Diagnosis and Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis with Ocular Complications
Received 4 September 2008; received in revised form 26 November 2008; accepted 18 December 2008. published online 25 February 2009.
Purpose
To present a detailed clarification of the symptoms at disease onset of Stevens-Johnson syndrome (SJS) and its more severe variant, toxic epidermal necrolysis (TEN), with ocular complications and to clarify the relationship between topical steroid use and visual prognosis.
Design
Cross-sectional study.
Participants
Ninety-four patients with SJS and TEN with ocular complications.
Methods
A structured interview, examination of the patient medical records, or both addressing clinical manifestations at disease onset were conducted for 94 patients seen at Kyoto Prefectural University of Medicine. Any topical steroid use during the first week at the acute stage also was investigated.
Main Outcome Measures
The incidence and the details of prodromal symptoms and the mucosal involvements and the relationship between topical steroid use and visual outcomes.
Results
Common cold-like symptoms (general malaise, fever, sore throat, etc.) preceded skin eruptions in 75 cases, and extremely high fever accompanied disease onset in 86 cases. Acute conjunctivitis and oral and nail involvements were reported in all patients who remembered the details. Acute conjunctivitis occurred before the skin eruptions in 42 patients and simultaneously in 21 patients, whereas only 1 patient reported posteruption conjunctivitis. Visual outcomes were significantly better in the group receiving topical steroids compared with those of the no-treatment group (P<0.00001).
Conclusions
Acute conjunctivitis occurring before or simultaneously with skin eruptions accompanied by extremely high fever and oral and nail involvement indicate the initiation of SJS or TEN. Topical steroid treatment from disease onset seems to be important for the improvement of visual prognosis.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: February 25, 2009.
1Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
2Department of Dermatology, Ehime University School of Medicine, Ehime, Japan
3Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
Correspondence: Chie Sotozono, MD, PhD, Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-0841, Japan
Manuscript no. 2008-1063.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported in part by Health and Labor Sciences Research Grants (Research on Intractable Diseases) from the Ministry of Health, Labour and Welfare of Japan, Tokyo, Japan; the Japanese Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan; the Kyoto Foundation for the Promotion of Medical Science, Kyoto, Japan; and the Intramural Research Fund of Kyoto Prefectural University of Medicine, Kyoto, Japan.
ABSTRACT