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Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications.
Ophthalmology. 2009 Apr; 116(4):685-90.O

Abstract

PURPOSE

To present a detailed clarification of the symptoms at disease onset of Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), with ocular complications and to clarify the relationship between topical steroid use and visual prognosis.

DESIGN

Cross-sectional study.

PARTICIPANTS

Ninety-four patients with SJS and TEN with ocular complications.

METHODS

A structured interview, examination of the patient medical records, or both addressing clinical manifestations at disease onset were conducted for 94 patients seen at Kyoto Prefectural University of Medicine. Any topical steroid use during the first week at the acute stage also was investigated.

MAIN OUTCOME MEASURES

The incidence and the details of prodromal symptoms and the mucosal involvements and the relationship between topical steroid use and visual outcomes.

RESULTS

Common cold-like symptoms (general malaise, fever, sore throat, etc.) preceded skin eruptions in 75 cases, and extremely high fever accompanied disease onset in 86 cases. Acute conjunctivitis and oral and nail involvements were reported in all patients who remembered the details. Acute conjunctivitis occurred before the skin eruptions in 42 patients and simultaneously in 21 patients, whereas only 1 patient reported posteruption conjunctivitis. Visual outcomes were significantly better in the group receiving topical steroids compared with those of the no-treatment group (P<0.00001).

CONCLUSIONS

Acute conjunctivitis occurring before or simultaneously with skin eruptions accompanied by extremely high fever and oral and nail involvement indicate the initiation of SJS or TEN. Topical steroid treatment from disease onset seems to be important for the improvement of visual prognosis.

Authors+Show Affiliations

Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan. csotozon@koto.kpu-m.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19243825

Citation

Sotozono, Chie, et al. "Diagnosis and Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Ocular Complications." Ophthalmology, vol. 116, no. 4, 2009, pp. 685-90.
Sotozono C, Ueta M, Koizumi N, et al. Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. Ophthalmology. 2009;116(4):685-90.
Sotozono, C., Ueta, M., Koizumi, N., Inatomi, T., Shirakata, Y., Ikezawa, Z., Hashimoto, K., & Kinoshita, S. (2009). Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. Ophthalmology, 116(4), 685-90. https://doi.org/10.1016/j.ophtha.2008.12.048
Sotozono C, et al. Diagnosis and Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Ocular Complications. Ophthalmology. 2009;116(4):685-90. PubMed PMID: 19243825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. AU - Sotozono,Chie, AU - Ueta,Mayumi, AU - Koizumi,Noriko, AU - Inatomi,Tsutomu, AU - Shirakata,Yuji, AU - Ikezawa,Zenro, AU - Hashimoto,Koji, AU - Kinoshita,Shigeru, Y1 - 2009/02/25/ PY - 2008/09/04/received PY - 2008/11/26/revised PY - 2008/12/18/accepted PY - 2009/2/27/entrez PY - 2009/2/27/pubmed PY - 2009/4/25/medline SP - 685 EP - 90 JF - Ophthalmology JO - Ophthalmology VL - 116 IS - 4 N2 - PURPOSE: To present a detailed clarification of the symptoms at disease onset of Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), with ocular complications and to clarify the relationship between topical steroid use and visual prognosis. DESIGN: Cross-sectional study. PARTICIPANTS: Ninety-four patients with SJS and TEN with ocular complications. METHODS: A structured interview, examination of the patient medical records, or both addressing clinical manifestations at disease onset were conducted for 94 patients seen at Kyoto Prefectural University of Medicine. Any topical steroid use during the first week at the acute stage also was investigated. MAIN OUTCOME MEASURES: The incidence and the details of prodromal symptoms and the mucosal involvements and the relationship between topical steroid use and visual outcomes. RESULTS: Common cold-like symptoms (general malaise, fever, sore throat, etc.) preceded skin eruptions in 75 cases, and extremely high fever accompanied disease onset in 86 cases. Acute conjunctivitis and oral and nail involvements were reported in all patients who remembered the details. Acute conjunctivitis occurred before the skin eruptions in 42 patients and simultaneously in 21 patients, whereas only 1 patient reported posteruption conjunctivitis. Visual outcomes were significantly better in the group receiving topical steroids compared with those of the no-treatment group (P<0.00001). CONCLUSIONS: Acute conjunctivitis occurring before or simultaneously with skin eruptions accompanied by extremely high fever and oral and nail involvement indicate the initiation of SJS or TEN. Topical steroid treatment from disease onset seems to be important for the improvement of visual prognosis. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/19243825/Diagnosis_and_treatment_of_Stevens_Johnson_syndrome_and_toxic_epidermal_necrolysis_with_ocular_complications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(08)01348-1 DB - PRIME DP - Unbound Medicine ER -