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Thong BY. Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective. Asia Pac Allergy. 2013;3(4):215-23doi: 10.5415/apallergy.2013.3.4.215.
Thong, B. Y. (2013). Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective. Asia Pacific allergy, 3(4), 215-23. https://doi.org/10.5415/apallergy.2013.3.4.215
Thong, Bernard Yu-Hor. "Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective." Asia Pacific allergy vol. 3,4 (2013): 215-23. doi: https://doi.org/10.5415/apallergy.2013.3.4.215
Thong BY. Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective. Asia Pac Allergy. 2013 Oct;3(4):215-23. doi: 10.5415/apallergy.2013.3.4.215. Epub 2013 Oct 31. PMID: 24260726; PMCID: PMC3826606.
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Asia Pac Allergy. 2013 Oct;3(4):215-23. doi: 10.5415/apallergy.2013.3.4.215. Epub 2013 Oct 31.

Stevens-Johnson syndrome / toxic epidermal necrolysis: an Asia-Pacific perspective.

Asia Pacific allergy

Bernard Yu-Hor Thong

Affiliations

  1. Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore.

PMID: 24260726 PMCID: PMC3826606 DOI: 10.5415/apallergy.2013.3.4.215

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) to drugs which are associated with significant morbidity and mortality. High risk drugs in Asia are similar to those reported worldwide. Human leukocyte antigen (HLA)-related risk alleles for carbamazepine and allopurinol SCAR are unique to Asians. Although prognostic scoring systems like the SCORTEN have been used for more than a decade, pitfalls and caveats need to be recognized, in particular in patients with multiple medical co-morbidities and systemic features in SJS/TEN. In centres without a tertiary Burns Centre, SJS/TEN patients can still be managed successfully in general and dermatology wards with well-executed supportive/nursing care. Controversy remains regarding the effectiveness of immunomodulation in reducing SJS/TEN morbidity, mortality and hastening re-epithelialization. Despite paucity of robust evidence, intravenous immunoglobulins and ciclosporin remain the most commonly used modalities worldwide. Acute and long-term ocular effects are an important source of morbidity for which emerging ophthalmic therapies appear promising. Quality of life issues have now become an important outcome in patients with SJS/TEN as they often impact survivors' future attitudes towards pharmacotherapy. Even though pharmacogenetic testing for high-risk drugs appears to be the panacea for preventing carbamazepine- and allopurinol-induced SJS/TEN in ethnic Asians, many issues remain before health regulators in our region can conclusively determine whether testing should be made mandatory or highly recommended as standard of care.

Keywords: HLA antigens; Immunomodulatory therapy; Pharmacogenetics; Quality of life

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