The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China

Abstract

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI) and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5%) and anticonvulsants (24.1%). Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%). Chinese patent medicines accounted for 5.4%. There were 76 (45.8%) patients receiving systemic steroid and intravenous immunoglobulin (IVIG) in combination therapy, especially for TEN (80.3%), and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.

Figure 1

Typical cases of SJS from Chinese literature [20]. (a) Detachment of the eyelids, erosions and crusts of lips, and brownish macules on face and neck with scattered skin detachment. (b) Brownish macules with blisters and detachment on the trunk.

Figure 2

Typical cases of TEN from Chinese literature [12]. (a) Widespread reddish to purplish macules and bullae on the trunk and upper limbs, with erosions on swollen face. (b) Macules and large skin detachment on the lateral trunk and upper limbs.