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Severe Cutaneous Adverse Reactions: A Single-Center Retrospective Study of 173 Patients in China

Annals of Dermatology 2019년 31권 5호 p.545 ~ 554
 ( Xu Zhongyi ) - Fudan University Huashan Hospital Department of Dermatology

 ( Shen Jie ) - Fudan University Shanghai Cancer Center Department of Cancer Prevention
 ( Yang Yiwen ) - Fudan University Huashan Hospital Department of Dermatology
 ( Yuan Ruoyue ) - Fudan University Huashan Hospital Department of Dermatology
 ( Xiang Leihong Flora ) - Fudan University Huashan Hospital Department of Dermatology
 ( Zhang Chengfeng ) - Fudan University Huashan Hospital Department of Dermatology

Abstract


Background: Severe cutaneous adverse reactions (SCAR) to drugs are a crucial public health issue and the use of systemic corticosteroids in SCAR has been controversial.

Objective: To analyze clinical features, causative drugs, treatment, outcomes, and prognostic factors of SCAR in the case-series of 173 patients, and add more information to the debate of using systemic corticosteroids in SCAR management.

Methods: A retrospective study of 173 SCAR patients diagnosed with drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) or acute generalized exanthematous pustulosis (AGEP) at a tertiary care institution in China between January 2014 and December 2017 was conducted.

Results: Of 173 patients, allopurinol, carbamazepine, and antibiotics are the most frequently implicated drugs for DRESS (40.4%), SJS/TEN (26.0%), and AGEP (40.0%) respectively. Moreover, there is a strongly negative correlation between early corticosteroids use and the progression (p=0.000) and severity (p=0.01) of skin lesions. However, there is no association between early corticosteroids use and the mortality of SCAR (odds ratio: 1.01, 95% confidence interval: 0.95~1.08). In addition, lymphadenopathy, eosinophilia, and interval from onset to corticosteroids treatment were correlated with SCAR prognosis.

Conclusion: Prompt short-course systemic corticosteroids use is associated with early-stage skin lesions remission without influencing the disease mortality. Lymphadenopathy and eosinophilia were the independent poor prognostic factors of SCAR.

키워드

Acute generalized exanthematous pustulosis; Drug reaction with eosinophilia and systemic symptoms; Stevens-Johnson syndrome; Systemic corticosteroids treatment; Toxic epidermal necrolysis
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