McNish Alicia J S, Ho Jonathan D, East-Innis Althea D C
Dermatology Unit, Department of Medicine, University of the West Indies, Kingston, Jamaica.
JAAD Int. 2024 Feb 19;15:139-146. doi: 10.1016/j.jdin.2024.02.007. eCollection 2024 Jun.
Severe cutaneous adverse reactions (SCARs) are associated with morbidity and mortality.
The aim was to determine the different types of SCARs, their morphology, common offending drugs, interventions, and outcomes.
A retrospective cohort study was conducted of all patients admitted to the dermatology service at the University Hospital of the West Indies with Stevens-Johnson syndrome (SJS), SJS/toxic epidermal necrolysis overlap (TEN), TEN, drug reaction with eosinophilia and systemic symptoms and acute generalized exanthematous pustulosis between January 1, 2012 to June 1, 2022.
Fifty-one cases (51) met the inclusion criteria for SCAR. SJS, SJS/TEN overlap and TEN together accounted for 71.2% of cases. SCARs were most frequent in the fourth, fifth and 6th decades of life and there was a female preponderance. Antibiotics (31%) and anticonvulsants (29%) were the most common causative agents for SCARs. Most patients had at least 1 complication. The liver was the most common extracutaneous organ affected. Mortality was 7.8%. The main cause of death was sepsis.
Results were not generalizable. There were missing data and loss to follow-up.
Judicious use of antimicrobials and corticosteroids may be beneficial in treatment of severe cutaneous drug reactions.
严重皮肤不良反应（SCARs）与发病率和死亡率相关。
确定不同类型的SCARs、其形态、常见致病药物、干预措施及结局。
对2012年1月1日至2022年6月1日期间西印度群岛大学医院皮肤科收治的所有史蒂文斯-约翰逊综合征（SJS）、SJS/中毒性表皮坏死松解症重叠型（TEN）、TEN、伴有嗜酸性粒细胞增多和全身症状的药物反应以及急性泛发性脓疱病患者进行回顾性队列研究。
51例患者符合SCAR的纳入标准。SJS、SJS/TEN重叠型和TEN共占病例的71.2%。SCARs在40、50和60岁年龄段最为常见，女性居多。抗生素（31%）和抗惊厥药（29%）是SCARs最常见的致病因素。大多数患者至少有1种并发症。肝脏是最常受影响的皮肤外器官。死亡率为7.8%。主要死亡原因是败血症。
结果不可推广。存在数据缺失和失访情况。
明智地使用抗菌药物和糖皮质激素可能有助于治疗严重皮肤药物反应。
