DRUG-INDUCED SEVERE SKIN REACTIONS - DIAG NOSIS, EPIDEMIOLOGY AND THERAPY OF TOXIC EPIDERMAL NECROLYSIS AND STEVENS-JOHNSON SYNDROME

The severe reactions erythema exsudativum multiforme majus (EEMM), Ste vens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are c haracterized by erythematous skin eruptions with more or less extensiv e blistering. In most cases the mucosal surfaces are also affected. Du e to the rareness of these skin reactions with an incidence of about t wo cases per one million inhabitants per year only very few study desi gns as retrospective or prospective total assessment and case-control study are feasible. Since the 1.4. 1990 all hospitalized patients with EEMM, SJS and TEN in West-Germany and Berlin are registered by the Do kumentationszentrum schwerer Hautreaktionen (dZh). Until 30.6. 1993 55 0 patients were interviewed and 337 patients were finally included int o the study. 59 patients presented with EEMM, 134 with SJS. Among TEN patients 91 patients with SJS/TEN overlap, 45 patients with TEN with m aculae and 8 patients with TEN on large erythema were documented. Base d on these data, incidences of the severe skin reactions and drug base d incidences in order to measure the risk of single drugs were calcula ted. As drugs associated with these skin reactions antiepileptics as p henytoin, carbamazepine, antibiotics as aminopenicillins, cephalospori ns and antibacterial chemotherapeutics as sulfonamides were identified . NSAIDS were not frequently associated with severe skin reactions. Th e most important treatment is the withdrawal of all drugs which may be causally related, i.e. given three weeks before the skin reaction. De pending on the amount of erosions and blisters of the body surface are a an intravenous substitution therapy based on intensive care treatmen t schedules should be performed. The benefits or risks of the glucocor ticosteroid treatment are still not clear. If steroids are given, they should be administered in a high dosage only for a few days.