Although the rate of acute severe adverse cutaneous reactionsto medications is low, these reactions can affect anyone whotakes medications and can result in death or disability1. Evena small number of cases associated with a particular drug mayalter the recommendations for its use2,3,4. Prompt differentiationof severe adverse cutaneous reactions from less serious skindisorders may be difficult. Rapid recognition of severe reactionsis essential. Prompt withdrawal of the offending drug is oftenthe most important action to minimize morbidity.
Adverse cutaneous reactions to drugs are frequent, affecting2 to 3 percent of hospitalized patients5. . . [Full Text of this Article]
Recognition
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Clinical Features
Differential Diagnosis
Epidemiologic Features
Pathophysiology
Prognosis and Treatment
Hypersensitivity Syndrome
Vasculitis and Serum Sickness
Clinical Presentation
Differential Diagnosis
Anticoagulant-Induced Skin Necrosis
Angioedema
Conclusions
Source Information
From the Department of Dermatology, Henri Mondor Hospital, University of Paris XII, Creteil, France (J.C.R.), and Beth Israel Hospital, Harvard Medical School, Boston (R.S.S.).
Address reprint requests to Dr. Stern at the Department of Dermatology, Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.
References
Related Letters:
Severe Adverse Cutaneous Reactions to Drugs
Fernández-Fernández F. J., Garrido J.A., Hauben M., Drenth J. P.H., Michiels J. J., Hughes-Davies L., Stern R. S., Roujeau J. C.
Extract |
Full Text
N Engl J Med 1995;
332:959-960, Apr 6, 1995.
Correspondence
This article has been cited by other articles:
Shahverdian, D. E., Anastassiades, C. P., Charles, J. C.
(2009). 60-Year-Old Man With Rash. Mayo Clin Proc.
84: 838-841
[Full Text]
Takahashi, R., Kano, Y., Yamazaki, Y., Kimishima, M., Mizukawa, Y., Shiohara, T.
(2009). Defective Regulatory T Cells In Patients with Severe Drug Eruptions: Timing of the Dysfunction Is Associated with the Pathological Phenotype and Outcome. J. Immunol.
182: 8071-8079
[Abstract][Full Text]
Emerson, C R, Post, J J, Workman, C
(2009). A delayed hypersensitivity reaction to enfuvirtide after rechallenge. Int J STD AIDS
20: 288-289
[Abstract][Full Text]
Gueudry, J., Roujeau, J.-C., Binaghi, M., Soubrane, G., Muraine, M.
(2009). Risk Factors for the Development of Ocular Complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Arch Dermatol
145: 157-162
[Abstract][Full Text]
Levi, N., Bastuji-Garin, S., Mockenhaupt, M., Roujeau, J.-C., Flahault, A., Kelly, J. P., Martin, E., Kaufman, D. W., Maison, P.
(2009). Medications as Risk Factors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children: A Pooled Analysis. Pediatrics
123: e297-e304
[Abstract][Full Text]
Eshki, M., Allanore, L., Musette, P., Milpied, B., Grange, A., Guillaume, J.-C., Chosidow, O., Guillot, I., Paradis, V., Joly, P., Crickx, B., Ranger-Rogez, S., Descamps, V.
(2009). Twelve-Year Analysis of Severe Cases of Drug Reaction With Eosinophilia and Systemic Symptoms: A Cause of Unpredictable Multiorgan Failure. Arch Dermatol
145: 67-72
[Abstract][Full Text]
Patnaik, M., Renda, M. J., Athanasiou, M. C., Reed, C. R.
(2008). The Role of Pharmacogenetics in Treating Central Nervous System Disorders. Exp. Biol. Med.
233: 1504-1509
[Abstract][Full Text]
Hirsch, L. J., Arif, H., Nahm, E. A., Buchsbaum, R., Resor, S. R. Jr, Bazil, C. W.
(2008). Cross-sensitivity of skin rashes with antiepileptic drug use. Neurology
71: 1527-1534
[Abstract][Full Text]
Borras-Blasco, J., Navarro-Ruiz, A., Borras, C., Castera, E.
(2008). Adverse cutaneous reactions associated with the newest antiretroviral drugs in patients with human immunodeficiency virus infection. J Antimicrob Chemother
62: 879-888
[Abstract][Full Text]
Seth, D., Kamat, D., Montejo, J.
(2008). DRESS Syndrome: A Practical Approach for Primary Care Practitioners. CLIN PEDIATR
47: 947-952
Teraki, Y., Murota, H., Izaki, S.
(2008). Toxic Epidermal Necrolysis Due to Zonisamide Associated With Reactivation of Human Herpesvirus 6. Arch Dermatol
144: 232-235
[Abstract][Full Text]
Mukasa, Y, Craven, N
(2008). Management of toxic epidermal necrolysis and related syndromes. Postgrad. Med. J.
84: 60-65
[Abstract][Full Text]
Segal, A. R., Doherty, K. M., Leggott, J., Zlotoff, B.
(2007). Cutaneous Reactions to Drugs in Children. Pediatrics
120: e1082-e1096
[Abstract][Full Text]
Shah, A. P., Xu, H., Sime, P. J., Trawick, D. R.
(2006). Severe airflow obstruction and eosinophilic lung disease after Stevens-Johnson syndrome. Eur Respir J
28: 1276-1279
[Abstract][Full Text]
Schmid, D. A., Depta, J. P. H., Luthi, M., Pichler, W. J.
(2006). Transfection of Drug-Specific T-Cell Receptors into Hybridoma Cells: Tools to Monitor Drug Interaction with T-Cell Receptors and Evaluate Cross-Reactivity to Related Compounds. Mol. Pharmacol.
70: 356-365
[Abstract][Full Text]
Prais, D., Straussberg, R., Amir, J., Nussinovitch, M., Harel, L.
(2006). Treatment of Anticonvulsant Hypersensitivity Syndrome with Intravenous Immunoglobulins and Corticosteroids. J Child Neurol
21: 380-384
[Abstract]
GIMNIG, J. E., MacARTHUR, J. R., M'BANG'OMBE, M., KRAMER, M. H., CHIZANI, N., STERN, R. S., MKANDALA, C., NEWMAN, R. D., STEKETEE, R. W., CAMPBELL, C. H.
(2006). SEVERE CUTANEOUS REACTIONS TO SULFADOXINE-PYRIMETHAMINE AND TRIMETHOPRIM-SULFAMETHOXAZOLE IN BLANTYRE DISTRICT, MALAWI.. Am J Trop Med Hyg
74: 738-743
[Abstract][Full Text]
Sheridan, R. L., Liu, V., Anupindi, S.
(2005). Case 34-2005 -- A 10-Year-Old Girl with a Bullous Skin Eruption and Acute Respiratory Failure.. NEJM
353: 2057-2066
[Full Text]
Sturkenboom, M., Nicolosi, A., Cantarutti, L., Mannino, S., Picelli, G., Scamarcia, A., Giaquinto, C., for the NSAIDs Paediatric Research Group,
(2005). Incidence of Mucocutaneous Reactions in Children Treated With Niflumic Acid, Other Nonsteroidal Antiinflammatory Drugs, or Nonopioid Analgesics. Pediatrics
116: e26-e33
[Abstract][Full Text]
Vincenzi, B., Santini, D., Grilli, C., La Cesa, A., Dianzani, C., Tonini, G.
(2004). Complications of Therapy in Cancer Patients: CASE 3. Toxic Epidermal Necrolysis Induced by Oral Phenobarbital and Whole-Brain Radiotherapy in a Breast Cancer Patient. JCO
22: 4649-4651
[Full Text]
Chopra, A., Drage, L. A., Hanson, E. M., Touchet, N. L.
(2004). Stevens-Johnson Syndrome After Immunization With Smallpox, Anthrax, and Tetanus Vaccines. Mayo Clin Proc.
79: 1193-1196
[Abstract]
Guilhot, F.
(2004). Indications for Imatinib Mesylate Therapy and Clinical Management. The Oncologist
9: 271-281
[Abstract][Full Text]
Perrett, C M, McBride, S R
(2004). Teicoplanin induced drug hypersensitivity syndrome. BMJ
328: 1292-1292
[Full Text]
Enomoto, M., Ochi, M., Teramae, K., Kamo, R., Taguchi, S., Yamane, T.
(2004). Codeine Phosphate-Induced Hypersensitivity Syndrome. The Annals of Pharmacotherapy
38: 799-802
[Abstract][Full Text]
Jones, D. H., Todd, M., Craig, T. J.
(2004). Early Diagnosis Is Key in Vancomycin-Induced Linear IgA Bullous Dermatosis and Stevens-Johnson Syndrome. JAOA: Journal of the American Osteopathic Association
104: 157-163
[Abstract][Full Text]
LaRoche, S. M., Helmers, S. L.
(2004). The New Antiepileptic Drugs: Scientific Review. JAMA
291: 605-614
[Abstract][Full Text]
Kano, Y., Inaoka, M., Shiohara, T.
(2004). Association Between Anticonvulsant Hypersensitivity Syndrome and Human Herpesvirus 6 Reactivation and Hypogammaglobulinemia. Arch Dermatol
140: 183-188
[Abstract][Full Text]
Metry, D. W., Jung, P., Levy, M. L.
(2003). Use of Intravenous Immunoglobulin in Children With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Seven Cases and Review of the Literature. Pediatrics
112: 1430-1436
[Abstract][Full Text]
Pichler, W. J.
(2003). Delayed Drug Hypersensitivity Reactions. ANN INTERN MED
139: 683-693
[Abstract][Full Text]
Borras-Blasco, J., Navarro-Ruiz, A., Matarredona, J., Devesa, P., Montesinos-Ros, A., Gonzalez-Delgado, M.
(2003). Photo-Induced Stevens-Johnson Syndrome Due to Sulfasalazine Therapy. The Annals of Pharmacotherapy
37: 1241-1243
[Abstract][Full Text]
Liberopoulos, E. N, Liamis, G. L, Elisaf, M. S
(2003). Possible Cefotaxime-Induced Stevens-Johnson Syndrome. The Annals of Pharmacotherapy
37: 812-814
[Abstract][Full Text]
Abe, R., Shimizu, T., Shibaki, A., Nakamura, H., Watanabe, H., Shimizu, H.
(2003). Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome Are Induced by Soluble Fas Ligand. Am. J. Pathol.
162: 1515-1520
[Abstract][Full Text]
Chen, K.-T., Twu, S.-J., Chang, H.-J., Lin, R.-S.
(2003). Outbreak of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Associated With Mebendazole and Metronidazole Use Among Filipino Laborers in Taiwan. AJPH
93: 489-492
[Abstract][Full Text]
Alkurtass, D. A, Al-Jazairi, A. S
(2003). Possible Captopril-Induced Toxic Epidermal Necrolysis. The Annals of Pharmacotherapy
37: 380-383
[Abstract][Full Text]
Prins, C., Kerdel, F. A., Padilla, R. S., Hunziker, T., Chimenti, S., Viard, I., Mauri, D. N., Flynn, K., Trent, J., Margolis, D. J., Saurat, J.-H., French, L. E., for the TEN-IVIG Study Group,
(2003). Treatment of Toxic Epidermal Necrolysis With High-Dose Intravenous Immunoglobulins: Multicenter Retrospective Analysis of 48 Consecutive Cases. Arch Dermatol
139: 26-32
[Abstract][Full Text]
Bachot, N., Revuz, J., Roujeau, J.-C.
(2003). Intravenous Immunoglobulin Treatment for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Prospective Noncomparative Study Showing No Benefit on Mortality or Progression. Arch Dermatol
139: 33-36
[Abstract][Full Text]
Boosinger, A. B., Thomas, H. L.
(2002). Stevens-Johnson Syndrome Secondary to Vancomycin Exposure. Journal of Pharmacy Practice
15: 515-518
[Abstract]
Messenheimer, J.
(2002). Efficacy and Safety of Lamotrigine in Pediatric Patients. J Child Neurol
17: 2S34-2S42
[Abstract]
Correia, O., Delgado, L., Roujeau, J.-C., Le Cleach, L., Fleming-Torrinha, J. A.
(2002). Soluble Interleukin 2 Receptor and Interleukin 1{alpha} in Toxic Epidermal Necrolysis: A Comparative Analysis of Serum and Blister Fluid Samples. Arch Dermatol
138: 29-32
[Abstract][Full Text]
Svensson, C. K., Cowen, E. W., Gaspari, A. A.
(2001). Cutaneous Drug Reactions. Pharmacol. Rev.
53: 357-379
[Abstract][Full Text]
Milionis, H. J, Skopelitou, A., Elisaf, M. S
(2000). Hypersensitivity syndrome caused by amitriptyline administration. Postgrad. Med. J.
76: 361-363
[Abstract][Full Text]
Garcia-Doval, I., LeCleach, L., Bocquet, H., Otero, X.-L., Roujeau, J.-C.
(2000). Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome: Does Early Withdrawal of Causative Drugs Decrease the Risk of Death?. Arch Dermatol
136: 323-327
[Abstract][Full Text]
Stern, R. S.
(2000). Improving the Outcome of Patients With Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. Arch Dermatol
136: 410-411
[Full Text]
Duchowny, M., Pellock, J. M., Graf, W. D., Billard, C., Gilman, J., Casale, E., Womble, G., Risner, M., Manasco, P.
(1999). A placebo-controlled trial of lamotrigine add-on therapy for partial seizures in children. Neurology
53: 1724-1724
[Abstract][Full Text]
Lai, W. G., Zahid, N., Uetrecht, J. P.
(1999). Metabolism of Trimethoprim to a Reactive Iminoquinone Methide by Activated Human Neutrophils and Hepatic Microsomes. J. Pharmacol. Exp. Ther.
291: 292-299
[Abstract][Full Text]
Sarris, B. M., Wong, J. G.
(1999). Multisystem hypersensitivity reaction to lamotrigine. Neurology
53: 1367-1367
[Full Text]
Viard, I., Wehrli, P., Bullani, R., Schneider, P., Holler, N., Salomon, D., Hunziker, T., Saurat, J., Tschopp, J., French, L. E.
(1998). Inhibition of Toxic Epidermal Necrolysis by Blockade of CD95 with Human Intravenous Immunoglobulin. Science
282: 490-493
[Abstract][Full Text]
Sontheimer, R. D., Houpt, K. R., Bocquet, H., Bagot, M., Roujeau, J.-C., Schlienger, R. G., Shear, N. H.
(1998). DIDMOHS: A Proposed Consensus Nomenclature for the Drug-Induced Delayed Multiorgan Hypersensitivity Syndrome. Arch Dermatol
134: 874-876
[Full Text]
Pfeiffer, C. M., Kazenoff, S., Rothberg, H. D.
(1998). Toxic Epidermal Necrolysis From Atorvastatin. JAMA
279: 1613-1614
[Full Text]
deShazo, R. D., Kemp, S. F.
(1997). Allergic Reactions to Drugs and Biologic Agents. JAMA
278: 1895-1906
[Abstract]
Pellock, J. M.
(1997). Overview of Lamotrigine and the New Antiepileptic Drugs: The Challenge. J Child Neurol
12: S48-S52
[Abstract]
Feeney, J.
(1997). Diaminopyrimidines and Severe Cutaneous Adverse Reactions. Arch Dermatol
133: 1173-1173
[Abstract]
Thaler, S.J., Bailey, E.M.
(1996). Case 14-1996- A 66-year-old woman with toxic epidermal necrolysis and a fatal course. NEJM
334: 1254-1261
[Full Text]
Wagner, F. F., Flegel, W. A., Feder, H. M., Hoss, D. M., Dimond, R. L., Roujeau, J.-C., Kaufman, D. W.
(1996). Toxic Epidermal Necrolysis. NEJM
334: 922-923
[Full Text]
Guibal, F., Roujeau, J.-C., Stern, R. S., Weissel, M., Fine, J.-D.
(1996). Management of Acquired Bullous Skin Diseases. NEJM
334: 864-865
[Full Text]
Roujeau, J.-C., Kelly, J. P., Naldi, L., Rzany, B., Stern, R. S., Anderson, T., Auquier, A., Bastuji-Garin, S., Correia, O., Locati, F., Mockenhaupt, M., Paoletti, C., Shapiro, S., Shear, N., Schopf, E., Kaufman, D. W.
(1995). Medication Use and the Risk of Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis. NEJM
333: 1600-1608
[Abstract][Full Text]
Griffin, M. R., Brandt, K. D., Liang, M. H., Pincus, T., Ray, W. A.
(1995). Practical Management of Osteoarthritis: Integration of Pharmacologic and Nonpharmacologic Measures. Arch Fam Med
4: 1049-1055
[Abstract]
Fernandez-Fernandez, F. J., Garrido, J.A., Hauben, M., Drenth, J. P.H., Michiels, J. J., Hughes-Davies, L., Stern, R. S., Roujeau, J. C.
(1995). Severe Adverse Cutaneous Reactions to Drugs. NEJM
332: 959-960
[Full Text]