Brandt Christian, McGuire Lynanne, Uetrecht Jack
Department of General Epileptology, Bethel Epilepsy Centre, Mara Hospital, Bielefeld, Germany.
MedVal Scientific Information Services, LLC, Princeton, NJ, USA.
Epilepsy Behav. 2021 Apr;117:107844. doi: 10.1016/j.yebeh.2021.107844. Epub 2021 Feb 25.
Severe cutaneous adverse reactions (SCARs) are potentially life-threatening, with considerable morbidity and mortality. They are nonimmediate hypersensitivity reactions that occur in specifically predisposed patients with delayed T-cell-mediated hypersensitivity reaction. Antiseizure medications (ASMs) are among the drugs that can induce SCAR. Increased awareness of SCAR among clinicians treating patients with ASMs is critically important for early recognition of symptoms, prompt identification and removal of the causal drug, and early intervention to reduce SCAR-related acute and long-term morbidity and mortality. The diagnosis, management, and prevention of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) are reviewed, along with the current understanding of the pathomechanisms and role of genetics in SCAR development. Supportive care and immunomodulating treatments for SCAR are discussed.
严重皮肤不良反应（SCARs）有潜在生命危险，具有相当高的发病率和死亡率。它们是非即刻型超敏反应，发生在具有特定易感性、有延迟性T细胞介导超敏反应的患者中。抗癫痫药物（ASMs）是可诱发SCAR的药物之一。在治疗使用ASMs患者的临床医生中提高对SCAR的认识，对于早期识别症状、迅速识别并停用致病药物以及早期干预以降低与SCAR相关的急性和长期发病率及死亡率至关重要。本文综述了史蒂文斯-约翰逊综合征（SJS）、中毒性表皮坏死松解症（TEN）和伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）的诊断、管理及预防，以及目前对发病机制和遗传学在SCAR发生中作用的认识。还讨论了SCAR的支持性治疗和免疫调节治疗。
