Schöpf E, Stühmer A, Rzany B, Victor N, Zentgraf R, Kapp J F
Department of Dermatology, University of Freiburg, Federal Republic of Germany.
Arch Dermatol. 1991 Jun;127(6):839-42. doi: 10.1001/archderm.1991.01680050083008.
Little work has been carried out on the epidemiology of the two serious skin reactions--toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). We collected details of all the hospitalized cases of TEN and SJS in the Federal Republic of Germany for the years 1981 through 1985 inclusive. Inquiries by telephone, letter, and personal visits produced an overall response of 91%; 259 cases of TEN and 315 cases of SJS were identified. From these data, we were able to calculate an overall annual risk of 0.93 and 1.1 per million for TEN and SJS, respectively. The average age group was higher for TEN (63 years) than for SJS (25 years). Women are markedly more at risk for TEN in the ratio of 2:1, these figures being reversed for SJS. The mortality was 34% (87/259) for TEN and only 1% (2/315) for SJS. An association with previous medication defined as "definite, probable, possible" could be established for 89% of cases of TEN and 54% of cases of SJS. The drugs most commonly involved were antibiotics (TEN, 40%; SJS, 34%), followed by the analgesics (TEN, 23%; SJS, 33%). As with the drug groups, the incidences being based on the defined daily doses, were high for sulfonamides, beta-lactam antibiotics, and some nonsteroidal anti-inflammatory drugs.
针对两种严重皮肤反应——中毒性表皮坏死松解症（TEN）和史蒂文斯-约翰逊综合征（SJS）的流行病学研究开展得较少。我们收集了1981年至1985年（含）期间德意志联邦共和国所有住院的TEN和SJS病例的详细信息。通过电话、信件及亲自走访进行调查，总体回复率为91%；共识别出259例TEN病例和315例SJS病例。根据这些数据，我们分别计算出TEN和SJS的总体年风险为百万分之0.93和百万分之1.1。TEN的平均年龄组（63岁）高于SJS（25岁）。女性患TEN的风险明显更高，比例为2:1，而SJS的情况则相反。TEN的死亡率为34%（87/259），SJS的死亡率仅为1%（2/315）。89%的TEN病例和54%的SJS病例可确定与之前使用的药物存在“肯定、很可能、可能”的关联。最常涉及的药物是抗生素（TEN为40%；SJS为34%），其次是镇痛药（TEN为23%；SJS为33%）。与药物类别一样，基于限定日剂量计算的磺胺类药物、β-内酰胺类抗生素和一些非甾体抗炎药的发病率较高。
