Allison Weinkle1, Cory Pettit2, Aditi Jani3, Jesse Keller4, Yuanyuan Lu5, Stephen Malachowski1, John C Trinidad2, Benjamin H Kaffenberger2, Elizabeth N Ergen3, Lauren C Hughey3, David Smith6, Lucia Seminario-Vidal7. 1. Department of Dermatology, University of South Florida Health Morsani College of Medicine, Tampa, Florida. 2. Wexner Medical Center, Ohio State University, Columbus, Ohio. 3. Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama. 4. Oregon Health and Science University, Portland, Oregon. 5. School of Public Health, University of South Florida, Tampa, Florida. 6. Department of Plastic Surgery, University of South Florida Health Morsani College of Medicine, Tampa, Florida. 7. Department of Dermatology, University of South Florida Health Morsani College of Medicine, Tampa, Florida. Electronic address: luciasem@health.usf.edu.
Abstract
BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions that may present with similar findings to other severe dermatologic diseases. OBJECTIVE: The primary objective of this exploratory study was to explore factors associated with SJS/TEN and develop a model that provides the predicted probability of SJS/TEN for patients for whom the diagnosis of SJS/TEN is considered. METHODS: Retrospective review of consultations for patients with suspected SJS, TEN, or overlap at 4 academic dermatology consultation services. RESULTS: Overall, 208 patients were included; 59 (28.4%) had a final diagnosis of SJS/TEN, and 149 (71.6%) were given a different diagnosis. The most common mimickers were drug hypersensitivity syndrome (n = 21, 10.1%), morbilliform drug eruption (n = 18, 8.7%), erythema multiforme (n = 15, 7.2%), and acute generalized exanthematous pustulosis (n = 13, 6.2%). Nikolsky sign, atypical targets, fever, and lymphopenia were included in a model for predicting the probability of SJS/TEN. LIMITATIONS: All cases were obtained from academic centers, which may limit the generalization of findings to community-based settings. This was an exploratory study with a small number of cases, and external validation of the model performance is needed. CONCLUSION: Early dermatologic evaluation of patients with suspected SJS/TEN is key to separating patients with this condition from those who ultimately receive diagnoses of other serious skin diseases.
BACKGROUND:Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions that may present with similar findings to other severe dermatologic diseases. OBJECTIVE: The primary objective of this exploratory study was to explore factors associated with SJS/TEN and develop a model that provides the predicted probability of SJS/TEN for patients for whom the diagnosis of SJS/TEN is considered. METHODS: Retrospective review of consultations for patients with suspected SJS, TEN, or overlap at 4 academic dermatology consultation services. RESULTS: Overall, 208 patients were included; 59 (28.4%) had a final diagnosis of SJS/TEN, and 149 (71.6%) were given a different diagnosis. The most common mimickers were drug hypersensitivity syndrome (n = 21, 10.1%), morbilliform drug eruption (n = 18, 8.7%), erythema multiforme (n = 15, 7.2%), and acute generalized exanthematous pustulosis (n = 13, 6.2%). Nikolsky sign, atypical targets, fever, and lymphopenia were included in a model for predicting the probability of SJS/TEN. LIMITATIONS: All cases were obtained from academic centers, which may limit the generalization of findings to community-based settings. This was an exploratory study with a small number of cases, and external validation of the model performance is needed. CONCLUSION: Early dermatologic evaluation of patients with suspected SJS/TEN is key to separating patients with this condition from those who ultimately receive diagnoses of other serious skin diseases.
Authors: Awadh Alamri; Mohammed Alshareef; Sarah B Aljoudi; Luai Assaedi; Sara Alkassimi; Abdulmohsin Algethami; Mazen S Dajam Journal: Cureus Date: 2022-02-11