Fetriani Ulfa, Zakiawati Dewi
Oral Medicine Residency Program, Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia.
Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, West Java, Indonesia.
J Inflamm Res. 2025 Sep 12;18:12575-12588. doi: 10.2147/JIR.S546186. eCollection 2025.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe skin conditions characterized by widespread epidermal necrolysis and mucous membrane involvement. SJS affects less than 10% of the body surface area, while TEN involves over 30%, with cases between 10% and 30% classified as SJS/TEN overlap. Drug hypersensitivity reactions, especially to antibiotics, anticonvulsants, and non-steroidal anti-inflammatory medications, are the most common and well-established causes of SJS/TEN. In addition, infections, including viral ones like herpes simplex virus (HSV), influenza virus, varicella-zoster virus, and human immunodeficiency virus (HIV), have also been implicated as potential inducers, complicating management and requiring careful clinical vigilance.
This review aims to investigate and compile information on reported cases of SJS/TEN potentially linked to virus infections.
Literature from PubMed, NCBI, ScienceDirect, and Cochrane Library databases was searched. The inclusion criteria were studies reporting details of patients diagnosed with SJS, TEN, or SJS/TEN overlap, potentially induced by viral infections. Cases were included if the viral infection occurred within one week before the rash onset, emphasizing the association between these infections and severe skin reactions.
Ten studies were included in this systematic review, most of which demonstrated fair to good methodological quality. The review encompassed cases of virus-induced SJS/TEN, including herpes virus infection, influenza virus infection, varicella-zoster virus, HIV infection, COVID-19, and coxsackie infection, each with distinct manifestations.
The evidence strongly suggests that viral infections contribute to the development of SJS/TEN, yet the precise mechanisms remain unclear and warrant further research. Awareness of this risk is crucial, particularly in regions experiencing outbreaks of these viruses.
史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是严重的皮肤疾病，其特征为广泛的表皮坏死松解和黏膜受累。SJS累及的体表面积小于10%，而TEN累及超过30%，10%至30%的病例归类为SJS/TEN重叠。药物超敏反应，尤其是对抗生素、抗惊厥药和非甾体抗炎药的超敏反应，是SJS/TEN最常见且已明确的病因。此外，感染，包括单纯疱疹病毒（HSV）、流感病毒、水痘-带状疱疹病毒和人类免疫缺陷病毒（HIV）等病毒感染，也被认为是潜在诱因，这使治疗变得复杂，需要临床密切关注。
本综述旨在调查和汇编有关可能与病毒感染相关的SJS/TEN报告病例的信息。
检索了来自PubMed、NCBI、ScienceDirect和Cochrane图书馆数据库的文献。纳入标准为报告经诊断患有可能由病毒感染诱发的SJS、TEN或SJS/TEN重叠的患者详细信息的研究。如果病毒感染发生在皮疹出现前一周内，则纳入病例，重点关注这些感染与严重皮肤反应之间的关联。
本系统综述纳入了10项研究，其中大多数研究显示出中等至良好的方法学质量。该综述涵盖了病毒诱发的SJS/TEN病例，包括疱疹病毒感染、流感病毒感染、水痘-带状疱疹病毒、HIV感染、COVID-19和柯萨奇感染，每种感染都有不同的表现。
证据有力地表明病毒感染会导致SJS/TEN的发生，但确切机制仍不清楚，值得进一步研究。认识到这种风险至关重要，尤其是在这些病毒爆发的地区。
