A systematic review of stevens-johnson syndrome and/or toxic epidermal necrolysis over a period of 20 years in Thailand

Abstract

© 2018, Medical Association of Thailan. All rights reserved. Objective: To perform a systematic review of published literature to generate a large-scale database in order to report the causes, treatment, and clinical outcomes of Stevens-Johnson syndrome [SJS] and/or toxic epidermal necrolysis [TEN] in Thailand. Materials and Methods: Articles from 1995 to 2014 describing SJS and/or TEN in Thai population were searched in PubMed, MEDLINE, EMBASE and Thai Index Medicus electronic databases. Data were analyzed for the causes, management, and clinical outcomes of SJS and/or TEN in Thailand. Results: From 87 references, 9 references were included for the final analysis. Five hundred and forty cases of SJS and/or TEN were reported: 326 (60.4%) of whom were adults and the remaining 214 cases (39.6%) were children. The most common cause of SJS and/ or TEN in both adults (100%) and children (97.2%) was drug. The second most common cause of SJS and/ or TEN in children (2.8%) was Mycoplasma infection. The major culprit drugs in adults were cotrimoxazole (22%), nevirapine (8.6%) and allopurinol (8.3%), and in children were penicillin (21.1%), phenobarbital (16.3%) and carbamazepine (13.5%). In adults, the most common complication was hepatitis (12%) while the most common complication in children was skin infection (8.4%). The death rate from SJS and/or TEN in adults was 11.3%, which was significantly higher than the 6.1% rate in children (p = 0.04). Intravenous corticosteroids treatment in SJS and/ or TEN among children was significant higher than adults (59.2% vs. 27.0%, p<0.01). Conclusion: The major cause of SJS and TEN among Thai adults and children was drug reaction. Antibiotics were the most common culprit drug group in both adults and children. The mortality rate in SJS and/or TEN among adults was significant higher than that in children.