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2017 ; 34
(6
): 1235-1244
Nephropedia Template TP
gab.com Text
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English Wikipedia
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Concise Review with a
Comprehensive Summary of Therapeutic Interventions Emphasizing Supportive
Measures
#MMPMID28439852
Schneider JA
; Cohen PR
Adv Ther
2017[Jun]; 34
(6
): 1235-1244
PMID28439852
show ga
INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)
are two of the most severe dermatologic conditions occurring in the inpatient
setting. There is a lack of consensus regarding appropriate management of SJS and
TEN. PURPOSE: The scientific literature pertaining to SJS and TEN (subsequently
referred to as SJS/TEN) is summarized and assessed. In addition, an
interventional approach for the clinician is provided. METHODS: PubMed was
searched with the key words: corticosteroids, cyclosporine, etanercept,
intravenous immunoglobulin, Stevens-Johnson syndrome, and toxic epidermal
necrolysis. The papers generated by the search, and their references, were
reviewed. RESULTS: Supportive care is the most universally accepted intervention
for SJS/TEN. Specific guidelines differ from the care required for patients with
thermal burns. Adjuvant therapies are utilized in most severe cases, but the data
are thus far underwhelming and underpowered. Using systemic corticosteroids as
sole therapy is not supported. A consensus regarding combined corticosteroids and
intravenous immunoglobulin (IVIG) has not been reached. Data regarding IVIG,
currently the standard of care for most referral centers, is conflicting. Newer
studies regarding cyclosporine and tumor necrosis factor inhibitors are
promising, but not powered to provide definitive evidence of efficacy. Data
regarding plasmapheresis is equivocal. Thalidomide increases mortality.
CONCLUSION: Clinicians who manage SJS/TEN should seek to employ interventions
with the greatest impact on their patients' condition. While supportive care
measures may seem an obvious aspect of SJS/TEN patient care, providers should
understand that these interventions are imperative and that they differ from the
care recommended for other critically ill or burn patients. While adjuvant
therapies are frequently discussed and debated for hospitalized patients with
SJS/TEN, a standardized management approach is not yet clear based on the current
data. Therefore, until further data are available, decisions regarding such
treatments should be made on a case-by-case basis.
|Adrenal Cortex Hormones/therapeutic use
[MESH]
|Combined Modality Therapy
[MESH]
|Cyclosporine/therapeutic use
[MESH]
|Humans
[MESH]
|Immunoglobulins, Intravenous/therapeutic use
[MESH]