Assessment of underlying diseases and duration of hospitalization of Stevens - Johnson syndrome and Toxic Epidermal Necrolysis during at Shiraz, Iran

Background and Objective: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two ends of the spectrum of severe immunobullous state with long-term morbidity and high mortality characterized by keratinocyte apoptosis. In TEN, epidermal loss influences more than 30% of the total body surface, while SJS involves less than 10% of the body surface area. SJS/TEN overlap is characterized by epidermal detachment and the detachable skin between 10%-30%. A substantial amount of research has been published on different epidemiologic aspects of them. However, epidemiologic studies in Iran are scarce. Therefore, the present study aimed to draw attention to various epidemiological features of SJS and TEN diseases such as underlying diseases and duration of hospitalization in Iran. Materials and Methods: In this cross-sectional study, the records of all patients with the diagnosis of SJS, TEN, and SJS/TEN overlap during 2010-2015 were retrospectively reviewed. The patients were admitted to the Dermatology Tertiary Referral Center of Shahid Faghihi Hospital affiliated to the Shiraz University of Medical Sciences, Shiraz, Iran. The study was approved by the Ethics Committee of Shiraz University of Medical Sciences (code: ir.sums.med. rec.1395.s154). The diagnosis of these patients was mainly based on clinical signs and symptoms, and in a few cases, a skin biopsy was done to rule out any other conditions. From the records, patients’ admission and progress notes, charts, examination results, and treatments were retrospectively evaluated. Descriptive statistics were reported as mean±SD or frequency (%) for quantitative and qualitative data, respectively. The association between the two categorical variables was assessed using the chi-square or the Fisher s exact test, where appropriate, and non-parametric Kruskal-Wallis test was used to test quantitative variables among the three types of disorders. Statistical analysis was performed using the SPSS software (version18.0) and P<0.05 was considered statistically significant. Findings: Out of 97 patients with these skin disorder, 89 (91.8 %) were SJS, 3 (3.1%) were SJS/TEN-overlap, and 5 (5.1%) were TEN. Fisher s exact test showed that there was no association between sex and the type of disorder (P=0.71). Duration of hospitalization in TEN patients was 21.8 (+/-13.1) days which was significantly higher than the patients with SJS or overlap disorder (P<0.001). The most common underlying disease among the patients was epilepsy with 25.8% followed by hypertension (13.4%), previous drug hypersensitivities (8.2%). Conclusion: There are some differences between the epidemiological features of SJS and TEN diseases. . Duration of hospitalization in TEN patients was significantly higher than that of the patients with SJS or SJS/TEN overlap. We found that the most common underlying disease among patients was epilepsy followed by hypertension, hypersensitivity. To the best of our knowledge, this is one of the most large-scale investigations in Iran on various epidemiological features of SJS and TEN diseases.

کلیدواژه ها:

Stevens - Johnson syndrome ، Drug Eruptions ، Epidemiology