Severe cutaneous adverse reactions: an evidence based approach

Abstract

Background: Severe cutaneous adverse reactions (SCAR), comprising mainly Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), although rare, constitute a severe entity with life-threatening consequences. The aetiology is multifactorial but drugs have been implicated in the majority of cases. Depending on the severity of the reaction, it has a wide spectrum of clinical presentations and there is still confusion regarding its classification. Reliable information on the incidence of drug reactions has been difficult to obtain due to lack of standardised systems for data collection and reporting. The situation is poorer in developing countries where specific epidemiological studies have not been published, largely due to the lack of a reporting system and awareness of drug reaction patterns among medical professionals and patients alike. Method: We have reviewed available literature regarding SJS and TEN, and the hospital admission records of such patients at Tribhuvan University teaching hospital. A comparative study was done. Results: Drugs, mainly sulfonamides and anticonvulsants have been the aetiological factors in majority of the cases, and the presentation in the patients have ranged from mild to fatal reactions. In the TU teaching hospital, in almost all cases, steroids have been used in the management. Conclusion: Though a self-limiting disorder, patients with SCAR have a multi-system involvement, and a multi-disciplinary approach is necessary for its management. The need for intensive supportive care and the controversial role of steroids makes its management even more challenging. Thus, it is essential to develop a protocol/guidelines for the management of these disorders appropriate to our context. Journal of Institute of Medicine Vol.27(3) 2005