Background:Toxic Epidermal Necrolysis(TEN)is a potentially fatal dermatological condition primarily triggered by adverse drug reactions.It is characterized by extensive epidermal necrosis and separation,affecting more...Background:Toxic Epidermal Necrolysis(TEN)is a potentially fatal dermatological condition primarily triggered by adverse drug reactions.It is characterized by extensive epidermal necrosis and separation,affecting more than 30%of the body surface area,and leading to severe complications such as sepsis and multi-organ failure.Common causative agents include antibiotics,anticonvulsants,and NSAIDs.The pathophysiology of TEN in-volves an immune-mediated response,where cytotoxic T lymphocytes(CTLs)and natural killer(NK)cells release cytotoxic proteins such as perforin,granzyme B,and granulysin,leading to widespread keratinocyte apoptosis.This immune response results in massive skin detachment and mucosal damage.Despite its rarity,TEN has a high mortality rate,necessitating early diagnosis and intervention.Case presentation:This paper provides a comprehensive review of TEN,discussing its history,pathophysiology,clinical features,and current understanding of treatment strategies.A case series of 11 patients who developed TEN after exposure to various drugs,including Lamotrigine,Phenytoin,Diclofenac,Ibuprofen,Aceclofenac,Amoxicillin,Sulfadoxine-Pyrimethamine,Amoxiclav,and Gabapentin,is presented.The cases highlight the importance of early drug discontinuation,supportive care,and adjunctive therapies such as intravenous immunoglobulin(IVIG)and corticosteroids.Prognostic factors,such as the extent of skin detachment and sys-temic complications,significantly influenced patient outcomes.All patients recovered with timely intervention and intensive care,except for a few who succumbed to the severity of the condition.Conclusion:This study underscores the need for early intervention,multidisciplinary care,and robust pharma-covigilance systems to reduce the incidence and severity of TEN.Increased awareness of risk factors and early recognition of symptoms associated with high-risk medications are crucial in improving patient outcomes and reducing mortality.展开更多
BACKGROUND Toxic epidermal necrolysis(TEN)is a life-threatening dermatological emergency mainly induced by drug hypersensitivity reactions.Standard management includes discontinuation of culprit drug and application o...BACKGROUND Toxic epidermal necrolysis(TEN)is a life-threatening dermatological emergency mainly induced by drug hypersensitivity reactions.Standard management includes discontinuation of culprit drug and application of immunomodulatory therapy.However,mortality remains high due to complications like septic shock and multiorgan failures.Innovative approaches for skin care are crucial.This report introduces borneol-gypsum,a traditional Chinese drug but a novel dressing serving as an adjuvant of TEN therapy,might significantly improve skin conditions and patient outcomes in TEN.CASE SUMMARY A 38-year-old woman diagnosed with eosinophilic granulomatosis with polyangiitis experienced gangrenous complications and motor nerve involvement.After initial treatment of high-dose corticosteroids and cyclophosphamide,symptom of foot drop improved,absolute eosinophil counts decreased,while limb pain sustained.Duloxetine was added to alleviate her symptom.Subsequently,TEN developed.Additional topical application of borneol-gypsum dressing not only protected the skin lesions from infection but also significantly eased localized pain.This approach demonstrated its merit in TEN management by promoting skin healing and potentially reducing infection risks.CONCLUSION Borneol-gypsum dressing is a promising adjuvant that could significantly improve TEN management,skin regeneration,and patient comfort.展开更多
BACKGROUND Stevens–Johnson syndrome and toxic epidermal necrolysis(SJS/TEN)are very serious skin allergies,with an etiology related to infections and medication.Since the coronavirus disease 2019(COVID-19)pandemic,se...BACKGROUND Stevens–Johnson syndrome and toxic epidermal necrolysis(SJS/TEN)are very serious skin allergies,with an etiology related to infections and medication.Since the coronavirus disease 2019(COVID-19)pandemic,severe acute respiratory syndrome coronavirus-2 has also been considered to cause SJS/TEN.CASE SUMMARY We report the case of a woman in her thirties who took acetaminophen after contracting COVID-19.After 3 d of fever relief,she experienced high fever and presented with SJS/TEN symptoms,accompanied by intrahepatic cholestasis.Three days of corticosteroid treatment did not alleviate the skin damage;therefore,double plasma molecular adsorption system(DPMAS)therapy was initiated,with treatment intervals of 48 h.Her skin symptoms improved gradually and were resolved after seven DPMAS treatments.CONCLUSION DPMAS therapy is beneficial for abrogating SJS/TEN because plasma adsorption and perfusion techniques reduce the inflammatory mediators(e.g.,tumor necrosis factor-alpha and interleukin-10 and-12)speculated to be involved in the pathology of the skin conditions.展开更多
BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor an...BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and effective.However,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination therapy.CASE SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 inhibitor.The skin injury covered more than 70%of the body surface area.He was previously diagnosed with liver cancer with cervical vertebra metastasis.Histologically,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the epidermis.Blood vessels in the dermis were infiltrated by lymphocytes and eosinophils.Direct immunofluorescence staining was negative.Thus,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were administered.The rashes gradually faded;however,as expected,the tumor progressed.Therefore, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo follow-up.CONCLUSIONCautious attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.展开更多
BACKGROUND Toxic epidermal necrolysis and Stevens-Johnson syndrome are acute lifethreatening skin reactions.AZD9291 has been developed as a third-generation epidermal growth factor receptor(EGFR)-tyrosine kinase inhib...BACKGROUND Toxic epidermal necrolysis and Stevens-Johnson syndrome are acute lifethreatening skin reactions.AZD9291 has been developed as a third-generation epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitor(TKI)with activity against T790M mutation.CASE SUMMARY Herein we report a 68-year-old woman who developed a large area of skin necrosis and was diagnosed with toxic epidermal necrolysis after AZD-9291 ingestion.To the best of our knowledge,this is the first case reported in patients with EGFR T790M mutation in non-small cell lung cancer(NSCLC).Cabozantinib combined with erlotinib had clinically meaningful effectiveness,with additional toxicity that was generally manageable.CONCLUSION Treatment with AZD-9261 is effective in regressing the growth of the NSCLC and can bring some hope to despairing patients.We hope that more research will be carried out on the association between severe rashes and EGFR-TKIs,and more safe and effective drugs can be developed.展开更多
Stevens-Johnson syndrome/toxic epidermal necrolysis(SJS/TEN)is a rare adverse cutaneous reaction with a low incidence and high mortality.Despite posing a serious threat to patients’health and lives,there is no high-q...Stevens-Johnson syndrome/toxic epidermal necrolysis(SJS/TEN)is a rare adverse cutaneous reaction with a low incidence and high mortality.Despite posing a serious threat to patients’health and lives,there is no high-quality evidence for a standard treatment regimen.Here we report the case of a 62-year-old man with stage IV pancreatic cancer who experienced immunotherapy-induced SJS/TEN.After consensus-based regular treatments at a local hospital,his symptoms became worse.Thus,he consented to receive Chinese herbal medicine(CHM)therapy.The affected parts of the patient were treated with the CHM Pi-Yan-Ning which was applied externally for 20 min twice a day.After 7 days of treatment,the dead skin began peeling away from the former lesions that had covered his hands,feet,and lips,indicating that skin had regenerated.After 12 days of treatment,the patient’s skin was completely recovered.In this case,SJS/TEN was successfully treated with Pi-Yan-Ning,suggesting that there might be tremendous potential for the use of Pi-Yan-Ning in the treatment of severe skin reactions to drug treatments.Further basic investigations and clinical trials to explore the mechanism and efficacy are needed.展开更多
BACKGROUND Toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large areas.Healing of this type of wound is difficult because of pressure,infection and other factors.It can increase the lengt...BACKGROUND Toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large areas.Healing of this type of wound is difficult because of pressure,infection and other factors.It can increase the length of hospital stay and result in wound sepsis and even death.CASE SUMMARY A 49-year-old woman developed a skin lesion covering 80%of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back;she developed life-threatening wound sepsis and septic shock.Methicillin-resistant Staphylococcus aureus,carbapenem-resistant Acinetobacter baumannii,carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue,deep venous catheter and blood samples.Imipenem cilastatin sodium,tigecycline and teicoplanin were used for anti-infection therapy.Finally,the patient was transferred to the burn department because of severe wound sepsis.In the burn intensive care unit,pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results.After three operations within 2 wk,the wound healed and sepsis resolved.CONCLUSION TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis.Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients,and it leaves no scar at the donor site.展开更多
Toxic epidermal necrolysis(TEN) is a severe adverse drug reaction, which is characterized by erythema, blisters, and/or erosions of the mucous membranes and skin, but intestinal involvement is rare. In contrast, pneum...Toxic epidermal necrolysis(TEN) is a severe adverse drug reaction, which is characterized by erythema, blisters, and/or erosions of the mucous membranes and skin, but intestinal involvement is rare. In contrast, pneumatosis cystoides intestinalis(PCI) is a rare condition associated with a wide variety of underlying diseases, but to date no patient has presented with PCI associated with TEN. A 55-year-old man was admitted to intensive care unit for treatment of TEN caused by phenobarbital. On day 8 after admission, he presented with progressive abdominal distention and hypotension. Computed tomography(CT) showed gas in the superior mesenteric vein and air filled cysts in the walls of the small intestine. He was suspected of having septic shock due to PCI. As there were no indications of bowel ischemia or necrosis, the patient was managed conservatively with antibiotics and oxygen therapy. On day 10 after admission, he was weaned off catecholamines, with CT on day 11 showing complete resolution of gas in the superior mesenteric vein and air filled cysts. To our knowledge, this article describes the first patient presenting with PCI associated with TEN.展开更多
BACKGROUND Preterm birth accounts for about 12%of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality.In order to avoid premature birth and prolong gestational age,tocolytics are the...BACKGROUND Preterm birth accounts for about 12%of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality.In order to avoid premature birth and prolong gestational age,tocolytics are the first and the best choice.Ritodrine is the most commonly used tocolytic medication.However,side effects such as pulmonary edema,hypokalemia,and hyperglycemia are known.Here we report a rare but serious side effect–toxic epidermal necrolysis(TEN)–caused by ritodrine.CASE SUMMARY A woman(31 years,gravida 4,para 2)was hospitalized because of premature contractions at 27+6 wk of gestation.A skin rash with pruritus appeared at 32+3 wk of gestation after administration of ritodrine,indomethacin,and dexamethasone,and it spread throughout the whole body in 3 d,particularly the four limbs.After 11 d’treatment,she was diagnosed with TEN.An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery.She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment.CONCLUSION When a skin rash appears during the administration of ritodrine,we are supposed to consider the risk of TEN.展开更多
Introduction: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal...Introduction: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal. Supportive management has been proven to be the mainstay with well executed nursing care resulting in quality clinical outcomes. The aim was to evaluate the nursing care interventions in management of patients with SJS/TEN in the dermatology unit. Methods: Qualitative design was used, data were collected through observation of nursing care activities, informant interviews and focus group discussion with the nurses. Qualitative data were recorded in audio tapes and transcribed. Qualitative content analysis was used for the analysis of the transcribed texts. Study was approved by KNH/ERC and informed written consent from participants. Funding was obtained from KNH through the Research and Programs department. Findings: 20 nurses participated in the study. The commonest nursing care interventions were described as routine tasks initiated at clinical diagnosis and routinely performed. They include aggressive skin care, wound care, mucosal and eye care, infection surveillance and prevention practices and general patient monitoring for complications. Skin and wound care were most challenging part of nursing care due to severe erosion or exfoliation. Nurses do not use any specific guidelines of care but consider their role a key in quality outcomes for patients with SJS/TEN in this hospital.展开更多
The ocular surface is covered by an epithelium encompassing an area including the cornea,the limbus and the conjunctiva bordered by the upper and lower lids.The healthy state of the ocular surface epithelium depends o...The ocular surface is covered by an epithelium encompassing an area including the cornea,the limbus and the conjunctiva bordered by the upper and lower lids.The healthy state of the ocular surface epithelium depends on a stable and protective preocular tear film when the eye is open.A stable preocular tear film is governed by sound ocular surface defense that involves effective展开更多
Bullous epidermal necrolysis drug eruption is mainly caused by drug allergy, also known as toxic epidermal necrolysis, TEN, first reported by Lyell A in 1956, also known as Lyell syndrome, is the most serious type of ...Bullous epidermal necrolysis drug eruption is mainly caused by drug allergy, also known as toxic epidermal necrolysis, TEN, first reported by Lyell A in 1956, also known as Lyell syndrome, is the most serious type of drug eruption, the fatality rate is about 25%-50%[1]. The disease is characterized by acute onset, obvious systemic toxic symptoms, and flaccid blisters of varying sizes on the skin of the whole body. At the beginning of the disease, the skin rash is dark red or dark red. It quickly fuses into flakes and develops into the whole body. There are flaccid blisters and epidermolysis in the lesions, which are slightly rubbed or broken, and the tenderness is obvious and accompanied by a large amount of exudation. Severe cases may involve various organs and tissues of the body, accompanied by oral, conjunctival, respiratory, gastrointestinal mucosa erosion, ulcer, some patients may have liver and kidney function damage, serious cases may die of infection, liver and kidney failure, toxicemia, electrolyte disorders or visceral bleeding.展开更多
<span style="font-family:Verdana;">Enzalutamide is a hormonal therapy that blocks the action of androgens, such as testosterone in the treatment of metastatic castration-resistant prostate cancer. <...<span style="font-family:Verdana;">Enzalutamide is a hormonal therapy that blocks the action of androgens, such as testosterone in the treatment of metastatic castration-resistant prostate cancer. </span><span style="font-family:Verdana;">Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) overlap and are part of an adverse drug reaction continuum of disease, in which there is a 10% - 30% involvement of the skin surface with mucositis, blisters, skin slough, and a macular rash. A 66-year-old male was treated with enzalutamide for metastatic prostate cancer and developed SJS/TEN overlap with 25% total body surface area skin involvement. The patient received a </span><span style="font-family:Verdana;">seven-day course of cyclosporine to which he responded by re-epithelialization </span><span style="font-family:Verdana;">but succumbed to multi-organ failure. While SJS/TEN has been reported with apalutamide, to our knowledge, this is the first case of SJS/TEN overlap with enzalutamide.</span>展开更多
Liver injury in Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)is a multifaceted disorder,lacking cohort homogeneity due to a variety of potential causes,including drugs,arsenic and other heavy metals...Liver injury in Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)is a multifaceted disorder,lacking cohort homogeneity due to a variety of potential causes,including drugs,arsenic and other heavy metals,glyphosate,infections,and ultraviolet radiation.The goals of this review were(1)to analyze the role of diagnostic algorithms in assessing causality for potential culprits involved in the development of liver injury associated with immune-mediated SJS and TEN,which represent immune-based variant disorders within a continuous spectrum.Milder forms are classified as SJS or SJS/TEN overlap,while TEN is known as the most serious form;and(2)to interpret the findings that allow for the characterization of the different types of these disorders.The manuscript is based on an extensive literature search for single case reports,case cohorts,and review articles.Search terms included:Stevens-Johnson Syndrome,Toxic Epidermal Necrolysis,and specific diagnostic algorithms such as the Roussel Uclaf Causality Assessment Method(RUCAM)and the Algorithm of Drug Causality for Epidermal Necrolysis(ALDEN).For the purpose of basic feature description,the uniform term SJS/TEN is used in the current analysis.SJS/TEN presents with five different cohort types:SJS/TEN type(1),which refers to a cohort of SJS/TEN caused by drugs,as assessed by both ALDEN and RUCAM;type(2),representing SJS/TEN due to drugs and assessed by ALDEN only,but not by RUCAM;type(3),which includes a cohort of SJS/TEN caused by drugs,assessed by non-ALDEN and non-RUCAM tools;type(4),which focuses on a cohort of SJS/TEN caused by non-drug culprits,assessed by various tools;and type(5),which considers a cohort of SJS/TEN caused by unknown culprits.Using this new SJS/TEN typology will help better characterize individual features,personalize treatment,and clarify pathogenetic specifics for each of the five disease types.This new SJS/TEN typology provides clarity by replacing issues of inhomogeneity with cohort homogeneity.展开更多
In a recent study,published in Nature,Nordmann et al.identified Janus kinase inhibitors(JAKi)as a new treatment option for lifethreatening toxic epidermal necrolysis(TEN).They showed this through spatial proteomics on...In a recent study,published in Nature,Nordmann et al.identified Janus kinase inhibitors(JAKi)as a new treatment option for lifethreatening toxic epidermal necrolysis(TEN).They showed this through spatial proteomics on human skin samples combined with in vivo administration of JAKi in individuals with TEN,demonstrating rapid reepithelization and recovery of patients.1 As TEN has a high mortality rate(30-50%),2 this study offers a new avenue for targeted treatment.展开更多
This paper summarizes the nursing experience of a 75-year-old patient who developed exfoliative dermatitis-type drug eruption induced by cold medicine and progressed to toxic epidermal necrolysis(TEN).The core nursing...This paper summarizes the nursing experience of a 75-year-old patient who developed exfoliative dermatitis-type drug eruption induced by cold medicine and progressed to toxic epidermal necrolysis(TEN).The core nursing measures included(1)Establishing a multidisciplinary team and implementing bundled care led by trauma specialist nurses;(2)Precise wound management using the“three-stage debridement method”and silver ion dressings;(3)Implementing multimodal analgesia based on dynamic pain assessment;(4)Strengthening fluid,electrolyte,and nutritional management;and(5)Providing individualized psychological support.After 14 days of treatment and nursing,the patient’s wounds were completely epithelialized,infection indicators returned to normal,pain was effectively controlled,and the patient was discharged successfully.No serious complications were observed during the 6-month follow-up.For elderly critically ill patients with TEN,constructing a systematic nursing model based on multidisciplinary collaboration and centered on trauma care is crucial for improving patient outcomes.展开更多
Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are life-threatening conditions characterized by extensive detachment of the epidermis and mucous membranes.These severe disorders carry a high mortality...Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are life-threatening conditions characterized by extensive detachment of the epidermis and mucous membranes.These severe disorders carry a high mortality rate,and their pathogenesis remains largely unclear.Furthermore,optimal therapeutic strategies for SJS/TEN remain a subject of ongoing debate.Early diagnosis of SJS/TEN is challenging,and reliable biomarkers for diagnosis or severity prediction have not been firmly established.Certain drugs,such as carbamazepine and allopurinol,have shown a strong association with specific human leukocyte antigen(HLA)types.Recently,the potential benefits of HLA screening prior to administering these drugs to reduce the incidence of SJS/TEN have been explored.Epidermal cell death in SJS/TEN lesions is caused by extensive apoptosis,primarily through the Fas-Fas ligand(FasL)and perforin/granzyme pathways.Our findings suggest that necroptosis,a form of programmed necrosis,also contributes to epidermal cell death.Annexin A1,released from monocytes,interacts with the formyl peptide receptor 1 to induce necroptosis.Several biomarkers,such as CC chemokine ligand(CCL)-27,interleukin-15,galectin-7,receptor-interacting protein kinases 3(RIP3),and lipocalin-2,have been identified for diagnostic and prognostic purposes in SJS/TEN.Supportive care is recommended for treating SJS/TEN,but the efficacy of various therapeutic options-including systemic corticosteroids,intravenous immunoglobulin,cyclosporine,and tumor necrosis factor-αantagonists-remains controversial.Recent studies have investigated the potential benefits of tumor necrosis factor-αantagonists.In this review,we discuss recent advances in the understanding and management of SJS/TEN.展开更多
Introduction:Toxic epidermal necrolysis(TEN)is a medical emergency that most commonly occurs as an adverse effect of certain drugs.Here,we describe a case of a 41-year-old man with no comorbid illness who developed TE...Introduction:Toxic epidermal necrolysis(TEN)is a medical emergency that most commonly occurs as an adverse effect of certain drugs.Here,we describe a case of a 41-year-old man with no comorbid illness who developed TEN.Case presentation:The patient had been prescribed ibuprofen for myalgia and developed skin lesions after the single dose.The lesions were erythematous papules and macules distributed all over the body after ibuprofen intake.TEN was diagnosed based on the patient’s clinical presentation and laboratory findings.He was treated with intravenous dexamethasone,intravenous immunoglobulin,and cyclosporine.Daily dressing changes and skin care was done with saline,chlorhexidine,and liquid paraffin.The patient was intubated and tracheostomized,and he gradually improved and survived.Later,he developed septicemia in the intensive care unit and was treated successfully.Discussion:The management of TEN includes cessation of the causative cause,multidisciplinary intensive care unit(ICU)care,prevention and early detection of sepsis,fluid and electrolyte balance,adequate analgesia and temperature control,proper organ support,aggressive nutritional management,and good psychological support.The pharmacological therapy for TEN includes corticosteroids,intravenous immunoglobulin,and cyclosporine.The key elements of management are aseptic care and proper dressing of the skin.Conclusion:TEN is associated with high mortality if not managed in a systemic and protocolized way.展开更多
Background： Stevens-Johnson syndrome （SJS） and toxic epidennal necrolysis （TEN） are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifes...Background： Stevens-Johnson syndrome （SJS） and toxic epidennal necrolysis （TEN） are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifestations, complications, treatment, and prognosis of SJS/TEN and to explore the differences between surviving and deceased patients. Methods： SJS/TEN patients admitted to Beijing Friendship Hospital from January 2006 to December 2015 were included in the study. Patients＇ data were retrospectively analyzed. Comparative studies were performed on the survival group and the deceased group, and Fisher＇s exact probability test was used for statistical analysis. Results： Among the 88 patients included, 40 （45.5%） were male with a mean age of 45 - 18 years. Forty-eight （54.5%） had SJS, 34 （38.6%） had SJS/TEN, and 6 （6.8%） had TEN. Fifty-three （60.2%） cases were caused by medications, mainly antibiotics （n = 24） followed by traditional Chinese medicines 97 - 7）. Forty-two cases （47.7%） developed visceral damage. Eighty-two patients improved or recovered and were discharged from hospital, and six patients died. Comparative studies on the survival group and the deceased group showed that the presence of malignant tumor （Z2 = 27.969, P 〈 0.001）, connective tissue diseases （x^2 - 9.187, P = 0.002）, previous abnormal liver/kidney functions （x^2 = 6.006, P = 0.014）, heart rate 〉100 times/rain （x^2 = 6.347, P = 0.012）, detached skin area 〉20% （x^2 = 5.594, P = 0.018）, concurrent mucosal involvement at the mouth, eyes, and external genitals （Z2 = 4.945, P = 0.026）, subsequent accompanying liver/kidney damage （x^ = 11.839, P = 0.001, and x^2 = 36.302, P 〈 0.00 l, respectively）, and SCORTEN score 〉2 （x^2 = 37.148, P 〈 0.001 ） increased the risk of death. Conclusions： SJS/TEN is mainly caused by medications, and nearly half of patients develop visceral damage. Multiple factors increase the mortality risk.展开更多
Ethical Statements and Participant’s Consents were not included in the published version of the following articles that appeared in previous issues of Allergy Medicine.The appropriate Ethical Statements and Particip...Ethical Statements and Participant’s Consents were not included in the published version of the following articles that appeared in previous issues of Allergy Medicine.The appropriate Ethical Statements and Participant’s Consents provided by the Authors,are included below:“Exploring drug-induced toxic epidermal necrolysis:A case series and comprehensive review”[Allergy Medicine,Volume 3,March 2025,100011]https://doi.org/10.1016/j.allmed.2024.100011 Ethical Statement:This research involves retrospective case analyses using de-identified patient data.There were no prospective interventions,and informed consent has been obtained.展开更多
文摘Background:Toxic Epidermal Necrolysis(TEN)is a potentially fatal dermatological condition primarily triggered by adverse drug reactions.It is characterized by extensive epidermal necrosis and separation,affecting more than 30%of the body surface area,and leading to severe complications such as sepsis and multi-organ failure.Common causative agents include antibiotics,anticonvulsants,and NSAIDs.The pathophysiology of TEN in-volves an immune-mediated response,where cytotoxic T lymphocytes(CTLs)and natural killer(NK)cells release cytotoxic proteins such as perforin,granzyme B,and granulysin,leading to widespread keratinocyte apoptosis.This immune response results in massive skin detachment and mucosal damage.Despite its rarity,TEN has a high mortality rate,necessitating early diagnosis and intervention.Case presentation:This paper provides a comprehensive review of TEN,discussing its history,pathophysiology,clinical features,and current understanding of treatment strategies.A case series of 11 patients who developed TEN after exposure to various drugs,including Lamotrigine,Phenytoin,Diclofenac,Ibuprofen,Aceclofenac,Amoxicillin,Sulfadoxine-Pyrimethamine,Amoxiclav,and Gabapentin,is presented.The cases highlight the importance of early drug discontinuation,supportive care,and adjunctive therapies such as intravenous immunoglobulin(IVIG)and corticosteroids.Prognostic factors,such as the extent of skin detachment and sys-temic complications,significantly influenced patient outcomes.All patients recovered with timely intervention and intensive care,except for a few who succumbed to the severity of the condition.Conclusion:This study underscores the need for early intervention,multidisciplinary care,and robust pharma-covigilance systems to reduce the incidence and severity of TEN.Increased awareness of risk factors and early recognition of symptoms associated with high-risk medications are crucial in improving patient outcomes and reducing mortality.
文摘BACKGROUND Toxic epidermal necrolysis(TEN)is a life-threatening dermatological emergency mainly induced by drug hypersensitivity reactions.Standard management includes discontinuation of culprit drug and application of immunomodulatory therapy.However,mortality remains high due to complications like septic shock and multiorgan failures.Innovative approaches for skin care are crucial.This report introduces borneol-gypsum,a traditional Chinese drug but a novel dressing serving as an adjuvant of TEN therapy,might significantly improve skin conditions and patient outcomes in TEN.CASE SUMMARY A 38-year-old woman diagnosed with eosinophilic granulomatosis with polyangiitis experienced gangrenous complications and motor nerve involvement.After initial treatment of high-dose corticosteroids and cyclophosphamide,symptom of foot drop improved,absolute eosinophil counts decreased,while limb pain sustained.Duloxetine was added to alleviate her symptom.Subsequently,TEN developed.Additional topical application of borneol-gypsum dressing not only protected the skin lesions from infection but also significantly eased localized pain.This approach demonstrated its merit in TEN management by promoting skin healing and potentially reducing infection risks.CONCLUSION Borneol-gypsum dressing is a promising adjuvant that could significantly improve TEN management,skin regeneration,and patient comfort.
文摘BACKGROUND Stevens–Johnson syndrome and toxic epidermal necrolysis(SJS/TEN)are very serious skin allergies,with an etiology related to infections and medication.Since the coronavirus disease 2019(COVID-19)pandemic,severe acute respiratory syndrome coronavirus-2 has also been considered to cause SJS/TEN.CASE SUMMARY We report the case of a woman in her thirties who took acetaminophen after contracting COVID-19.After 3 d of fever relief,she experienced high fever and presented with SJS/TEN symptoms,accompanied by intrahepatic cholestasis.Three days of corticosteroid treatment did not alleviate the skin damage;therefore,double plasma molecular adsorption system(DPMAS)therapy was initiated,with treatment intervals of 48 h.Her skin symptoms improved gradually and were resolved after seven DPMAS treatments.CONCLUSION DPMAS therapy is beneficial for abrogating SJS/TEN because plasma adsorption and perfusion techniques reduce the inflammatory mediators(e.g.,tumor necrosis factor-alpha and interleukin-10 and-12)speculated to be involved in the pathology of the skin conditions.
基金Supported by Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases,No. 2018B030322012
文摘BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor treatment.It is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and effective.However,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination therapy.CASE SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 inhibitor.The skin injury covered more than 70%of the body surface area.He was previously diagnosed with liver cancer with cervical vertebra metastasis.Histologically,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the epidermis.Blood vessels in the dermis were infiltrated by lymphocytes and eosinophils.Direct immunofluorescence staining was negative.Thus,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were administered.The rashes gradually faded;however,as expected,the tumor progressed.Therefore, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo follow-up.CONCLUSIONCautious attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.
基金National Natural Science Foundation of China,No.81974570.
文摘BACKGROUND Toxic epidermal necrolysis and Stevens-Johnson syndrome are acute lifethreatening skin reactions.AZD9291 has been developed as a third-generation epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitor(TKI)with activity against T790M mutation.CASE SUMMARY Herein we report a 68-year-old woman who developed a large area of skin necrosis and was diagnosed with toxic epidermal necrolysis after AZD-9291 ingestion.To the best of our knowledge,this is the first case reported in patients with EGFR T790M mutation in non-small cell lung cancer(NSCLC).Cabozantinib combined with erlotinib had clinically meaningful effectiveness,with additional toxicity that was generally manageable.CONCLUSION Treatment with AZD-9261 is effective in regressing the growth of the NSCLC and can bring some hope to despairing patients.We hope that more research will be carried out on the association between severe rashes and EGFR-TKIs,and more safe and effective drugs can be developed.
基金supported by National Natural Science Foundation of China(grant No.81704013)clinical(gastric cancer)cooperation pilot project of Chinese and Western Medicine for Major and Difficult DiseasesZhejiang Traditional Chinese Medicine of Science and Technology Program(grant No.2020ZA053)。
文摘Stevens-Johnson syndrome/toxic epidermal necrolysis(SJS/TEN)is a rare adverse cutaneous reaction with a low incidence and high mortality.Despite posing a serious threat to patients’health and lives,there is no high-quality evidence for a standard treatment regimen.Here we report the case of a 62-year-old man with stage IV pancreatic cancer who experienced immunotherapy-induced SJS/TEN.After consensus-based regular treatments at a local hospital,his symptoms became worse.Thus,he consented to receive Chinese herbal medicine(CHM)therapy.The affected parts of the patient were treated with the CHM Pi-Yan-Ning which was applied externally for 20 min twice a day.After 7 days of treatment,the dead skin began peeling away from the former lesions that had covered his hands,feet,and lips,indicating that skin had regenerated.After 12 days of treatment,the patient’s skin was completely recovered.In this case,SJS/TEN was successfully treated with Pi-Yan-Ning,suggesting that there might be tremendous potential for the use of Pi-Yan-Ning in the treatment of severe skin reactions to drug treatments.Further basic investigations and clinical trials to explore the mechanism and efficacy are needed.
基金The State Key Laboratory of Trauma,Burns and Combined Injury,No.SKLJYJF18the First Affiliated Hospital,Army Medical University,No.SWH2019QNLC-04.
文摘BACKGROUND Toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large areas.Healing of this type of wound is difficult because of pressure,infection and other factors.It can increase the length of hospital stay and result in wound sepsis and even death.CASE SUMMARY A 49-year-old woman developed a skin lesion covering 80%of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back;she developed life-threatening wound sepsis and septic shock.Methicillin-resistant Staphylococcus aureus,carbapenem-resistant Acinetobacter baumannii,carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue,deep venous catheter and blood samples.Imipenem cilastatin sodium,tigecycline and teicoplanin were used for anti-infection therapy.Finally,the patient was transferred to the burn department because of severe wound sepsis.In the burn intensive care unit,pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results.After three operations within 2 wk,the wound healed and sepsis resolved.CONCLUSION TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis.Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients,and it leaves no scar at the donor site.
文摘Toxic epidermal necrolysis(TEN) is a severe adverse drug reaction, which is characterized by erythema, blisters, and/or erosions of the mucous membranes and skin, but intestinal involvement is rare. In contrast, pneumatosis cystoides intestinalis(PCI) is a rare condition associated with a wide variety of underlying diseases, but to date no patient has presented with PCI associated with TEN. A 55-year-old man was admitted to intensive care unit for treatment of TEN caused by phenobarbital. On day 8 after admission, he presented with progressive abdominal distention and hypotension. Computed tomography(CT) showed gas in the superior mesenteric vein and air filled cysts in the walls of the small intestine. He was suspected of having septic shock due to PCI. As there were no indications of bowel ischemia or necrosis, the patient was managed conservatively with antibiotics and oxygen therapy. On day 10 after admission, he was weaned off catecholamines, with CT on day 11 showing complete resolution of gas in the superior mesenteric vein and air filled cysts. To our knowledge, this article describes the first patient presenting with PCI associated with TEN.
文摘BACKGROUND Preterm birth accounts for about 12%of all pregnancies worldwide and is the leading cause of neonatal morbidity and mortality.In order to avoid premature birth and prolong gestational age,tocolytics are the first and the best choice.Ritodrine is the most commonly used tocolytic medication.However,side effects such as pulmonary edema,hypokalemia,and hyperglycemia are known.Here we report a rare but serious side effect–toxic epidermal necrolysis(TEN)–caused by ritodrine.CASE SUMMARY A woman(31 years,gravida 4,para 2)was hospitalized because of premature contractions at 27+6 wk of gestation.A skin rash with pruritus appeared at 32+3 wk of gestation after administration of ritodrine,indomethacin,and dexamethasone,and it spread throughout the whole body in 3 d,particularly the four limbs.After 11 d’treatment,she was diagnosed with TEN.An emergency cesarean section was performed immediately to deliver the baby and intensive symptomatic treatment was promptly commenced after delivery.She recovered from the severe condition without any sequelae except for slight pigmentation after symptomatic treatment.CONCLUSION When a skin rash appears during the administration of ritodrine,we are supposed to consider the risk of TEN.
文摘Introduction: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are adverse reaction to drugs whose manifestation affect the skin and mucous membranes whose outcomes may be life threatening and fatal. Supportive management has been proven to be the mainstay with well executed nursing care resulting in quality clinical outcomes. The aim was to evaluate the nursing care interventions in management of patients with SJS/TEN in the dermatology unit. Methods: Qualitative design was used, data were collected through observation of nursing care activities, informant interviews and focus group discussion with the nurses. Qualitative data were recorded in audio tapes and transcribed. Qualitative content analysis was used for the analysis of the transcribed texts. Study was approved by KNH/ERC and informed written consent from participants. Funding was obtained from KNH through the Research and Programs department. Findings: 20 nurses participated in the study. The commonest nursing care interventions were described as routine tasks initiated at clinical diagnosis and routinely performed. They include aggressive skin care, wound care, mucosal and eye care, infection surveillance and prevention practices and general patient monitoring for complications. Skin and wound care were most challenging part of nursing care due to severe erosion or exfoliation. Nurses do not use any specific guidelines of care but consider their role a key in quality outcomes for patients with SJS/TEN in this hospital.
基金The development of PROKERA^(█)was supported in part with grant number EY014768 from the National Institute of Health(NIH)National Eye Institute(NEI)
文摘The ocular surface is covered by an epithelium encompassing an area including the cornea,the limbus and the conjunctiva bordered by the upper and lower lids.The healthy state of the ocular surface epithelium depends on a stable and protective preocular tear film when the eye is open.A stable preocular tear film is governed by sound ocular surface defense that involves effective
文摘Bullous epidermal necrolysis drug eruption is mainly caused by drug allergy, also known as toxic epidermal necrolysis, TEN, first reported by Lyell A in 1956, also known as Lyell syndrome, is the most serious type of drug eruption, the fatality rate is about 25%-50%[1]. The disease is characterized by acute onset, obvious systemic toxic symptoms, and flaccid blisters of varying sizes on the skin of the whole body. At the beginning of the disease, the skin rash is dark red or dark red. It quickly fuses into flakes and develops into the whole body. There are flaccid blisters and epidermolysis in the lesions, which are slightly rubbed or broken, and the tenderness is obvious and accompanied by a large amount of exudation. Severe cases may involve various organs and tissues of the body, accompanied by oral, conjunctival, respiratory, gastrointestinal mucosa erosion, ulcer, some patients may have liver and kidney function damage, serious cases may die of infection, liver and kidney failure, toxicemia, electrolyte disorders or visceral bleeding.
文摘<span style="font-family:Verdana;">Enzalutamide is a hormonal therapy that blocks the action of androgens, such as testosterone in the treatment of metastatic castration-resistant prostate cancer. </span><span style="font-family:Verdana;">Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) overlap and are part of an adverse drug reaction continuum of disease, in which there is a 10% - 30% involvement of the skin surface with mucositis, blisters, skin slough, and a macular rash. A 66-year-old male was treated with enzalutamide for metastatic prostate cancer and developed SJS/TEN overlap with 25% total body surface area skin involvement. The patient received a </span><span style="font-family:Verdana;">seven-day course of cyclosporine to which he responded by re-epithelialization </span><span style="font-family:Verdana;">but succumbed to multi-organ failure. While SJS/TEN has been reported with apalutamide, to our knowledge, this is the first case of SJS/TEN overlap with enzalutamide.</span>
文摘Liver injury in Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)is a multifaceted disorder,lacking cohort homogeneity due to a variety of potential causes,including drugs,arsenic and other heavy metals,glyphosate,infections,and ultraviolet radiation.The goals of this review were(1)to analyze the role of diagnostic algorithms in assessing causality for potential culprits involved in the development of liver injury associated with immune-mediated SJS and TEN,which represent immune-based variant disorders within a continuous spectrum.Milder forms are classified as SJS or SJS/TEN overlap,while TEN is known as the most serious form;and(2)to interpret the findings that allow for the characterization of the different types of these disorders.The manuscript is based on an extensive literature search for single case reports,case cohorts,and review articles.Search terms included:Stevens-Johnson Syndrome,Toxic Epidermal Necrolysis,and specific diagnostic algorithms such as the Roussel Uclaf Causality Assessment Method(RUCAM)and the Algorithm of Drug Causality for Epidermal Necrolysis(ALDEN).For the purpose of basic feature description,the uniform term SJS/TEN is used in the current analysis.SJS/TEN presents with five different cohort types:SJS/TEN type(1),which refers to a cohort of SJS/TEN caused by drugs,as assessed by both ALDEN and RUCAM;type(2),representing SJS/TEN due to drugs and assessed by ALDEN only,but not by RUCAM;type(3),which includes a cohort of SJS/TEN caused by drugs,assessed by non-ALDEN and non-RUCAM tools;type(4),which focuses on a cohort of SJS/TEN caused by non-drug culprits,assessed by various tools;and type(5),which considers a cohort of SJS/TEN caused by unknown culprits.Using this new SJS/TEN typology will help better characterize individual features,personalize treatment,and clarify pathogenetic specifics for each of the five disease types.This new SJS/TEN typology provides clarity by replacing issues of inhomogeneity with cohort homogeneity.
文摘In a recent study,published in Nature,Nordmann et al.identified Janus kinase inhibitors(JAKi)as a new treatment option for lifethreatening toxic epidermal necrolysis(TEN).They showed this through spatial proteomics on human skin samples combined with in vivo administration of JAKi in individuals with TEN,demonstrating rapid reepithelization and recovery of patients.1 As TEN has a high mortality rate(30-50%),2 this study offers a new avenue for targeted treatment.
基金Hospital-level Young and Middle-aged Cultivation Project of Xiangyang No.1 People’s Hospital(Project No.:XYY2025QN2)。
文摘This paper summarizes the nursing experience of a 75-year-old patient who developed exfoliative dermatitis-type drug eruption induced by cold medicine and progressed to toxic epidermal necrolysis(TEN).The core nursing measures included(1)Establishing a multidisciplinary team and implementing bundled care led by trauma specialist nurses;(2)Precise wound management using the“three-stage debridement method”and silver ion dressings;(3)Implementing multimodal analgesia based on dynamic pain assessment;(4)Strengthening fluid,electrolyte,and nutritional management;and(5)Providing individualized psychological support.After 14 days of treatment and nursing,the patient’s wounds were completely epithelialized,infection indicators returned to normal,pain was effectively controlled,and the patient was discharged successfully.No serious complications were observed during the 6-month follow-up.For elderly critically ill patients with TEN,constructing a systematic nursing model based on multidisciplinary collaboration and centered on trauma care is crucial for improving patient outcomes.
基金supported by Grant-in-Aid for Scientific Research(KAKENHI)(No.23K15264).
文摘Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are life-threatening conditions characterized by extensive detachment of the epidermis and mucous membranes.These severe disorders carry a high mortality rate,and their pathogenesis remains largely unclear.Furthermore,optimal therapeutic strategies for SJS/TEN remain a subject of ongoing debate.Early diagnosis of SJS/TEN is challenging,and reliable biomarkers for diagnosis or severity prediction have not been firmly established.Certain drugs,such as carbamazepine and allopurinol,have shown a strong association with specific human leukocyte antigen(HLA)types.Recently,the potential benefits of HLA screening prior to administering these drugs to reduce the incidence of SJS/TEN have been explored.Epidermal cell death in SJS/TEN lesions is caused by extensive apoptosis,primarily through the Fas-Fas ligand(FasL)and perforin/granzyme pathways.Our findings suggest that necroptosis,a form of programmed necrosis,also contributes to epidermal cell death.Annexin A1,released from monocytes,interacts with the formyl peptide receptor 1 to induce necroptosis.Several biomarkers,such as CC chemokine ligand(CCL)-27,interleukin-15,galectin-7,receptor-interacting protein kinases 3(RIP3),and lipocalin-2,have been identified for diagnostic and prognostic purposes in SJS/TEN.Supportive care is recommended for treating SJS/TEN,but the efficacy of various therapeutic options-including systemic corticosteroids,intravenous immunoglobulin,cyclosporine,and tumor necrosis factor-αantagonists-remains controversial.Recent studies have investigated the potential benefits of tumor necrosis factor-αantagonists.In this review,we discuss recent advances in the understanding and management of SJS/TEN.
文摘Introduction:Toxic epidermal necrolysis(TEN)is a medical emergency that most commonly occurs as an adverse effect of certain drugs.Here,we describe a case of a 41-year-old man with no comorbid illness who developed TEN.Case presentation:The patient had been prescribed ibuprofen for myalgia and developed skin lesions after the single dose.The lesions were erythematous papules and macules distributed all over the body after ibuprofen intake.TEN was diagnosed based on the patient’s clinical presentation and laboratory findings.He was treated with intravenous dexamethasone,intravenous immunoglobulin,and cyclosporine.Daily dressing changes and skin care was done with saline,chlorhexidine,and liquid paraffin.The patient was intubated and tracheostomized,and he gradually improved and survived.Later,he developed septicemia in the intensive care unit and was treated successfully.Discussion:The management of TEN includes cessation of the causative cause,multidisciplinary intensive care unit(ICU)care,prevention and early detection of sepsis,fluid and electrolyte balance,adequate analgesia and temperature control,proper organ support,aggressive nutritional management,and good psychological support.The pharmacological therapy for TEN includes corticosteroids,intravenous immunoglobulin,and cyclosporine.The key elements of management are aseptic care and proper dressing of the skin.Conclusion:TEN is associated with high mortality if not managed in a systemic and protocolized way.
文摘Background： Stevens-Johnson syndrome （SJS） and toxic epidennal necrolysis （TEN） are life-threatening diseases with high mortality rates. This study was designed to analyze the pathogenic factors, clinical manifestations, complications, treatment, and prognosis of SJS/TEN and to explore the differences between surviving and deceased patients. Methods： SJS/TEN patients admitted to Beijing Friendship Hospital from January 2006 to December 2015 were included in the study. Patients＇ data were retrospectively analyzed. Comparative studies were performed on the survival group and the deceased group, and Fisher＇s exact probability test was used for statistical analysis. Results： Among the 88 patients included, 40 （45.5%） were male with a mean age of 45 - 18 years. Forty-eight （54.5%） had SJS, 34 （38.6%） had SJS/TEN, and 6 （6.8%） had TEN. Fifty-three （60.2%） cases were caused by medications, mainly antibiotics （n = 24） followed by traditional Chinese medicines 97 - 7）. Forty-two cases （47.7%） developed visceral damage. Eighty-two patients improved or recovered and were discharged from hospital, and six patients died. Comparative studies on the survival group and the deceased group showed that the presence of malignant tumor （Z2 = 27.969, P 〈 0.001）, connective tissue diseases （x^2 - 9.187, P = 0.002）, previous abnormal liver/kidney functions （x^2 = 6.006, P = 0.014）, heart rate 〉100 times/rain （x^2 = 6.347, P = 0.012）, detached skin area 〉20% （x^2 = 5.594, P = 0.018）, concurrent mucosal involvement at the mouth, eyes, and external genitals （Z2 = 4.945, P = 0.026）, subsequent accompanying liver/kidney damage （x^ = 11.839, P = 0.001, and x^2 = 36.302, P 〈 0.00 l, respectively）, and SCORTEN score 〉2 （x^2 = 37.148, P 〈 0.001 ） increased the risk of death. Conclusions： SJS/TEN is mainly caused by medications, and nearly half of patients develop visceral damage. Multiple factors increase the mortality risk.
文摘Ethical Statements and Participant’s Consents were not included in the published version of the following articles that appeared in previous issues of Allergy Medicine.The appropriate Ethical Statements and Participant’s Consents provided by the Authors,are included below:“Exploring drug-induced toxic epidermal necrolysis:A case series and comprehensive review”[Allergy Medicine,Volume 3,March 2025,100011]https://doi.org/10.1016/j.allmed.2024.100011 Ethical Statement:This research involves retrospective case analyses using de-identified patient data.There were no prospective interventions,and informed consent has been obtained.
