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1.
Medicine (Baltimore) ; 99(12): e19431, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195938

RESUMO

RATIONALE: Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are extremely rare but potentially life-threatening disorders. We presented 3 fatal pediatric SJS/TEN cases. PATIENT CONCERNS: Our patients had some severe complications such as septic shock, respiratory failure and obliterans bronchiolitis (BO) etc. DIAGNOSIS:: Three patients diagnosed SJS/TEN with clinical symptoms that were triggered by antibiotics, nonsteroidal anti-inflammatory drugs, previous infection, or neoplasms. INTERVENTIONS: All of them accepted mechanical ventilation, intravenous immunoglobulin (IVIG), blood transfusion, glucocorticoid, and multi-anti-infectious therapy. OUTCOMES: They all died because of out-of-control severe infections. In Patient 1, he died 6 days after being admitted to the PICU on the 28th day from onset. In Patient 2, he died on the 211th day from the onset of illness during the third time of PICU admission. In Patient 3, she died 12 days after PICU admission on the 87th day from onset. LESSONS: We should be aware that mucosal damage occurs on the skin and within the mucosa of visceral organs, leading to the occurrence of bronchiectasia, BO, enterocolitis, acute renal failure, and severe secondary infections. Establish a clinically predictive score that includes severe infection for pediatric patients to evaluate the risk of mortality in children in order to improve poor outcomes.


Assuntos
Doenças Transmissíveis/fisiopatologia , Síndrome de Stevens-Johnson/fisiopatologia , Criança , Pré-Escolar , Doenças Transmissíveis/etiologia , Doenças Transmissíveis/terapia , Comorbidade , Evolução Fatal , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/terapia
2.
Yakugaku Zasshi ; 139(12): 1557-1562, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31787645

RESUMO

Severe cutaneous adverse reactions (SCARs) are important in postmarketing drug safety because SCAR patients were highest in the adverse drug reaction relief system of Japan. The SCAR symptoms of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) include high fever, severe mucosal impairment, and epidermal necrosis-induced erosions and blisters. Approximately 600 cases of SJS and 300 cases of TEN are reported annually in Japan. Many suspected drugs such as acetaminophen, lamotrigine, allopurinol, and carbamazepine have been reported. Over the last 15 years, an association between human leukocyte antigen and SJS/TEN onset has been reported with several drugs. Pathophysiological examinations in those reports revealed marked CD8-positive T cell infiltration into epidermal lesions, and the presence of cytotoxic granulysin, soluble Fas ligand, and tumor necrosis factor (TNF)-α in blister fluid. Therefore, SJS and TEN are immunological disorders that lead to epidermal necrosis and are consequently treated with the systemic administration of corticosteroids and with high-dose intravenous immunoglobulin therapy and plasma exchange in severe cases. Additionally, because the epidermal necrosis has characteristics similar to those of organ rejection after transplantation, the administration of cyclosporine, an immunosuppressant that inhibits helper T cell activation, has been attempted. Further, the administration of the TNF-α inhibitor etanercept has also been reported. This review summarizes current knowledge on the mechanisms of onset of SJS/TEN and their treatments.


Assuntos
Acetaminofen/efeitos adversos , Alopurinol/efeitos adversos , Carbamazepina/efeitos adversos , Lamotrigina/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Corticosteroides/uso terapêutico , Antígenos de Diferenciação de Linfócitos T , Linfócitos T CD8-Positivos/imunologia , Ciclosporina/uso terapêutico , Epiderme/imunologia , Etanercepte/uso terapêutico , Proteína Ligante Fas , Antígenos HLA , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imunossupressores/uso terapêutico , Japão/epidemiologia , Troca Plasmática , Síndrome de Stevens-Johnson/epidemiologia , Síndrome de Stevens-Johnson/terapia , Fator de Necrose Tumoral alfa
3.
Int J Dermatol ; 58(11): 1293-1299, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31166019

RESUMO

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially life-threatening mucocutaneous reactions. Given their rarity, limited cohort studies have been done. The aim of this study is to evaluate and compare the demographics, etiology, management, clinical and laboratory characteristics, complications, and outcome of SJS/TEN patients seen by the inpatient dermatology service at the University of Puerto Rico. METHODS: A retrospective review of 30 cases with identified diagnosis of SJS, overlap SJS/TEN, or TEN who were consulted to the Dermatology Department of the University of Puerto Rico from 2006 to 2017. RESULTS: A total of 24 adult and six pediatric cases were reviewed. Females were predominant with a female to male ratio of 1.3 : 1. The most frequent offending drugs identified were antibiotics (56.7%), anticonvulsants (23.3%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (16.7%) with the most frequent antibiotic identified being trimethoprim/sulfamethoxazole (23.3%). Seventy percent of patients experienced at least one complication, most often of infectious etiology (80.1%). During hospital course, 73% received pharmacologic therapy (23% received IVIG alone, 17% received steroids alone, and 33% both) versus 27% which received only supportive care. Mortality rate in this study was 13.8%. When comparing SCORTEN at day one of admission, deceased cases had a mean SCORTEN at day 1 of 4.0, while survivors had an average of 1.54 (P < 0.001). CONCLUSION: Antibiotics followed by anticonvulsants were the most frequently offending drugs identified within this study.


Assuntos
Antibacterianos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Anticonvulsivantes/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Porto Rico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/mortalidade , Síndrome de Stevens-Johnson/terapia , Adulto Jovem
4.
Cutis ; 103(5): 254-256;258, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31233575

RESUMO

Acute generalized exanthematous pustulosis (AGEP), drug rash with eosinophilia and systemic symptoms (DRESS) syndrome, and Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are types of adverse drug reactions (ADRs), each with their own set of characteristic symptoms and sequelae. Although guidelines for inpatient management of these conditions exist, guidelines for outpatient follow-up are lacking. Based on the existing literature, we propose guidelines for outpatient follow-up of AGEP, DRESS, and SJS/TEN.


Assuntos
Assistência ao Convalescente/normas , Assistência Ambulatorial/normas , Erupção por Droga/terapia , Pustulose Exantematosa Aguda Generalizada/terapia , Síndrome de Hipersensibilidade a Medicamentos/terapia , Humanos , Alta do Paciente , Síndrome de Stevens-Johnson/terapia
5.
Medicine (Baltimore) ; 98(19): e15553, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083216

RESUMO

RATIONALE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are 2 rare but life-threatening diseases characterized by detachment of epidermis, bullous skin lesions, and mucous membrane erosions. Drugs are highly suspected to be the causative agents. We report a case of SJS/TEN induced by oseltamivir, which is a very rare event. PATIENT CONCERNS: A 9-year-old girl with upper respiratory tract infections presented with generalized maculopapular rash the second day after taking oseltamivir. DIAGNOSIS: The diagnosis of SJS/TEN was made based on cytotoxic skin lesions and mucous membrane involvement. INTERVENTIONS: After discontinuing of the drug and combination therapy of corticosteroid and human immunoglobulin initiation, the lesions were improved. Human leukocyte antigen (HLA) gene sequencing was done. OUTCOMES: The girl was followed-up for 1 year. The skin and mucous membranes symptoms were relieved. LESSONS: We report this case to attract attention to the rare but serious side effect of this antiviral drug.


Assuntos
Antivirais/efeitos adversos , Oseltamivir/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Antivirais/uso terapêutico , Criança , Feminino , Antígeno HLA-A2/genética , Humanos , Oseltamivir/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/genética , Síndrome de Stevens-Johnson/terapia
6.
J Dermatol ; 46(6): 540-543, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31106904

RESUMO

Toxic epidermal necrolysis (TEN) is a rare condition, causing life-threatening adverse cutaneous reactions. TEN occurrence after bone marrow transplantation (BMT) is a well-known phenomenon; however, to date, only a few cases have been reported in the published work. Here, we describe the case of a 53-year-old woman who experienced TEN after undergoing allogenic BMT for malignant lymphoma. Skin erosion spread across a maximum of 70% of the body surface area and severe mucosal lesions developed. Steroid pulse therapy, plasma apheresis and immunoglobulin therapy were administrated, which resulted in the complete resolution of TEN. However, she developed hemophagocytic lymphohistiocytosis and died 38 days after BMT, owing to rupture of the lower digestive tract complicated by multi-organ failure. In our case, engraftment failure occurred, and the peripheral white blood cell count was less than 100/µL during the TEN course, suggesting that the presence of only a few immune cells could cause TEN. Our findings showed that high mortality rates and widespread skin erosion could be regarded as the most important characteristics of TEN occurring after BMT.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Rejeição de Enxerto/imunologia , Síndrome de Stevens-Johnson/imunologia , Evolução Fatal , Feminino , Rejeição de Enxerto/complicações , Rejeição de Enxerto/prevenção & controle , Humanos , Enteropatias/etiologia , Linfo-Histiocitose Hemofagocítica/etiologia , Linfoma/terapia , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Ruptura Espontânea/etiologia , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapia
8.
Pediatr Dermatol ; 36(4): 550-551, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30931535

RESUMO

A 10-year-old girl, suspected 2 days prior to have streptococcal pharyngitis, presented with diffuse erythema, tense bullae, Nikolsky-positive desquamation, as well as ulcerations of her oral and genital mucosa. She denied recent travel, sick contacts, or preceding and concurrent use of medications, including over-the-counter and herbal supplements. A comprehensive viral polymerase chain reaction (PCR) panel, Mycoplasma pneumoniae PCR and IgM, streptococcal molecular antigen test, urine culture, blood culture, and rheumatologic serologies were negative. Based on the patient's clinical presentation and biopsy results, she was diagnosed with idiopathic toxic epidermal necrolysis.


Assuntos
Faringite/diagnóstico , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/patologia , Infecções Estreptocócicas/fisiopatologia , Adolescente , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Faringite/microbiologia , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/terapia , Fatores de Tempo
9.
Int J Dermatol ; 58(9): 1069-1077, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30825193

RESUMO

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe mucocutaneous disorders. To date, relatively few studies have looked at institutional approaches to treatment of SJS/TEN, particularly with a focus on wound care. METHODS: A retrospective review was conducted on patients admitted to the Hennepin County Medical Center from 2007 to 2017 with a final diagnosis of SJS or TEN. Data were obtained for demographics, causative drug, hospital course, supportive care, medical management, complications, and disposition. RESULTS: A total of 48 were diagnosed with SJS/TEN during the study period. A total of 41.7% (20/48) were men, and the mean age was 49.2 years. Sulfa antibiotics and nonsulfa antibiotics were the most common causative drug categories, each accounting for a quarter of cases. Supportive measures included intravenous fluid resuscitation in 4.2% of cases, enteral nutrition in 75%, surgical debridement in 27.1%, and porcine xenograft in 16.7%. Wound care consisted of use of a cleanser in 95.8% of patients, topical antibiotic in 95.8%, topical steroid in 20.8%, topical antifungal in 14.6%, emollient in 83.3%, nonadherent dressing in 97.9%, silver impregnated dressing in 39.6%, nonsilver impregnated dressing in 79.2%, and general wrap in 93.8%. For medical treatment, 64.6% of patients received intravenous immunoglobulin (IVIG), and 8.3% of patients received cyclosporine. Mortality rate was 12.5% overall, compared to an expected mortality rate of 25.2% as predicted by SCORTEN. CONCLUSIONS: Patients treated with our current regimen of care showed a mortality rate half of that predicted by SCORTEN.


Assuntos
Antibacterianos/uso terapêutico , Hidratação , Imunossupressores/uso terapêutico , Transplante de Pele/métodos , Síndrome de Stevens-Johnson/terapia , Adulto , Idoso , Animais , Bandagens , Criança , Desbridamento/métodos , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/mortalidade , Suínos , Transplante Heterólogo/métodos , Resultado do Tratamento , Adulto Jovem
10.
Adv Emerg Nurs J ; 41(1): 56-64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30702535

RESUMO

Stevens-Johnson syndrome and toxic epidermal necrolysis represent a spectrum of severe cutaneous adverse reactions that carry the potential for severe, long-term adverse effects, including death. Although medications are most commonly implicated in the development of these diseases, other factors, including infection and genetics, play a role. Management is generally supportive in nature and includes maintenance of the patient's airway, breathing, and circulation. Special disease considerations include the use of skin barrier management, unique infection prevention measures, and systemic immunomodulatory therapies.


Assuntos
Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapia , Diagnóstico Diferencial , Humanos , Síndrome de Stevens-Johnson/epidemiologia
11.
Am J Med Sci ; 357(4): 348-351, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30638600

RESUMO

Allopurinol is a first line agent in treating gout, but it also carries the risk of severe side effects. Stevens-Johnson syndrome (SJS) is one of the life threatening severe cutaneous adverse reactions caused by allopurinol. The severity of the severe cutaneous adverse reactions can be categorized based upon the area of skin involvement: (1) erythema multiforme major limited to 1-2 % of the body surface area (BSA); (2) SJS involving <10% of the BSA, (3) SJS and toxic epidermal necrolysis overlap involving 10-30% of the BSA and (4) toxic epidermal necrolysis syndrome involving >30% of the BSA. SJS can be caused by drugs and viruses, the former being more frequent. We report a case of an 85-year-old Han-Chinese female who developed SJS after ingestion of allopurinol 8 days prior to the hospitalization. The patient also had concomitant acute viral illness, which complicated the clinical scenario causing acute renal failure and hemodynamic compromise.


Assuntos
Alopurinol/efeitos adversos , Supressores da Gota/efeitos adversos , Síndrome de Stevens-Johnson/terapia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Lesão Renal Aguda/virologia , Idoso de 80 Anos ou mais , China , Feminino , Humanos , Síndrome de Stevens-Johnson/etiologia , Resultado do Tratamento , Viroses/complicações , Viroses/fisiopatologia , Viroses/terapia
12.
J Dermatolog Treat ; 30(7): 718-723, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30632424

RESUMO

Background: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare diseases with devastating consequences on morbidity and mortality. There are currently no standardized guidelines for treatment of SJS/TEN in Australia. Method: Retrospective chart review of all SJS/TEN cases treated at the Royal Adelaide Hospital from 2000 to 2017. Result: A total of 42 patients were identified (SJS = 18, TEN = 24). The average age of presentation for SJS was 45.8 years and 54.9 years for TEN. The overall mortality rate was 19%. Comparing the data between 2000-2009 and 2010-2017, there was an improvement in mortality in those who were treated with intravenous immunoglobulin (IVIg) compared to those who were treated with systemic steroids (mortality rate 27.2% vs. 50%). There were a total of 12 TEN patients admitted to the Burns unit, with only 2 observed deaths (mortality rate 16.7%). Conclusion: There was an improvement in mortality in those who were treated with IVIg and supportive care compared to those who were treated with systemic steroids and supportive care. Early admission into burns unit may also improve mortality outcomes. However, treatment paradigms in skin care and supportive measures have improved over the length of the study period, which makes definitive conclusions difficult.


Assuntos
Síndrome de Stevens-Johnson/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Pré-Escolar , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome de Stevens-Johnson/terapia , Resultado do Tratamento
13.
Am J Ophthalmol ; 201: 1-8, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30664843

RESUMO

PURPOSE: To report the outcomes of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in pediatric patients with chronic ocular surface disease associated with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). DESIGN: Retrospective, interventional case series. METHODS: Patients aged 18 years or younger seen in consultation for PROSE treatment at a single center between January 1992 and December 2016 with a history of SJS/TEN were reviewed. Demographics, etiology of SJS/TEN, age at treatment milestones, best-corrected visual acuity (BCVA) at treatment milestones, and treatment failures were recorded. BCVA at the initial presentation visit was compared to BCVA at the time of PROSE device dispense and at the last recorded visit. RESULTS: Twenty-seven female and 22 male patients were reviewed. Reported etiology was antibiotic (n = 19), antiepileptic (n = 9), antipyretic (n = 9), other (n = 3), and unknown (n = 9). The mean age was 6.4 years at disease onset and 9.3 years at time of initial presentation. The mean duration of follow-up was 5.45 years. The median BCVA at the initial presentation was 0.6 logMAR (20/80 Snellen), and was significantly improved to 0.18 logMAR (20/30 Snellen) at the time a PROSE device was dispensed (P < .0001). The median BCVA at the last recorded visit was significantly improved to 0.18 logMAR (20/30 Snellen, P = .0004). There were 15 patients who failed PROSE treatment (30.6%). CONCLUSIONS: PROSE treatment is feasible in over two thirds of pediatric patients with chronic ocular surface disease related to SJS/TEN and results in significant improvement in vision that is durable over a period of many years.


Assuntos
Lentes de Contato , Doenças da Córnea/terapia , Próteses e Implantes , Síndrome de Stevens-Johnson/terapia , Adolescente , Criança , Pré-Escolar , Doenças da Córnea/fisiopatologia , Ecossistema , Feminino , Seguimentos , Humanos , Masculino , Falha de Prótese , Estudos Retrospectivos , Síndrome de Stevens-Johnson/fisiopatologia , Acuidade Visual/fisiologia
14.
J Am Acad Dermatol ; 80(4): 990-997, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30399387

RESUMO

BACKGROUND: There is increasing recognition of distinct inflammatory eruptions associated with checkpoint inhibitors. A better understanding of their severity, therapeutic response, and impact on cancer treatment is needed. OBJECTIVE: To analyze the different rashes associated with immunotherapy referred to our institution's oncodermatology clinic and inpatient consultative service and to evaluate their therapeutic response and impact on immunotherapy. METHODS: We retrospectively reviewed the medical records of patients referred to the oncodermatology clinic or inpatient dermatology service during 2016-2018 at Yale-New Haven Hospital for eruptions that developed during immunotherapy. RESULTS: In total, 98 patients (51 men, 47 women) treated with checkpoint inhibitors developed 103 inflammatory eruptions, with a range of mean latency of 0.2-17.7 months. A minority of patients (25/103; 24.3%) required immunotherapy interruption; most of these cases involved immunobullous (7/8; 87.5%), lichenoid (8/26; 30.8%), maculopapular (6/18; 33.3%), and Stevens-Johnson syndrome-like (2/2, 100%) reactions. Only 3 of 16 (18.8%) patients who had their immunotherapy interrupted had a grade 2 or 3 flare on rechallenge. Most reactions (93/103; 90.3%) responded to dermatologic therapy or immunotherapy interruption. LIMITATIONS: This was a retrospective study from a single tertiary care center. CONCLUSION: A variety of inflammatory reactions might occur from immunotherapy with differing degrees of severity. While most rashes responded to topical treatment, immunobullous and exfoliative presentations frequently interrupted immunotherapy. Increased awareness and early recognition could reduce the need for unnecessary immunotherapy interruption.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Erupção por Droga/etiologia , Exantema/induzido quimicamente , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/administração & dosagem , Antineoplásicos Imunológicos/efeitos adversos , Erupção por Droga/patologia , Erupção por Droga/terapia , Exantema/patologia , Exantema/terapia , Feminino , Humanos , Ipilimumab/administração & dosagem , Ipilimumab/efeitos adversos , Erupções Liquenoides/induzido quimicamente , Erupções Liquenoides/patologia , Erupções Liquenoides/terapia , Masculino , Pessoa de Meia-Idade , Nivolumabe/administração & dosagem , Nivolumabe/efeitos adversos , Estudos Retrospectivos , Síndrome de Stevens-Johnson/etiologia , Síndrome de Stevens-Johnson/patologia , Síndrome de Stevens-Johnson/terapia , Suspensão de Tratamento
16.
Korean J Intern Med ; 34(1): 195-201, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29466850

RESUMO

BACKGROUND/AIMS: There are only a few reports on the direct costs of severe cutaneous adverse reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), despite the tremendous negative impact these reactions can have on patients. We estimated the direct costs of treating SCARs. METHODS: Patients admitted to a tertiary teaching hospital for the treatment of SCARs from January 1, 2005 to December 31, 2010 were included. Patients who had experienced SCARs during their admission for other medical conditions were excluded. The direct costs of hospitalization and outpatient department visits were collected. Inpatient and outpatient care costs were calculated, and factors affecting inpatient care costs were analyzed. RESULTS: The total healthcare cost for the management of 73 SCAR patients (36 with DRESS, 21 with SJS, and 16 with TEN) was 752,067 US dollars (USD). Most of the costs were spent on inpatient care (703,832 USD). The median inpatient care cost per person was 3,720 (range, 1,133 to 107,490) USD for DRESS, 4,457 (range, 1,224 to 21,428) USD for SJS, and 8,061 (range, 1,127 to 52,220) USD for TEN. Longer hospitalization significantly increased the inpatient care costs of the patients with DRESS (by 428 USD [range, 395 to 461] per day). Longer hospitalization and death significantly increased the inpatient care costs of the patients with SJS/TEN (179 USD [range, 148 to 210] per day and an additional 14,425 USD [range, 9,513 to 19,337] for the deceased). CONCLUSION: The management of SCARs required considerable direct medical costs. SCARs are not only a health problem but also a significant financial burden for the affected individuals.


Assuntos
Erupção por Droga/economia , Erupção por Droga/terapia , Custos de Cuidados de Saúde , Adolescente , Adulto , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Síndrome de Hipersensibilidade a Medicamentos/economia , Síndrome de Hipersensibilidade a Medicamentos/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Síndrome de Stevens-Johnson/economia , Síndrome de Stevens-Johnson/terapia , Centros de Atenção Terciária , Adulto Jovem
18.
Plast Surg Nurs ; 38(3): 121-127, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30157125

RESUMO

Stevens-Johnson syndrome (SJS) is a disease that causes skin exfoliative lesions, characterized by fever, necrosis, and epidermal detachment. Biological skin substitutes may be considered interesting options for the treatment of this disease. This study aims at identifying in the literature the evidence on the current role of these biomaterials in the treatment of SJS and its related diseases. A systematic review with a search period between 2003 and 2017 was carried out, consulting the Lilacs, BVS, and PubMed databases. The quality of the included studies was evaluated by the Oxford Center for Evidence-Based Medicine Classification, for evaluating levels of evidence from the scientific publications. Ninety-five publications were found, and after applying inclusion and exclusion criteria, they resulted in 9 articles. In total, 20 patients with 73.87% average of body surface affected received SJS skin treatment with some biological substitutes, among them are cutaneous allograft, amnion, and xenograft. Mortality rate was 10%, and in these situations, literature indicates mortality rates ranging from 25% to 70%. Effectiveness of the use of biological dressings may be a possible explanation for this finding. Findings indicate the use of these biomaterials may favor reepithelialization, reduce water loss, decrease the chance of infection, and, consequently, improve the survival of patients with SJS and toxic epidermal necrolysis. Biological skin substitutes have characteristics that make them very promising in the topical treatment of these wounds, but their use remains very restricted in the treatment of SJS.


Assuntos
Pele Artificial/normas , Síndrome de Stevens-Johnson/terapia , Fenômenos Biológicos , Humanos
19.
Adv Emerg Nurs J ; 40(3): 176-182, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30059372

RESUMO

Stevens-Johnson syndrome is a rare, yet life-threatening, delayed-type hypersensitivity reaction characterized by mucocutaneous epidermal necrolysis. Toxic epidermal necrolysis is a severe manifestation of Stevens-Johnson syndrome, defined as greater than 30% skin detachment. Stevens-Johnson syndrome with toxic epidermal necrolysis is characterized as an adverse cutaneous drug reaction and is associated with the use of sulfonamides, antiepileptics, and some classes of nonsteroidal anti-inflammatory drugs. The case presented in this report is that of a 17-year-old female who presented to her primary care provider with a chief complaint of headache; she was initially diagnosed with a urinary tract infection and prescribed nitrofurantoin (Macrobid). Over the next 2 days, her symptoms worsened, she presented to the emergency department twice, and was transferred to a burn unit for definitive care. This case highlights the importance of prompt identification and diagnosis of Stevens-Johnson syndrome and underscores the need for emergency providers to have a comprehensive knowledge of adverse cutaneous drug reactions.


Assuntos
Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapia , Adolescente , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos
20.
J Burn Care Res ; 39(4): 585-592, 2018 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-29901804

RESUMO

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, type IV hypersensitivity reactions of the skin and mucosa. These reactions (SJS/TEN) are frequently managed in burn units; however, no standardized guidelines exist for the treatment and management of SJS/TEN. To gain insight into current SJS/TEN management practices, a survey on admission, diagnosis, and management, was conducted across accredited burn units in the United States. A 28-item question survey on SJS/TEN management, diagnosis, and treatment practices was distributed among medical directors and co-directors of American Burn Association-verified burn centers. Responses were collected over a 6-week period. In total, 31 (48% response rate) burn unit medical directors/co-directors participated in the survey. The majority of responders indicate that acceptance to their burn unit is based on clinical suspicion of SJS/TEN (74%), and biopsy or dermatological evaluation is not required (67 and 87%, respectively). More than half (61%) of the burn units have their own SJS/TEN protocol in place. No consensus was observed on different treatment aspects, such as infection control, systemic treatment, and wound care. Most directors reported their burn units to consult ophthalmology (77%) and dermatology (54%) for the management of patients with SJS/TEN. Large variability in procedures of admission, treatment, and management of SJS/TEN was identified across burn centers. This study demonstrates the urgent need for SJS/TEN standardized guidelines in the United States.


Assuntos
Unidades de Queimados , Padrões de Prática Médica/estatística & dados numéricos , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapia , Protocolos Clínicos , Feminino , Humanos , Masculino , Encaminhamento e Consulta , Inquéritos e Questionários , Estados Unidos
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