hospitalization, for example, higher predictive accuracy of SCORTEN based on parameters collected on day 3 of hospitalization, we also assessed the overall predictive value of ABCD-10 on days 1 and 3, respectively. <b><i>Methods:</i></b> A retrospective study was performed over a 10-year period (2010–2020) from 3 medical institutions in Wuhan. The performance of predictive models was assessed by both discrimination and calibration. Receiver-operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit tests and calibration plots were used to evaluate the model discrimination and calibration. <b><i>Results:</i></b> Of 84 included patients, 11 (13.1%) did not survive. The discrimination power of ABCD-10 was not significantly different from that of SCORTEN (area under the curve: day 1, <i>p</i> &#x3e; 0.05; day 3, <i>p</i> &#x3e; 0.05). Although the calibration of ABCD-10 was good, it was inferior to SCORTEN as it underestimated total mortality (Hosmer-Lemeshow goodness-of-fit test: day 1, <i>p</i> = 0.17 vs. <i>p</i> = 0.63; day 3, <i>p</i> = 0.35 vs. <i>p</i> = 0.93). Besides, the performance of ABCD-10 was slightly better on day 3 relative to day 1. During hospitalization, bacteremia developed in 21 (25.0%) patients, which was associated with a higher risk of death in our cohort (odds ratio, 22.88; 95% CI, 4.38–119.40; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> ABCD-10 showed acceptable overall performance, but revealed mortality underestimation and was inferior to the performance of SCORTEN. In consistence with SCORTEN, ABCD-10 was a better model when using values collected at day 3 of hospitalization relative to day 1.

scholarly journals Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States

2018 ◽  
Vol 138 (11) ◽  
pp. 2315-2321 ◽  
Author(s):  
Robert G. Micheletti ◽  
Zelma Chiesa-Fuxench ◽  
Megan H. Noe ◽  
Sasha Stephen ◽  
Maria Aleshin ◽  
...  
Keyword(s):  
United States ◽  
Retrospective Study ◽  
Toxic Epidermal Necrolysis ◽  
The United States ◽  
Adult Patients ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

Unnecessary Biopsy?

PEDIATRICS ◽  
1981 ◽  
Vol 67 (3) ◽  
pp. 444-444
Author(s):  
Benjamin C. Berliner
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Mucous Membrane ◽  
Erythema Multiforme ◽  
Scarlet Fever ◽  
Stevens Johnson Syndrome ◽  
Staphylococcal Scalded Skin Syndrome ◽  
Johnson Syndrome ◽  
Mucous Membranes ◽  
Clinical Description ◽  
Typical Instance

The clinical description of the little girl's disease which is provided in the article by Manzella et al1 is certainly sufficient for a diagnosis, and biopsy rather than being "essential" is an unnecessary and unwarranted intervention. I am puzzled by the diagnostic term "toxic epidermal necrolysis" as used here. What is described is a typical instance of erythema multiforme bullosa (Stevens-Johnson syndrome), a disorder which involves the mucous membranes as well as the skin. This entity is readily distinguishable from the staphylococcal scalded skin syndrome (toxic epidermal necrolysis, staphylococcal scarlet fever, Ritter's disease of the newborn) by the fact that the latter patients exhibit neither bullae nor mucous membrane involvement.

scholarly journals Stevens-Johnson Syndrome

KYAMC Journal ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 31-35
Author(s):  
Arpan Kumar Basak ◽  
Joya Debnath
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Erythema Multiforme ◽  
Primary Care Physicians ◽  
Skin Lesions ◽  
Stevens Johnson Syndrome ◽  
Unknown Etiology ◽  
Initial Report ◽  
Johnson Syndrome ◽  
Erythema Multiforme Major ◽  
Mucous Membranes

Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and mucous membranes. While minor presentations may occur, significant involvement of oral, nasal, eye, vaginal, urethral, gastrointestinal, and lower respiratory mucous membranes may develop in the course of the illness. GI and respiratory involvement may progress to necrosis. Stevens-Johnson syndrome is a serious systemic disorder with the potential for severe morbidity and even death. The syndrome was first described in 1922, when the American pediatricians Albert Mason Stevens and Frank Chambliss Johnson reported the cases of 2 boys aged 7 and 8 years with "an extraordinary, generalized eruption with continued fever, inflamed buccal mucosa, and severe purulent conjunctivitis". Both cases had been misdiagnosed by primary care physicians as hemorrhagic measles. Erythema multiforme (EM), originally described by Von Hebra in 1866, was part of the differential diagnosis in both cases but was excluded because of the 'character of skin lesions, the lack of subjective symptoms, the prolonged high fever, and the terminal heavy crusting". Despite the presence of leucopenia in both cases, Stevens and Johnson in their initial report suspected an infectious disease of unknown etiology as the cause. In 1950, Thomas divided EM into 2 catagories: erythema multiforme minor (Von Hebra) and Erythema multiforme major (EMM). Since 1983, erythema multiforme major and Stevens-Johnson syndrome had been considered synonymous. In the 1990s, however, Bastuji and Roujeau each proposed that Erythema multiforme major and Stevens-Johnson syndrome are 2 distinct disorders. Several investigators propose that Stevens-Johnson syndrome and Toxic epidermal necrolysis (TEN) represent the same disease at different levels of severity. Although several classification schemes have been reported, the simplest breaks the disease down as follows: * Stevens-Johnson syndrome-A "minor form of TEN", with less than 10% body surface area (BSA) detachment. * Overlapping Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN)-Detachment of 10-30% BSA. * Toxic epidermal necrolysis-Detachment of more than 30%BSA.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 31-35

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