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
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[Abstract][Full Text]
TOZSER, J.
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946: 145-159
[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
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[Abstract][Full Text]
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[Abstract][Full Text]
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Sarris, B. M., Wong, J. G.
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53: 1367-1367
[Full Text]
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[Abstract][Full Text]
Sontheimer, R. D., Houpt, K. R., Bocquet, H., Bagot, M., Roujeau, J.-C., Schlienger, R. G., Shear, N. H.
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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]
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]
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(1995). Medication Use and the Risk of Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis. NEJM
333: 1600-1608
[Abstract][Full Text]
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