Journal
ANNALS OF DERMATOLOGY
Volume 31, Issue 5, Pages 545-554Publisher
KOREAN DERMATOLOGICAL ASSOC
DOI: 10.5021/ad.2019.31.5.545
Keywords
Acute generalized exanthematous pustulosis; Drug reaction with eosinophilia and systemic symptoms; Stevens-Johnson syndrome; Systemic corticosteroids treatment; Toxic epidermal necrolysis
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Funding
- Natural Science Foundation of China [81573064, 81472901]
- Shanghai Sailing Program [19YF1404800]
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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 similar to 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.
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