Risk factors for, and treatment of, Stevens-Johnson syndrome and toxic epidermal necrolysis: Evidence from the literature

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. They occur in the form of mild and sometimes severe cutaneous eruptions, with high morbidity and mortality, requiring fast and appropriate diagnosis and treatment. The aim of this study was to describe and discuss the evidence regarding the risk factors, complications and treatment of SJS and TEN in inpatients. The present study is a literature review of case reports published between January 1981 and December 2016, in the following databases: The Virtual Health Library (Biblioteca Virtual da Saude - BVS), MEDLINE (National Library of Medicine, USA), LILACS (Latin American and Caribbean Health Sciences Literature), and PUBMED – NCBI (National Center for Biotechnology Information). A total of thirteen case reports were selected. Most of the cases (54%) developed adverse reactions to anticonvulsant drugs. The most common were valproic acid, lamotrigine and carbamazepine. In 69% of all cases, the patients were female. The patients’ age range varied from 18 to 82 years old.  In two cases which correspond to 15%, the patients were either infected with HIV or were receiving chemotherapy treatment for cancer. These patients had a higher possibility for immunosuppression. In relation to the actions taken as treatment, the suspension of the drugs or the treatment of the skin lesions occurred in 85 and 54% of the cases, respectively. A total of 6 cases, corresponding to 46%, occurred in the Latin American and Caribbean region. In conclusion, the use of anticonvulsants, and female gender, are among the main risk factors identified by the study. The main therapeutic action for SJS and TEN is the suspension of the use of the drug that triggered the inflammatory process and the topical treatment of the lesions caused.   Key words: Stevens-Johnson syndrome, toxic epidermal necrolysis, adverse drug reaction.