Antiepileptic Medication-induced Severe Cutaneous Adverse Reactions in Hospitalized Children: A Retrospective Study.

BACKGROUND: There are limited data on severe cutaneous adverse reactions (SCARs) associated with antiepileptic medications. The current study aims to investigate the clinical and epidemiological characteristics of antiepileptic medication-induced SCARs in hospitalized children. MATERIALS AND METHODS: The current five-year retrospective study was conducted at Isfahan University of Medical Sciences, Iran. This study included all children with a definite diagnosis of SCARs secondary to the use of antiepileptic medications based on the world health organization (WHO) definition. In our study SCARs were categorized into three fields: Hypersensitivity syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). RESULTS: Among 259 children with SCARs induced by antiepileptic medications, 199 (76.83%), 42 (16.22%), and 18 (6.95%) had hypersensitivity syndrome, DRESS, and SJS/TEN, respectively. Phenobarbital was the most common offending drug in all types of SCARs. The multinomial logistic regression model revealed that lymphadenopathy increased the occurrence of DRESS by 35 times compared to hypersensitivity syndrome (P < 0.001). Girls were at risk of SJS/TEN approximately 6 times more than boys (P = 0.027). Age (P = 0.021), weight (P = 0.036), and mucosal involvement (P < 0.001) affected the hospitalization duration in children with SCARs related to antiepileptic medication. CONCLUSION: There are some similarities and differences in the clinical and epidemiological features of Iranian children suffering from antiepileptic medication-induced SCARs.

Drugs associated with epidermal necrolysis in children: A World Health Organization pharmacovigilance database analysis.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening mucocutaneous reactions most often induced by drugs. To date, no large pharmacovigilance study has been conducted in the paediatric population. OBJECTIVES: To describe the spectrum of drugs associated with SJS-TEN in children through the analysis of cases reported in the WHO pharmacovigilance database (VigiBase). METHODS: Disproportionality study using data from VigiBase. All paediatric (age under 18 years) cases reported between January 1, 1967, and July 6, 2022, were included. For each molecule, a case-non-case study was performed to assess a potential pharmacovigilance signal by computing the lower end of the 95% credibility interval for the information component (IC025). We performed sensitivity analyses, (i) taking into account only cases reported by physicians and (ii) taking into account only cases reported in the last 10 years. RESULTS: Among 31,376,783 adverse drug reactions reported in VigiBase, 2,248,727 were paediatric cases and 7342 were encoded as paediatric SJS-TEN. Significant statistical pharmacovigilance signals were observed for 165 drugs. The two most represented drug classes were antiepileptics and anti-infectious drugs. The five drugs with the highest IC025 were lamotrigine (IC025 4.99), carbamazepine (IC025 4.88), phenobarbital (IC025 4.67), phenytoin (IC025 4.52) and nimesulide (IC025 4.23). Acetaminophen was significantly associated with paediatric SJS-TEN (IC025 2.85) and we also described various new suspected drugs. Vaccines had no significant pharmacovigilance signal. These results were confirmed with the sensitivity analyses. CONCLUSIONS: This study updates the spectrum of drugs potentially associated with paediatric SJS-TEN.

Stevens-Johnson syndrome and toxic epidermal necrolysis in Hong Kong.

INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) [hereafter, SJS/TEN] are uncommon but severe mucocutaneous reactions. Although they have been described in many populations worldwide, data from Hong Kong are limited. Here, we explored the epidemiology, disease characteristics, aetiology, morbidity, and mortality of SJS/TEN in Hong Kong. METHODS: This retrospective cohort study included all hospitalised patients who had been diagnosed with SJS/TEN in Prince of Wales Hospital from 1 January 2004 to 31 December 2020. RESULTS: There were 125 cases of SJS/TEN during the 17-year study period. The annual incidence was 5.07 cases per million. The mean age at onset was 51.4 years. The mean maximal body surface area of epidermal detachment was 23%. Overall, patients in 32% of cases required burns unit or intensive care unit admission. Half of the cases involved concomitant sepsis, and 23.2% of cases resulted in multiorgan failure or disseminated intravascular coagulation. The mean length of stay was 23.9 days. The cause of SJS/TEN was attributed to a drug in 91.9% of cases, including 84.2% that involved anticonvulsants, allopurinol, antibiotics, or analgesics. In most cases, patients received treatment comprising either best supportive care alone (35.2%) or combined with intravenous immunoglobulin (43.2%). The in-hospital mortality rate was 21.6%. Major causes of death were multiorgan failure and/or fulminant sepsis (81.5%). CONCLUSION: This study showed that SJS/TEN are uncommon in Hong Kong but can cause substantial morbidity and mortality. Early recognition, prompt withdrawal of offending agents, and multidisciplinary supportive management are essential for improving clinical outcomes.

Incidencia de síndrome de Stevens-Johnson y necrólisis epidérmica tóxica en Chile años 2001-2015 y su asociación con latitud / Hospital discharges due to Stevens-Johnson syndrome and toxic epidermal necrolysis in Chile from 2001 to 2015

Background: Stevens-Johnson Syndrome (SSJ) and Toxic Epidermal Necrolysis (NET) are infrequent and life-threatening mucocutaneous diseases, which occur predominantly as adverse drug reactions. Aim: To describe the frequency of SSJ and NET diagnoses at a national level, estimate their incidence and describe their distribution among the different regions of the country. Material and Methods: Analysis of hospital discharge databases available at the website of the Chilean Ministry of Health searching for the tenth version of the International Classification of Diseases (ICD 10) codes for SSJ or NET, between 2001 and 2015. Results: We analyzed 24,521,796 hospital discharges nationwide. SSJ caused 855 discharges, with a lethality of 2%. NET caused 128 discharges with a lethality of 16%. The global cumulative incidence was 3.87 cases per million inhabitants per year nationwide, with a trend line to increase incidence towards the regions of higher latitude. Conclusions: SSJ and NET are dermatological emergencies with high mortality. The increase in incidence towards regions at higher latitudes may suggest an association between these conditions and lower levels of vitamin D, correlated with latitude and exposure to UV radiation.

Epidermal necrolysis: SCORTEN performance in AIDS and non-AIDS patients

Abstract: Background: Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening blistering drug reactions with high incidence of ocular sequela. The term 'Epidermal Necrolysis' has been recently used to better describe the full spectrum of the disease that includes Stevens-Johnson syndrome and toxic epidermal necrolysis at opposite ends, which differ by the extent of body surface area with epidermal detachment. SCORTEN is a mortality prognosis score for 'Epidermal Necrolysis' cases that still needed validation in acquired immunodeficiency syndrome. Objective: To evaluate the SCORTEN performance in acquired immunodeficiency syndrome, and the differences in outcomes between acquired immunodeficiency syndrome and non- acquired immunodeficiency syndrome cohorts. Methods: Retrospective cohort study of AIDS and non-AIDS 'Epidermal Necrolysis' cases admitted to a Brazilian reference center from 1990-2014. Results: Five deaths (16.7%) occurred as a consequence of EN in 30 AIDS patients, and seven (17.9%) in 39 non-AIDS patients, relative risk (RR) .92 (p=1.0). SCORTEN showed great performance, with an Area Under the Receiver Operating Curve (AUC) (ROC) of 0.90 with a 95% confidence interval ranging from .81 to .99. The performance of SCORTEN was better among non- AIDS patients than AIDS patients: AUC non- acquired immunodeficiency syndrome =0.99 (CI 05% 0.96-1.00), AUC acquired immunodeficiency syndrome = 0.74 (CI 95% 0.53-0.95), p=.02. Study Limitations: Heterogeneity of cases, wide variation of systemic corticosteroid doses when used. Conclusion: SCORTEN is valid for the Brazilian population, including among those patients with acquired immunodeficiency syndrome, and, as such, its use is recommended for aiding treatment choice in this subgroup of patients.

Ectodermosis erosiva plurioficialis, un evento adverso inesperado de la fenitoína: presentación de un caso / Ectodermosis plurioficialis erosiva, an unexpected adverse event of phenytoin: presentation of a case

Fundamento: la ectodermosis erosiva pluriorificial también conocida como el síndrome de Stevens Johnson, forma menor de la necrosis epidérmica tóxica, es una enfermedad grave, típica, secundaria a medicamentos y en un menor porciento relacionada a infecciones.Objetivo: fundamentar la necesidad del diagnóstico y tratamiento oportuno de la ectodermosis erosiva pluriorificialis, ante su aparición como evento adverso grave inesperado al uso de la fenitoína oral.Caso clínico: paciente femenina de seis años de edad que manifestó esta enfermedad con un compromiso del 10 porciento de su superficie corporal. Ingresa con manifestaciones de inestabilidad hemodinámica en la unidad de cuidados intensivos del Hospital Pediátrico Universitario Dr. Eduardo Agramonte Piña de la provincia de Camagüey, se le diagnostica una ectodermosis erosiva pluriorificialis como una reacción adversa grave relacionada a la administración de fenitoína oral. El tratamiento se enmarca en la suspensión del medicamento, se trata con antibiótico endovenoso de amplio espectro, así como, la cura local para las lesiones de piel y mucosas. Es egresada con una evolución favorable y sin secuelas luego de 25 días de estadía.Conclusiones: la ectodermosis erosiva pluriorificialis fue una reacción adversa grave relacionada con el uso de fenitoina, de ahí la importancia del diagnóstico oportuno y su tratamiento(AU)

Background: ectodermosis pluriorificialis erosive also known as Stevens Johnson syndrome, a minor form of toxic epidermal necrosis, is a serious disease, typically found after taking drugs and related to infections in a lower percentage.Objective: justify the need for the diagnosis and timely treatment of ectodermosis pluriorificialis erosive, due to its appearance as an unexpected serious adverse event when using oral phenytoin.Clinical case: the case referred to a 6-year-old girl who presented this disease in her 10 percent body surface. She entered the intensive care unit of the university pediatric hospital Dr. Eduardo Agramonte Piña, Camagüey province, with symptoms of hemodynamic instability. The ectodermosis pluriorificialis erosive diagnosis is considered as a serious adverse reaction related to the administration of oral phenytoin. The treatment consists on the suspension of the drug, a broad-spectrum intravenous antibiotic treatment, as well as local cure for skin and mucosal lesions. The girl left the hospital with a favorable evolution, without sequels after 25 days of stay.Conclusions: the ectodermosis pluriorificialis erosive was a serious adverse reaction related to the use of phenytoin, hence the importance of timely diagnosis and its treatment(AU)

Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals

Abstract: Background: Adverse drug reactions are harmful and involuntary responses to drugs that occur at doses normally used for a given condition. Among them are Stevens-Johnson syndrome and toxic epidermal necrolysis, both rare and potentially fatal conditions. Objectives: To analyze the epidemiological and clinical characteristics related to patients diagnosed with Stevens-Johnson syndrome and toxic epidermal necrolysis in public hospitals in the Federal District - Brazil. Methods: Retrospective, cross-sectional and descriptive study, in which data were collected referring to patients hospitalized in the public healthcare system of the Federal District from 1999 to 2014. Results: Between 1999 and 2014, 86 cases of hospitalized patients with diagnosis of Stevens-Johnson syndrome and toxic epidermal necrolysis in the Federal District were reported. The majority of patients were women; the most affected age group was 0 to 10 years. Patients older than 60 years (elderly) represent 6.98% of the cases. Most patients admitted to the referral hospital were discharged. However, occurrence of deaths exceeded that of discharge in elderly patients. Limitations of the study: There is fragility in the registry of hospitalization of patients, both in the hospital information system and in the medical records of the reference hospital. Conclusion: There is a need for greater production and better dissemination of information on the incidence of adverse drug reactions.

Aspectos epidemiológicos y opciones de tratamiento para las complicaciones oftalmológicas de las enfermedades mucosinequiantes / Epidemiology and treatment options for ophthalmic complications of mucosinequiant diseases

Introducción: Las enfermedades mucosinequiantes son aquellas que afectan piel y mucosas con lesiones vesículo-ampollar, generalmente son bilaterales y se caracterizan por distorsionar la anatomía de la conjuntiva, párpados, vías lagrimales y universalmente conducen a queratoconjuntivitis seca. Objetivo: Actualizar aspectos epidemiológicos y opciones de tratamiento para las complicaciones oftalmológicas de las enfermedades mucosinequiantes. Material y Métodos: Se realizó una revisión bibliográfica sobre aspectos conceptuales, clasificación, etiopatogenia, epidemiología, cuadro clínico, complicaciones y tratamiento oftalmológico de las enfermedades mucosinequiantes en la literatura impresa y en soporte digital disponible. Utilizamos para la búsqueda electrónica bases de datos como PubMed, BioMed Central y SCIELO, abarcando varios años hasta el presente. Abordamos enfermedades como Tracoma, Penfigoide cicatrizal, Síndrome de Stevens-Johnson y Conjuntivitis leñosa, por ser de las enfermedades mucosinequiantes las que mayor compromiso conjuntival presentan.Resultados: Las enfermedades mucosinequiantes producen cicatrización conjuntival y graves complicaciones oftalmológicas que pueden comprometer la visión hasta llegar a la ceguera. Conclusiones: Las enfermedades mucosinequiantes son causa frecuente de morbilidad ocular por el severo daño que ocasionan a la superficie ocular. El uso de injerto de membrana amniótica, mucosa bucal y trasplante de células madre del limbo córneo conjuntival son opciones utilizadas con buenos resultados en el tratamiento de las complicaciones oftalmológicas de estas enfermedades(AU)

Introduction: mucosinequiant diseases are those that affect skin and mucosa with blister-vesicular wounds, they are usually bilateral and are characterized by distorting the conjunctival anatomy, eyelids, lachrymal way and that universally lead to a dry keratoconjunctivitis. Objective: to update epidemiological issues and treatment options for ophthalmic complications of mucosinequiant diseases. Material and Methods: a literature review on conceptual issues, classification, etiopathology, epidemiology, clinical manifestation, complications and treatment of mucosinequiant ophthalmological diseases available in hard copies and digital support was made. To search, we used electronic databases such as PubMed, Central BioMed and SCIELO, extending over several years to the present. We deal with diseases such as trachoma, cicatricial pemphigoid, Stevens-Johnson syndrome and woody conjunctivitis, because mucosinequiant diseases are those which present greater conjunctival compromise. Results: mucosinequiant cause conjunctival cicatrization and serious ophthalmologic complications that could compromise vision up to blindness. Conclusions: mucosinequiant diseases are a frequent cause of ocular morbidity causing severe damage to the ocular surface. The use of amniotic membrane graft, oral mucosa and corneal conjunctival limbus stem cell transplant are used options with good results in the treatment of ophthalmic complications of these diseases(AU)

FR - Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Actualización en el manejo terapéutico / RF - Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Treatment Update

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Síndrome de Stevens-Johnson: presentación de tres casos / Stevens-Johnson's syndrome: presentation of three cases

Fundamento: el Síndrome de Stevens-Johnson (SSJ) es una enfermedad grave, a menudo fatal, que ha sido considerada como un tipo de eritema multiforme, es causada generalmente por fármacos y de no ser diagnosticado y tratado de forma oportuna puede asociarse a secuelas importantes y la muerte.Objetivo: describir y reseñar el tratamiento y evolución clínica del cuadro clínico de tres casos con diagnóstico de Síndrome de Stevens-Johnson, ingresados en Cuidados Intensivos.Presentación de casos: se presentan tres enfermos, dos pertenecientes al sexo femenino y uno al masculino, con diagnóstico de SSJ asociados al empleo de fármacos. En los tres casos el tratamiento consistió en medidas de cuidados generales para la profilaxis y el tratamiento de complicaciones, esteroides sistémicos y además IgG intravenosa de producción nacional (intacglobin). Los tres pacientes evolucionaron de forma satisfactoria.Resultados: se destaca la utilidad del uso de inmunoglobulina G intravenosa en el tratamiento de estos pacientes, así como su importancia en una unidad de cuidados para enfermos graves.Conclusiones: en la casuística predominó el sexo femenino y el empleo precoz del Intacglobin (IgG IV) que contribuyó a una mejor evolución de los pacientes al detener la progresión de la enfermedad, evitar complicaciones y disminuir la estadía en las unidades de enfermos graves(AU)

Background: Stevens-Johnsons syndrome (SJS) is a serious disease, fatal most of the time, which has been considered as a type of erythema multiforme. It is generally caused by medicaments. If it is not diagnosed and treated at appropriate time it can be associated to considerable sequelae and death.Objective: to describe the treatment and evolution of the clinical manifestations of three cases with the diagnosis of Stevens-Johnsons syndrome admitted in the intensive care unit.Cases presentation: the cases of two female patients and a male patient with the diagnosis of SJS, associated to the use of medicaments, are briefly presented. The treatment consisted of measures of general care for the prophylaxis and treatment of complications for the three cases. The patients were treated with intravenous IgG of national production (intacglobin) and systemic steroids. The three patients improved their condition satisfactorily.Results: the use of intravenous immunoglobulin G in the treatment of these patients stands out; as well as the importance of the treatment of seriously ill patients in an intensive care unit.Conclusions: female sex predominated in the casuistics. The early use of Intacglobin (IgG IV) contributed to a better improvement of the patients condition arresting the development of the disease, avoiding complications and decreasing the hospital stay of seriously ill patients(AU)

Stevens-Johnson syndrome and toxic epidermal necrolysis at the University Hospital of the West Indies, Jamaica / El síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica en el Hospital Universitario de West Indies, Jamaica

OBJECTIVE: Stevens-Johnson syndrome and toxic epidermal necrolysis are uncommon acute dermatologic disorders. The purpose of this study was to examine the frequency, aetiology and outcome of cases of Stevens-Johnson syndrome and toxic epidermal necrolysis admitted to the dermatology ward at the University Hospital of the West Indies. METHODS: This was a retrospective study looking at all patients who were admitted with a diagnosis of Stevens-Johnson syndrome, Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome and toxic epidermal necrolysis over a nine-year period. RESULTS: The results showed almost equal numbers of males and females. The drugs most commonly implicated were phenytoin and cotrimoxazole. The most common complications were hepatic impairment and ophthalmic complications. CONCLUSION: Stevens-Johnson syndrome and toxic epidermal necrolysis contribute significantly to morbidity and mortality of patients on the dermatology ward although mortality was low compared to other studies.

OBJETIVO: El síndrome de Stevens-Johnson (SSJ) y la necrólisis epidérmica tóxica (NET) son trastornos dermatológicos agudos poco frecuentes. El propósito de este estudio fue examinar la frecuencia, la etiología y el resultado de casos de síndrome Stevens-Johnson y necrólisis epidérmica tóxica ingresados en la sala de dermatología del Hospital Universitario de West Indies. MÉTODOS: Se trata de un estudio retrospectivo con todos los pacientes que fueron ingresados con diagnóstico de síndrome de Stevens-Johnson, síndrome de solapamiento entre el síndrome de Stevens-Johnson y NET, y necrólisis epidérmica tóxica, por un período de nueve años. RESULTADOS: Los resultados mostraron casi igual número de varones y hembras. Los fármacos más comúnmente implicados fueron la fenitoína y el cotrimoxazol. Las complicaciones más frecuentes fueron deterioro hepático y complicaciones oftálmicas. CONCLUSIÓN: El síndrome Stevens-Johnson y la necrólisis epidérmica tóxica contribuyen significativamente a la morbilidad y mortalidad de los pacientes en la Sala de Dermatología, aunque la mortalidad fue baja en comparación con otros estudios.

Influencia de los factores neonatales y maternos en la prevalencia de vérnix caseosa / Influence of Neonatal and Maternal Factors on the Prevalence of Vernix Caseosa

Al nacimiento la vérnix caseosa puede cubrir toda la superficie corporal o acumularse sólo en la espalda y los pliegues. En los últimos años ha aumentado el interés por su composición, funciones y aplicaciones en la edad adulta. Nuestro objetivo fue conocer la prevalencia de la vérnix caseosa en los recién nacidos del Área Sanitaria de Ferrol, y ver cómo repercutían los parámetros neonatales y maternos en su desarrollo. Realizamos un estudio prospectivo de 1.000 recién nacidos vistos en los primeros tres días de vida en nuestro hospital. Encontramos vérnix caseosa en el 49,2% de los neonatos. El perfil clínico de presencia de vérnix caseosa sería: recién nacido de sexo femenino, sano, a término, con peso elevado producto de una gestante no primigesta, con ingesta de fármacos y suplementos dietéticos durante el embarazo sometida a un parto eutócico. Existe relación entre ausencia de vérnix caseosa y la presencia de descamación fisiológica y de eritema tóxico neonatal (AU)

At birth, vernix caseosa can cover the whole body surface or accumulate only on the back and in the skin folds. Interest in its composition and function and its possible applications in adults has increased in recent years. The objective of this study was to determine the prevalence of vernix caseosa in newborn infants in the health care area of Ferrol, Spain, and to assess its relationship with neonatal and maternal factors. We performed a prospective study of 1000 newborns seen within the first 3days of life in our hospital. Vernix caseosa was observed in 42.9% of cases. The clinical profile associated with the presence of vernix caseosa was the following: healthy newborn girl with a high birth weight, born at term by normal vaginal delivery to a multiparous mother who had received medication and dietary supplements during pregnancy. The absence of vernix caseosa was associated with the presence of physiological scaling of the newborn and erythema toxicum neonatorum (AU)

Cutaneous drug reactions in patients admitted to the dermatology unit at the University Hospital of the West Indies, Kingston, Jamaica / Reacciones cutáneas medicamentosas en pacientes ingresados en la Unidad de Dermatología del Hospital Universitario de West Indies, Kingston, Jamaica

OBJECTIVE: Cutaneous reactions are among the most common adverse reactions to drugs. The purpose of this study is to examine the aetiology and outcome of cutaneous drug reactions among patients admitted to the Dermatology Ward at the University Hospital of the West Indies. SUBJECTS AND METHODS: This was a retrospective study looking at all patients who were admitted with a diagnosis of a cutaneous drug eruption from January 1, 1997 to December 31, 2005. Data included patient demographics, date of admission to hospital, duration of hospitalization and a detailed drug history including any previous episodes of drug sensitivity. All drugs reportedly ingested by the patients up to three months prior to their cutaneous reaction were documented and the period of time between drug ingestion and the appearance of skin lesions was also noted. Clinical diagnosis, co-morbidities, histopathological diagnosis, final outcome and all ensuing disabilities were noted. The data retrieved were collated and analyzed using SPSS 12.0. RESULTS: The results showed a female to male ratio of 2.2:1. The categories of drugs most commonly implicated were antimicrobials followed by anti-epileptic drugs and nonsteroidal anti-inflammatory drugs. The most common form of drug eruption requiring admission was the exanthematous drug eruption followed by erythema multiforme, toxic epidermal necrolysis and Stevens-Johnson syndrome. CONCLUSION: In general, the causative agents identified and the types of drug eruptions were similar to those found in previous studies. However, the anti-epileptic drugs, phenytoin and carbamazepine, ranked among the most commonly implicated drugs which differ significantly from other studies.

Las reacciones cutáneas se hallan entre las reacciones adversas más comunes frente a los medicamentos. El propósito de este estudio fue examinar la etiología y la evolución clínica de las reacciones cutáneas medicamentosas entre pacientes ingresados a la sala de dermatología en el Hospital Universitario de West Indies. MÉTODOS: Este es un estudio retrospectivo que pasa revista a todos los pacientes que fueron ingresados con diagnóstico de erupción cutánea desde el 1ero. de enero de 1997 al 31 de diciembre de 2005. RESULTADOS: Los resultados mostraron una proporción hembra-varón de 2.2:1. Las categorías de los medicamentos más frecuentemente implicados fueron los antimicrobianos, seguidos por los medicamentos antiepilépticos y los antiinflamatorios no esteroideos. La forma más común de erupción que requirió ingreso a causa de medicamentos, fue la erupción exantemática medicamentosa seguida por el eritema multiforme, la necrólisis epidérmica tóxica, y el síndrome de Stevens-Johnson. CONCLUSIÓN: En general, los agentes causativos identificados y los tipos de erupciones medicamentosas, fueron similares a los hallados en estudios previos. Sin embargo, los antiepilépticos conocidos como fenitoína y carbamazepina, estuvieron entre los medicamentos más comúnmente implicados, presentándose en tal sentido una diferencia significativa con los otros estudios.

Caracteristiques epidemiocliniques des necrolyses epidermiques toxiques dans le service de reanimation de l'Hopital de Soavinandriana Antananarivo

Objectifs: Les objectifs de cette etude sont de recenser et d'analyser les cas de necroses epidermiques toxiques observes dans notre service et de les faire comparer aux donnees de la litterature. Materiels et methodes: Il s'agit d'une etude retrospective descriptive et analytique sur une periode de cinq ans. Nous avons recueilli les donnees : demographiques; cliniques; evolutives et les medicaments incrimines. Les differentes formes cliniques ont ete classifiees selon les symptomatologies observees. Ont ete regroupe dans le syndrome de Stevens-Johnson : les lesions muqueuses et cutanees bullo-erosives avec atteinte du cuir chevelu dont la lesion de la surface corporelle (SCL) est de 10a 30; dans le syndrome de Lyell : l'eruption cutaneo-muqueuse avec decollement cutane depassant 30de la surface corporelle. Resultats: 13 cas de toxidermies etaient enregistres dans le service avec une incidence de 0;4. L'age moyen etait de 37;4 ans. Les medicaments incrimines sont : la Sulfadoxine (n=5); la Penicilline A (n=1); les antituberculeux (n=1); le Cotrimoxazole (n=2); l'Allopurinol (n=1) e; une association Quinine-Lincocine (n=1); les antiepileptiques (n=2) et un cas indetermine. Le delai entre le debut des symptomes et l'arrivee a l'hopital varie entre 1 a 3 jours et la duree d'hospitalisation de cinq a quarante jours. Conclusion: Les necrolyses epidermiques toxiques sont des pathologies peu frequentes mais graves en reanimation. Beaucoup de medicaments sont en cause mais certains sont facilement accessibles au public. L'information de ces effets secondaires est une obligation des personnels medicaux et tous ceux qui manipulent des medicaments

Uso de inmunoglobulina intravenosa en el tratamiento de necrólisis epidérmica tóxica y síndrome de Stevens-Johnson / Use of intravenous immunoglobulin in toxic epidermal necrolysis and Stevens-Johnson syndrome

La necrólisis epidérmica tóxica (NET) y el síndrome de Stevens-Johnson (SSJ) se describen como variantes de una misma enfermedad con diferente severidad y constituyen las reacciones cutáneas más frecuentes en niños con una considerable morbilidad. Varias comunicaciones apoyan el uso de la inmunoglobulina intravenosa (IGIV) para el tratamiento de tales entidades. Nosotros presentamos el caso de 2 pacientes, uno con NET y uno con SSJ en quienes se utilizó inmunoglobulina con resultados exitosos. Además hacemos una revisión de la evolución de 13 pacientes con NET y SSJ en los últimos 10 años en el Hospital Infantil de México en quienes se utilizó tratamiento convencional

Toxic epidermal necrolysis and Stevens-Johnson syndrome are described as variants of the same disease with distinct severity and constitute the most frequent cutaneous reactions in children, causing considerable morbidity. Several reports support the use of intravenous immunoglobulin therapy in these entities. We report the cases of two patients, one with toxic epidermal necrolysis and the other with Stevens-Johnson syndrome, in whom immunoglobulin treatment was successfully used. We also reviewed the outcomes of 13 patients with toxic epidermal necrolysis and Stevens-Johnson syndrome in the previous 10 years in the Hospital Infantil de Mexico, in whom conventional treatment was used

Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica: experiencia clínica en el Hospital Nacional Guillermo Almenara Irigoyen, Lima - Perú / Stevens-Johnson Syndrome and toxic epidermal necrolysis: clinical experience at the Hospital Nacional Guillermo Almenara Irigoyen, Lima-Peru

Objetivo: Describir las características clínicas de un grupo de pacientes diagnosticados de síndrome de Stevens-Johnsons (SSJ) y necrólisis epidérmica tóxica (NET). Material y métodos: Estudio retrospectivo, transversal y descriptivo realizado en el Hospital Nacional Guillermo Almenara Irigoyen entre junio de 2004 y mayo del 2007. Se revisó las historias clínicas de los casos hospitalizados, recogiendo la información sobre drogas responsables, tratamiento y resultado final. Resultados: Se estudiaron siete pacientes, cinco con diagnóstico de NET, uno con SSJ y uno con síndrome SSJ-NET. Cinco pacientes fueron mujeres y dos varones, con una edad media de 47 años.Los fármacos asociados fueron los anticonvulsivantes (fenitoína y lamotrigina) en tres pacientes, metamizol en dos, cotrimoxazol en uno y fluconazol también en uno. La mucosa oral fue afectada en todos los casos, la mucosa genital en cuatro y la mucosa conjuntival en tres. El tratamiento de elección fueron los corticoides en seis pacientes y se inicio de forma rápida en cuatro, evolucionando con mínimas complicaciones y solo uno de ellos presento secuelas oculares. Solo hubo un deceso en este grupo. Conclusiones: El SSJ y la NET en nuestros casos fueron causados principalmente por anticonvulsivantes y metamizol, fueron tratados en su mayoría con corticoides sistémicos. Drogas de uso creciente como fluconazol y lamotrigina también deben considerarse entre los medicamentos de riesgo.

Eritema multifome - atualizações / Erythema multiforme - an update

O eritema multiforme ou polimorfo é um processo inflamatório agudo que apresenta lesões cutâneo-mucosas características. Representa uma enfermidade de interesse para Odontologia, uma vez que, por vezes, a boca pode ser a única área afetada. O objetivo deste trabalho é apresentar uma revisão da literatura destacando os aspectos relacionados à etiologia, características clínicas e histológicas, diagnóstico, tratamento e prognóstico da referida condição patológica