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Review
. 2022 Jul 1;158(7):787-790.
doi: 10.1001/jamadermatol.2022.1090.

Photodistributed Toxic Epidermal Necrolysis: Case Report and Review of Current Literature

Lindsey J Gaghan  1 , Margaret M Coates  2 , Lauren N Crouse  2 , Jayson Miedema  2 , Julie E Mervak  2 , Carolyn M Ziemer  2
Affiliations
Review

Photodistributed Toxic Epidermal Necrolysis: Case Report and Review of Current Literature

Lindsey J Gaghan et al. JAMA Dermatol. .

Abstract

Importance: Cases of photodistributed Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been infrequently reported since the first documented case in 1989. This emerging clinical entity and its underlying mechanism have yet to be fully characterized.

Objective: To report a case of photodistributed SJS/TEN and highlight similarities to other cases reported in the literature.

Design, setting, and participants: Case report and literature review of published cases of photodistributed SJS/TEN. The case report describes a 29-year-old woman with recent lamotrigine and trimethoprim-sulfamethoxazole exposure who developed TEN in a photodistributed pattern 1 day after prolonged sun exposure. A search of PubMed using the keywords toxic epidermal necrolysis, Stevens-Johnson syndrome, photo-distributed, photo-induced, and sun-exposed was performed to identify other cases reported in the literature.

Results: Literature review revealed 8 previously reported cases of healthy individuals with known drug and UV radiation (UVR) exposures who subsequently developed SJS or TEN with photodistribution. Cases reviewed were skewed demographically to young women aged 19 to 48 years (8 of 9 patients) with all cases reporting UVR exposure 24 to 72 hours prior to the onset of symptoms.

Conclusions and relevance: Photodistributed TEN has been increasingly described in the literature and may represent a distinct variant of SJS/TEN. While the pathogenesis remains unclear, the role of UVR as a "second hit" is suggested by the data presented in the cases documented thus far.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Photodistributed Toxic Epidermal Necrolysis
Photodistributed toxic epidermal necrolysis with stark sparing of the bathing suit regions of the chest, back, buttocks, and pubis, and prominent mucositis with oral, esophageal, ocular, and vaginal mucosal involvement.
Figure 2.
Figure 2.. Punch Biopsy of Left Thigh
Punch biopsy of left thigh with hematoxylin-eosin staining. A, Detached necrotic epidermis with vacuolar interface changes extending down a hair follicle with comparatively sparse inflammation. B, Detached epidermis with numerous necrotic keratinocytes with overlying basket weave orthokeratosis reflecting rapid onset of this process. C, Vacuolar interface changes with sparse inflammation are easily observed in the follicular epithelium.
See this image and copyright information in PMC

References

    1. Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on Stevens-Johnson syndrome and toxic epidermal necrolysis. Clin Rev Allergy Immunol. 2018;54(1):147-176. doi:10.1007/s12016-017-8654-z - DOI - PubMed
    1. Ortel B, Sivayathorn A, Hönigsmann H. An unusual combination of phototoxicity and Stevens-Johnson syndrome due to antimalarial therapy. Dermatologica. 1989;178(1):39-42. doi:10.1159/000248385 - DOI - PubMed
    1. Moghaddam S, Connolly D. Photo-induced Stevens-Johnson syndrome. J Am Acad Dermatol. 2014;71(3):e82-e83. doi:10.1016/j.jaad.2014.02.033 - DOI - PubMed
    1. Gatson NT, Travers JB, Al-Hassani M, Warren SJP, Hyatt AM, Travers JB. Progression of toxic epidermal necrolysis after tanning bed exposure. Arch Dermatol. 2011;147(6):719-723. doi:10.1001/archdermatol.2011.13 - DOI - PMC - PubMed
    1. Russomanno K, DiLorenzo A, Horeczko J, et al. . Photodistributed toxic epidermal necrolysis in association with lamotrigine and tanning bed exposure. JAAD Case Rep. 2021;14:68-71. doi:10.1016/j.jdcr.2021.05.015 - DOI - PMC - PubMed

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