Deadly Skin Reactions have High Risk of Recurrence

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening conditions that are typically caused by drug reactions. In patients who have these conditions, the upper layer of the skin detaches from the lower layer. According to a study published in the June 4 issue of the Journal of the American Medical Association (JAMA), people who have suffered from an episode of SJS or TEN are significantly more likely to experience a second episode compared to the risk of a first episode in the general population.

Yaron Finkelstein, M.D. of the Hospital for Sick Children, Toronto and his colleagues conducted a 10-year population based study using information from all Ontario residents who were hospitalized for a first episode of SJS or TEN between April 2002 and March 2011; there were 567 SJS patients and 141 TEN patients. There was a short-term mortality rate of 23.4 percent in patients with TEN, with 127 patients dying in the hospital and 43 dying within 60 days of discharge. The mortality rate of SJS patients was 9 percent.

The remaining 581 patients were followed for a median of 1,283 days. In 42 patients, or 7.2 percent, there was another episode of SJS or TEN that required hospitalization. This equates to an incidence rate of 16 recurrent SJS or TEN episodes per 1,000 person years. Eight patients, or 1.4 percent, had multiple recurrences. The median time for first recurrence was 315 days. Factors associated with recurrences included male sex, rurality and delivery of care at an academic hospital during the index admission.

The authors wrote that “The observed recurrence risk in our study (>7 percent) is several thousand-fold higher than would be expected if subsequent episodes were probabilistically independent of the first SJS or TEN episode,”