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

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.

scholarly journals Erythema Multiforme Versus Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis: Subtle Difference in Presentation, Major Difference in Management

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1847-e1850
Author(s):  
Russell E Newkirk ◽  
Daren A Fomin ◽  
Mary M Braden
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Erythema Multiforme ◽  
Management Strategies ◽  
Stevens Johnson Syndrome ◽  
Subtle Difference ◽  
Medical Evacuation ◽  
Johnson Syndrome ◽  
Clinical Presentations ◽  
Review Management ◽  
The Military

Abstract Erythema multiforme and Stevens–Johnson syndrome/toxic epidermal necrolysis are immune-mediated epidermal conditions with variable clinical presentations. Although their clinical presentations often overlap, they have distinct etiologies and potential outcomes, which necessitate specific management strategies. This case is presented to highlight the subtle differences and review management given that Stevens–Johnson syndrome/toxic epidermal necrolysis can rapidly become life-threatening. The need for astute diagnostic work-up and accuracy is magnified in the military setting given operations in austere environments and availability of medical and medical evacuation resources. Herein, we present a less common case of bullous erythema-multiforme, the diagnostic approach, and clinical differential with special attention to the importance of the military physician.

scholarly journals 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

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.

Combination therapy: Etanercept and intravenous immunoglobulin for the acute treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis

Burns ◽  
2019 ◽  
Vol 45 (7) ◽  
pp. 1634-1638 ◽  
Author(s):  
Christopher H. Pham ◽  
T. Justin Gillenwater ◽  
Eric Nagengast ◽  
Meghan C. McCullough ◽  
David H. Peng ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Toxic Epidermal Necrolysis ◽  
Intravenous Immunoglobulin ◽  
Acute Treatment ◽  
Stevens Johnson Syndrome ◽  
Johnson Syndrome

scholarly journals USA: Ophthalmologic Evaluation and Management of Acute Stevens-Johnson Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Darren G. Gregory
Keyword(s):  
Acute Phase ◽  
Ocular Surface ◽  
Vision Loss ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Johnson Syndrome ◽  
Significant Damage ◽  
Main Development ◽  
The Usa ◽  
Chronic Sequelae

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can cause significant damage to the ocular surface and eyelids. The sloughing and inflammation of the ocular mucosal epithelium during the acute phase may lead to scarring sequelae of the eyelids and ocular surface, resulting in pain and vision loss. Amniotic membrane transplantation (AMT) to the eyes and eyelids during the initial 1–2 weeks of the disease can decrease the chronic sequelae. The main development in the ophthalmologic treatment of SJS/TEN in the USA over the last 15 years has been the use of AMT on the ocular surface and eyelids during the acute phase. The evolution of AMT techniques, refinement of the evaluation of the eyes in acute SJS, and the efforts to increase the use of AMT in the USA are discussed.

scholarly journals Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in Taiwan

2021 ◽  
Vol 8 ◽  
Author(s):  
David Hui-Kang Ma ◽  
Tsung-Ying Tsai ◽  
Li-Yen Pan ◽  
Shin-Yi Chen ◽  
Ching-Hsi Hsiao ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Therapeutic Effect ◽  
Acute Stage ◽  
Stevens Johnson Syndrome ◽  
Amniotic Membrane Transplantation ◽  
Clinical Aspects ◽  
Ocular Complications ◽  
Etanercept Treatment ◽  
Johnson Syndrome

Purpose: Over the last decade, there has been tremendous progress in the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). To understand whether this has resulted in better ophthalmic outcomes, we aimed to study the incidence of severe ocular complications (SOCs) in the acute and chronic stage among SJS/TEN patients, major causative medications, and therapeutic effect of medical and surgical treatment.Methods: Using electronic medical records review of patients of Chang Gung Memorial Hospital Linkou Branch from 2010 to 2020, 119 patients (236 eyes) received ophthalmic consultation during the acute stage and were retrospectively studied. Sotozono's grading score systems for acute and chronic SJS/TEN were employed for accessing correlation between acute and chronic presentations, the therapeutic effect of systemic etanercept treatment, and outcome of early amniotic membrane transplantation (AMT) performed in patients with severe acute SOCs.Results: There were 46 male and 73 female patients with a mean age of 45.6 ± 22.7 years old (2–90 years), and follow-up time of 408.3 ± 351.0 (116–1,336) days. The numbers of patients with SJS, overlap syndrome, and TEN were 87, 9, and 23, respectively. In total, 109 eyes (55 patients) had acute SOCs, which comprised 46.2% of patients who underwent ophthalmic examination. Antiepileptics were the most common category of culprit drugs causing SOCs in the acute stage. At the end of follow-up, there were 14 eyes (9 patients) with chronic SOCs (5.9%), and non-steroidal anti-inflammatory drugs and cold medicine were the most common causative medications that were associated with severe chronic sequela. The correlation between Sotozono's acute and chronic grading score showed a positive relationship [Spearman's rank correlation coefficient (r) = 0.52, p < 0.001]. The average chronic grading scores in patients receiving systemic corticosteroid combined with etanercept treatment were significantly lower than those receiving corticosteroid only, Finally, the average chronic grading scores in patients receiving AMT <7 days after onset were significantly lower than those performed beyond 7 days.Conclusion: Our study implies that acute manifestation can be an indicator for chronic sequelae. Additional early etanercept treatment and early AMT showed beneficial effect in reducing chronic ocular sequela.

Sign in / Sign up

Export Citation Format

Share Document