Conner Clayton D, McKenzie Emily, Owen Cindy E, Callen Jeffrey P
Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky.
Dermatol Online J. 2018 Jan 1;24(1):13030/qt6d56n4j8.
Cyclosporine therapy for Stevens-Johnson syndrome-toxic epidermal necrolysis (SJSTEN) was first reported in the literature by Renfro et al. in 1989. Herein we report an additional 4 cases of SJS-TEN treated with cyclosporine.
Case information was collected retroactively at the University of Louisville Hospital in Louisville, KY. All cases had a diagnosis of SJS or TEN by a dermatologist. All patients were ≥18 years of age and treated with cyclosporine during their admission.
Three of four patients re-epithelialized within an average of 3.67 days of starting 3-4 mg/kg/day of cyclosporine. One patient passed away, likely due to advanced endometrial cancer.
We provide a review of the literature on cyclosporine use for SJS/TEN, including various outcome measures - stabilization (cessation of new lesions), time to re-epithelialization, mortality rate, and hospital length of stay and, where available, comparison to other systemic agents.
The outcomes appear to be consistent with rapid re-epithelialization and low mortality as seen in many previous reports. Treating SJS-TEN with systemic agents including cyclosporine will remaincontroversial because the vast majority of data comes from case reports, case series, or small open prospective trials.
1989年，Renfro等人首次在文献中报道了环孢素治疗史蒂文斯-约翰逊综合征-中毒性表皮坏死松解症（SJSTEN）的情况。在此，我们报告另外4例接受环孢素治疗的SJS-TEN病例。
病例信息在肯塔基州路易斯维尔市的路易斯维尔大学医院进行回顾性收集。所有病例均由皮肤科医生诊断为SJS或TEN。所有患者年龄≥18岁，在住院期间接受环孢素治疗。
4例患者中有3例在开始使用3 - 4mg/kg/天的环孢素后平均3.67天重新上皮化。1例患者死亡，可能是由于晚期子宫内膜癌。
我们对环孢素用于SJS/TEN的文献进行了综述，包括各种结局指标——病情稳定（新病变停止出现）、重新上皮化时间、死亡率、住院时间，并在可行的情况下与其他全身用药进行比较。
结果似乎与许多先前报告中所见的快速重新上皮化和低死亡率一致。用包括环孢素在内的全身用药治疗SJS-TEN仍存在争议，因为绝大多数数据来自病例报告、病例系列或小型开放前瞻性试验。
