[Stevens-Johnson syndrome and toxic epidermal necrolysis]. / Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica: experiencia clínica y revisión de la literatura especializada.

INTRODUCTION: The aim of this work is to reflect the clinical experience of the Dermatology Department of Hospital General in Valencia with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) or Lyell's syndrome over the last 15 years. METHODS: Data on epidemiology, likely causal agents, complementary tests, concomitant pathologies, management, evolution and complications was gathered through a retrospective study. RESULTS: Thirteen patients were included, with a mean age of 53 years. The most frequently involved drugs were antibiotics (50 %), followed by anti-convulsants (16.6 %). The mucous membranes were involved in 84.6 % of the cases. 61.5 % of the patients presented with systemic symptoms. The most frequent laboratory finding was hypoproteinemia. Corticosteroids were used in 69 % of the cases, and intravenous immunoglobulins in 15 %. Two oncological patients with a diagnosis of TEN died (15 % overall mortality). CONCLUSIONS: SJS and TEN are infrequent mucocutaneous reactions, often drug induced, with significant associated morbidity and mortality. Their pathogenesis is still partially unknown, and no specific treatment has been proven to be clearly beneficial; therefore, the best treatment consists of early diagnosis, the withdrawal of the suspect drug and support therapy.

[Chronic cutaneous fistula secondary to mandibular osteomyelitis]. / Fístula cutánea crónica secundaria a osteomielitis mandibular.

Cutaneous fistulas and sinuses in the maxillofacial region secondary to osteomyelitis rarely appear in clinical practice. The most frequent cause of mandibular osteomyelitis is a dental infection, but it may also be hematogenic in origin. The diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic changes in the radiological study. The differential diagnosis of an ulcerative lesion in the mandibular area includes several pathologies, such as a fistula of dental origin, a reaction to a foreign body, a deep mycotic infection, a pyogenic granuloma or a congenital malformation.

Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica: experiencia clínica y revisión de la literatura especializada / Stevens-Johnson syndrome and toxic epidermal necrolysis

Introducción. El objetivo de este trabajo es reflejar la experiencia clínica del Servicio de Dermatología del Hospital General de Valencia en el síndrome de Stevens-Johnson (SSJ) y necrólisis epidérmica tóxica (NET) o síndrome de Lyell durante los últimos 15 años. Métodos. A través de un estudio retrospectivo se recogieron datos sobre epidemiología, agentes causales probables, pruebas complementarias, patologías concomitantes, tratamiento, evolución y complicaciones. Resultados. Se incluyeron 13 pacientes con edad media de 53 años. Los fármacos más frecuentemente implicados fueron los antibióticos (50 %) seguidos de los anticomiciales (16,6 %). Las mucosas se afectaron en el 84,6 % de los casos. El 61,5 % de los pacientes presentó clínica sistémica. El hallazgo de laboratorio más frecuente fue la hipoproteinemia. Los corticoides se emplearon en el 69 % de casos y las inmunoglobulinas intravenosas, en el 15 %. Dos pacientes oncológicos con diagnóstico de NET fallecieron (15 % de mortalidad global). Conclusiones. El SSJ y la NET son reacciones mucocutáneas poco frecuentes a menudo inducidas por fármacos que asocian una importante morbimortalidad. La patogenia permanece en parte desconocida y ningún tratamiento específico se ha demostrado claramente beneficioso, por lo que la mejor terapéutica consiste en el diagnóstico precoz, la retirada del fármaco sospechoso y la terapia de soporte

Introduction. The aim of this work is to reflect the clinical experience of the Dermatology Department of Hospital General in Valencia with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) or Lyell's syndrome over the last 15 years. Methods. Data on epidemiology, likely causal agents, complementary tests, concomitant pathologies, management, evolution and complications was gathered through a retrospective study. Results. Thirteen patients were included, with a mean age of 53 years. The most frequently involved drugs were antibiotics (50 %), followed by anti-convulsants (16.6 %). The mucous membranes were involved in 84.6 % of the cases. 61.5 % of the patients presented with systemic symptoms. The most frequent laboratory finding was hypoproteinemia. Corticosteroids were used in 69 % of the cases, and intravenous immunoglobulins in 15 %. Two oncological patients with a diagnosis of TEN died (15 % overall mortality). Conclusions. SJS and TEN are infrequent mucocutaneous reactions, often drug induced, with significant associated morbidity and mortality. Their pathogenesis is still partially unknown, and no specific treatment has been proven to be clearly beneficial; therefore, the best treatment consists of early diagnosis, the withdrawal of the suspect drug and support therapy

Fístula cutánea crónica secundaria a osteomielitis mandibular / Chronic cutaneous fistula secondary to mandibular osteomyelitis

Las fístulas y senos cutáneos secundarios a osteomielitis en la región maxilofacial raramente aparecen en la práctica clínica. La causa más frecuente de osteomielitis mandibular es una infección dental, pero también puede ser de origen hematógeno. Los criterios diagnósticos de osteomielitis bacteriana son supuración y cambios osteolíticos en el estudio radiológico. El diagnóstico diferencial de una lesión ulcerativa en el área mandibular incluye varias patologías como una fístula de origen dental, reacción a cuerpo extraño, infección micótica profunda, granuloma piogénico o malformación congénita

Cutaneous fistulas and sinuses in the maxillofacial region secondary to osteomyelitis rarely appear in clinical practice. The most frequent cause of mandibular osteomyelitis is a dental infection, but it may also be hematogenic in origin. The diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic changes in the radiological study. The differential diagnosis of an ulcerative lesion in the mandibular area includes several pathologies, such as a fistula of dental origin, a reaction to a foreign body, a deep mycotic infection, a pyogenic granuloma or a congenital malformation