Genetic Markers for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in the Asian Indian Population: Implications on Prevention

This review attempts to collate all the studies performed in India or comprising a population originating from India and to find out if there is an association between the HLA (human leucocyte antigen) type of individual and development of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) subsequent to medication use. The authors performed a PubMed search of all articles published in English from 2009 to 2019 for articles that studied HLA type in patients who developed SJS/TEN after intake of a specific drug in the Asian Indian population or in individuals of Asian Indian origin. The selection criteria were satisfied by a total of 11 studies that reported HLA associations with specific drugs, which induced SJS/TEN, mainly anti-epileptic drugs, and cold medicine/non-steroidal anti-inflammatory drugs. These studies involved a small number of patients, and hence, there is limited evidence to conclude if these associations can be extrapolated to a larger population of the same ethnicity. Similar multi-center studies need to be conducted with a larger sample size to confirm these associations. This would have implications in policy making and for understanding the potential of using genetic markers as a screening tool before prescribing a drug to a patient, which might make them susceptible to developing a potentially life-threatening disease such as SJS/TEN. This is possibly the only mode of primary prevention for this potentially fatal severe cutaneous adverse drug reaction.

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The association of HLA B*15:02 allele and Stevens-Johnson syndrome/toxic epidermal necrolysis induced by aromatic anticonvulsant drugs in a South Indian population

International Journal of Dermatology ◽

10.1111/ijd.13812 ◽

2017 ◽

Vol 57 (1) ◽

pp. 70-73 ◽

Cited By ~ 3

Author(s):

Keerankulangara Devi

Keyword(s):

Toxic Epidermal Necrolysis ◽

Indian Population ◽

Anticonvulsant Drugs ◽

Stevens Johnson Syndrome ◽

South Indian Population ◽

South Indian ◽

Johnson Syndrome

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HLA-B*15:02 association with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in an Indian population: a pooled-data analysis and meta-analysis

Epilepsia ◽

10.1111/epi.12802 ◽

2014 ◽

Vol 55 (11) ◽

pp. e120-e124 ◽

Cited By ~ 22

Author(s):

Amy Hui-Ping Khor ◽

Kheng-Seang Lim ◽

Chong-Tin Tan ◽

Su-Ming Wong ◽

Ching-Ching Ng

Keyword(s):

Data Analysis ◽

Toxic Epidermal Necrolysis ◽

Indian Population ◽

Meta Analysis ◽

Stevens Johnson Syndrome ◽

Pooled Data ◽

Johnson Syndrome

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A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population

Indian Journal of Dermatology Venereology and Leprology ◽

10.4103/0378-6323.110749 ◽

2013 ◽

Vol 79 (3) ◽

pp. 389 ◽

Cited By ~ 33

Author(s):

TejasK Patel ◽

ManishJ Barvaliya ◽

Dineshchandra Sharma ◽

Chandrabhanu Tripathi

Keyword(s):

Systematic Review ◽

Toxic Epidermal Necrolysis ◽

Indian Population ◽

Stevens Johnson Syndrome ◽

Drug Induced ◽

Johnson Syndrome

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501 Burn Center Referral of Patients with Suspected Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.133 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S87-S87

Author(s):

Julie A Rizzo ◽

David S Lidwell ◽

Leopoldo C Cancio

Keyword(s):

Skin Biopsy ◽

Toxic Epidermal Necrolysis ◽

Disease Process ◽

Stevens Johnson Syndrome ◽

Burn Center ◽

Johnson Syndrome ◽

Number Of Patients ◽

Wide Range ◽

Burn Unit ◽

Life Threatening

Abstract Introduction Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but potentially life-threatening, as such referral of these patients to a burn center is appropriate. However, patients with suspected SJS/TEN are often referred to the Burn Center and are found to not actually be suffering from the disease process in question. This inefficient referral process warrants further examination to identify pre-arrival those patients who are appropriate for transfer. Methods As an approved PI project we examined the records of all patients referred to our Burn Center for suspicion of SJS/TEN for the time period 2016–2018. We analyzed the corresponding data to in an attempt to more effectively identify patients with SJS/TEN and prevent unnecessary Burn Center transfers. Results Of 84 patients referred for suspected SJS/TEN 32 received confirmatory diagnosis with skin biopsy after transfer (38%). The average length of stay was 8 ICU days and 14 hospital days versus 3.6 and 9.6 days, respectively, for patients with a negative diagnosis. The mortality rate of SJS/TEN patients was 12.5% (4/32). In addition to SJS/TEN, a wide range of skin conditions were identified among referred patients, many of whom also required hospitalization, including BICU care. The various diagnoses included: Drug eruptions (14%), psoriasis (6%), dermatitis (6%), erythema multiforme (2%), lupus erythematosus (2%) and generalized exanthematous pustulosis (2%). The remainder of patients had miscellaneous or nonspecific conditions (28%). Conclusions SJS/TEN is a potentially life threatening disease often requiring hospitalization in a Burn Intensive Care Unit (BICU). However, many other disease processes have similar presentations and may also be appropriate for Burn Unit care. Without a confirmatory skin biopsy prior to referral a large number of patients are transferred to the BICU unnecessarily. Applicability of Research to Practice In the absence of skin biopsy capabilities at the referring facility an algorithm using common characteristics of actual SJS/TEN patients may improve the accuracy of pre-referral diagnosis. Additionally, this data underscores the importance of dermatology support to the Burn Unit in diagnosing and treating desquamating skin disorders.

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