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High Risk of Recurrence of Serious Skin Reactions

Jun 11, 2014

The risk of a recurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), serious and sometimes fatal skin reactions, is substantially higher than the risk of a first episode, according to research published last week in the Journal of the American Medical Association.

Dr. Yaron Finkelstein, of the Hospital for Sick Children in Toronto, in a research letter, reported on a 10-year study of Ontario residents hospitalized for a first episode of SJS (567 patients) or TEN (141 patients) between April 2002 and March 2011. One hundred twenty-seven patients died in the hospital or within 60 days of hospital discharge (43 patients), representing a short-term mortality rate of 23.4 percent for patients with TEN and 9.0 percent for patients with SJS, reports. For the remaining 581 patients, hospitalization for a subsequent episode of SJS or TEN occurred in 42 patients (7.2 percent). Multiple recurrences were seen in eight patients (1.4 percent). The median time for a first recurrence was 315 days.

Stevens-Johnson and TEN are often reactions to medications, including the anti-gout medication allopurinol; pain relievers such as acetaminophen and ibuprofen; anticonvulsants and antipsychotics; and some antibiotics. The conditions can also develop after an infection. SJS symptoms include facial and tongue swelling, rash, and blisters on the skin and mucous membranes of mouth, nose, eyes, and genitals; and shedding of the skin, according to the Mayo Clinic. These symptoms can be preceded by flu-like symptoms. TEN affects many parts of the body, but especially mucous membranes; the skin blisters and sheds. The eyes can become swollen and ulcerated, in some cases leading to blindness. About 20 percent of patients who develop these conditions die and survivors face long-term complications including severe scarring or organ damage.

Because the recurrence rate is more than 7 percent, the authors urge caution in prescribing the drugs commonly associated with the development of these conditions for those who have had an episode of SJS or TEN. "The observed recurrence risk … is several thousand-fold higher than would be expected if subsequent episodes were probabilistically independent of the first SJS or TEN episode," the authors write, according to

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