The Experts below are selected from a list of 255 Experts worldwide ranked by ideXlab platform
Jean-claude Roujeau - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Interventions for Toxic Epidermal Necrolysis.
The Cochrane database of systematic reviews, 2002Co-Authors: Samit Majumdar, Jean-claude Roujeau, Maja Mockenhaupt, Askari P TownshendAbstract:Background Toxic Epidermal Necrolysis is a rare condition where a drug reaction induces skin loss, similar to that seen in extensive burns. It is associated with high morbidity and mortality and there is no clear agreement on effective treatment. Objectives To assess the effects of all interventions for the treatment of Toxic Epidermal Necrolysis. Search methods We searched the Cochrane Skin Group Specialised Register (March 2001), the Cochrane Controlled Trials Register (March 2001), MEDLINE (1966 to December 2001), EMBASE (1980 to December 2001), DARE (4th Quarter 2001) and CINAHL (1982 to October 2001). Selection criteria Randomised controlled trials of therapeutic and supportive interventions that included participants clinically diagnosed with Toxic Epidermal Necrolysis were included. Data collection and analysis Two independent authors carried out study selection and assessment of methodological quality. Main results Only one randomised controlled trial of treatment was identified. This trial compared the effectiveness of thalidomide with placebo and included 22 patients, 12 in the treatment group and 10 in the placebo group. Patients on the treatment arm received thalidomide 200 mg twice daily for 5 days. The main end point was the measurement of the progression of skin detachment after seven days. Other end points were the overall mortality and severity of the disease evaluated with the simplified acute physiology score. The study was terminated as the mortality on the treatment arm was 83% compared to 30% on the control arm (relative risk 2.78, 95% confidence interval 1.04 to 7.40). No randomised controlled trials of the most commonly used current treatments i.e. systemic steroids, cyclosporin A and intravenous immunoglobulins were found. Authors' conclusions Treatment with thalidomide was not shown to be effective and was associated with significantly higher mortality than placebo. There is no reliable evidence on which to base treatment for Toxic Epidermal Necrolysis, a disease commonly associated with mortality rates of around 30%. More research is required to understand the mechanisms of Toxic Epidermal Necrolysis. International multi-centre studies are needed in the form of randomised controlled trials, to evaluate treatments for Toxic Epidermal Necrolysis, especially those using high doses of steroid and intravenous immunoglobulins.
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SCORTEN: A Severity-of-Illness Score for Toxic Epidermal Necrolysis
The Journal of investigative dermatology, 2000Co-Authors: Sylvie Bastuji-garin, Jean-claude Roujeau, Jean Revuz, Nathalie Fouchard, M Bertocchi, Pierre WolkensteinAbstract:The mortality of Toxic Epidermal Necrolysis is about 30%. Our purpose was to develop and validate a specific severity-of-illness score for cases of Toxic Epidermal Necrolysis admitted to a specialized unit and to compare it with the Simplified Acute Physiology Score and a burn scoring system. A sample of 165 patients was used to develop the Toxic Epidermal Necrolysis-specific severity-of-illness score and evaluate the other scores, a sample of 75 for validation. Model development used logistic regression equations that were translated into probability of hospital mortality; validation used measures of calibration and discrimination. We identified seven independent risk factors for death and constituted the Toxic Epidermal Necrolysis-specific severity-of-illness score: age above 40 y, malignancy, tachycardia above 120 per min, initial percentage of Epidermal detachment above 10%, serum urea above 10 mmol per liter, serum glucose above 14 mmol per liter, and bicarbonate below 20 mmol per liter. For each Toxic Epidermal Necrolysis-specific severity-of-illness score point the odds ratio was 3.45 (confidence interval 2.26-5.25). Probability of death was: P(death) = elogit/1 + elogit with logit = -4.448 + 1.237 (Toxic Epidermal nec-rolysis-specific severity-of-illness score). Calibration demonstrated excellent agreement between expected (19. 6%) and actual (20%) mortality; discrimination was also excellent with a receiver operating characteristic area of 82%. The Simplified Acute Physiology Score and the burn score were also associated with mortality. The discriminatory powers were poorer (receiver operating characteristic area: 72 and 75%) and calibration of the Simplified Acute Physiology Score indicated a poor agreement between expected (9.1%) and actual (26.7%) mortality. This study demonstrates that the risk of death of Toxic Epidermal Necrolysis patients can be accurately predicted by the Toxic Epidermal Necrolysis-specific severity-of-illness score. The Simplified Acute Physiology Score and burn score appear to be less adequate.
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Toxic Epidermal Necrolysis
Journal of Dermatological Treatment, 1998Co-Authors: L. Le Cleach, Jean-claude RoujeauAbstract:Toxic Epidermal Necrolysis (TEN) is the most severe type of cutaneous reactions to drugs. Involvement of the epithelium of the gastrointestinal and respiratory tracts contribute to the severity of the disease. Antibacterial sulphonamides, anticonvulsants, allopurinol, several antibiotics and some antiinflammatory agents including steroids are the drugs associated with the highest risks. Therapy of this self-limited disease relies on symptomatic management based on the same principles as for major burns.
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Toxic Epidermal Necrolysis (Lyell Syndrome) in 77 Elderly Patients
Age and ageing, 1993Co-Authors: Sylvie Bastuji-garin, Jean-claude Guillaume, Mina Zahedi, Jean-claude RoujeauAbstract:Toxic Epidermal Necrolysis is a rare, severe drug-induced disorder characterized by extensive Epidermal loss. This study used the data of a national survey looking for all cases which occurred during a five-year period. The incidence of Toxic Epidermal Necrolysis (cases/million/year) was 2.7 times higher among elderly than among younger adults. In the elderly population no female preponderance was found but clinical patterns were similar. The fatality of Toxic Epidermal Necrolysis was twice as high in the elderly patients (51%) as in the younger (25%). The drugs incriminated in most cases of Toxic Epidermal Necrolysis were the same in both groups (NSAIDs, antibacterials and anticonvulsants).
Sylvie Bastuji-garin - One of the best experts on this subject based on the ideXlab platform.
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SCORTEN: A Severity-of-Illness Score for Toxic Epidermal Necrolysis
The Journal of investigative dermatology, 2000Co-Authors: Sylvie Bastuji-garin, Jean-claude Roujeau, Jean Revuz, Nathalie Fouchard, M Bertocchi, Pierre WolkensteinAbstract:The mortality of Toxic Epidermal Necrolysis is about 30%. Our purpose was to develop and validate a specific severity-of-illness score for cases of Toxic Epidermal Necrolysis admitted to a specialized unit and to compare it with the Simplified Acute Physiology Score and a burn scoring system. A sample of 165 patients was used to develop the Toxic Epidermal Necrolysis-specific severity-of-illness score and evaluate the other scores, a sample of 75 for validation. Model development used logistic regression equations that were translated into probability of hospital mortality; validation used measures of calibration and discrimination. We identified seven independent risk factors for death and constituted the Toxic Epidermal Necrolysis-specific severity-of-illness score: age above 40 y, malignancy, tachycardia above 120 per min, initial percentage of Epidermal detachment above 10%, serum urea above 10 mmol per liter, serum glucose above 14 mmol per liter, and bicarbonate below 20 mmol per liter. For each Toxic Epidermal Necrolysis-specific severity-of-illness score point the odds ratio was 3.45 (confidence interval 2.26-5.25). Probability of death was: P(death) = elogit/1 + elogit with logit = -4.448 + 1.237 (Toxic Epidermal nec-rolysis-specific severity-of-illness score). Calibration demonstrated excellent agreement between expected (19. 6%) and actual (20%) mortality; discrimination was also excellent with a receiver operating characteristic area of 82%. The Simplified Acute Physiology Score and the burn score were also associated with mortality. The discriminatory powers were poorer (receiver operating characteristic area: 72 and 75%) and calibration of the Simplified Acute Physiology Score indicated a poor agreement between expected (9.1%) and actual (26.7%) mortality. This study demonstrates that the risk of death of Toxic Epidermal Necrolysis patients can be accurately predicted by the Toxic Epidermal Necrolysis-specific severity-of-illness score. The Simplified Acute Physiology Score and burn score appear to be less adequate.
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Toxic Epidermal Necrolysis (Lyell Syndrome) in 77 Elderly Patients
Age and ageing, 1993Co-Authors: Sylvie Bastuji-garin, Jean-claude Guillaume, Mina Zahedi, Jean-claude RoujeauAbstract:Toxic Epidermal Necrolysis is a rare, severe drug-induced disorder characterized by extensive Epidermal loss. This study used the data of a national survey looking for all cases which occurred during a five-year period. The incidence of Toxic Epidermal Necrolysis (cases/million/year) was 2.7 times higher among elderly than among younger adults. In the elderly population no female preponderance was found but clinical patterns were similar. The fatality of Toxic Epidermal Necrolysis was twice as high in the elderly patients (51%) as in the younger (25%). The drugs incriminated in most cases of Toxic Epidermal Necrolysis were the same in both groups (NSAIDs, antibacterials and anticonvulsants).
Stephen C Foster - One of the best experts on this subject based on the ideXlab platform.
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stevens johnson syndrome and Toxic Epidermal Necrolysis a review of the literature
Annals of Allergy Asthma & Immunology, 2005Co-Authors: Erik Letko, Dean N Papaliodis, George N Papaliodis, Yassine J Daoud, Razzaque A Ahmed, Stephen C FosterAbstract:Objective To perform a comprehensive review of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis. Data Sources A MEDLINE search was performed for the years 1975 to 2003 using the keywords Stevens-Johnson syndrome and Toxic Epidermal Necrolysis to identify relevant articles published in English in peer-reviewed journals. Study Selection All clinical studies that reported on 4 or more patients, review articles, and experimental studies that concerned disease mechanisms were selected and further analyzed. Clinical reports that included fewer than 4 patients were selected only if they were believed to carry a significant message about disease mechanism or therapy. Results Stevens-Johnson syndrome and Toxic Epidermal Necrolysis seem to be variants of the same disease with differing severities. A widely accepted consensus regarding diagnostic criteria and therapy does not exist at present. Despite the recent experimental studies, the pathogenic mechanisms of these diseases remain unknown. Although progress in survival through early hospitalization in specialized burn units has been made, the prevalence of life-long disability from the ocular morbidity of Stevens-Johnson syndrome and Toxic Epidermal Necrolysis has remained unchanged for the past 35 years. Further progress depends on modification of the acute phase of the disease rather than continuation of supportive care. The available published evidence indicates that a principal problem in the pathogenesis is immunologic and that immunomodulatory intervention with short-term, high-dose intravenous steroids or intravenous immunoglobulin holds the most promise for effective change in survival and long-term morbidity. Conclusions The results of this review call for a widely accepted consensus on diagnostic criteria for Stevens-Johnson and Toxic Epidermal Necrolysis and multicenter collaboration in experimental studies and clinical trials that investigate disease mechanisms and novel therapeutic interventions, respectively.
Marcello Menta Simonsen Nico - One of the best experts on this subject based on the ideXlab platform.
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Toxic Epidermal Necrolysis-like Cutaneous Lupus Erythematosus: A Series of Three Patients
Acta dermato-venereologica, 2010Co-Authors: Claudia Gertrudis Cardoza Cisneros, Ricardo Romiti, Claudia Giuli Santi, Valeria Aoki, Neusa Y. S. Valente, Marcello Menta Simonsen NicoAbstract:Toxic Epidermal Necrolysis-like lesions have been described in the setting of lupus erythematosus, and have been considered as a specific hyperacute variant of cutaneous lupus erythematosus, with features different from classical drug-related Toxic Epidermal Necrolysis. We report here a series of three patients with lupus erythematosus who presented with severe worsening of their cutaneous disease in a Toxic Epidermal Necrolysis-like fashion. We compared these cases with cases reported previously. Based on this discussion, we speculate that some of these patients may have classical drug-related Toxic Epidermal Necrolysis rather than lupus erythematosus-related Toxic Epidermal Necrolysis.
Lars E French - One of the best experts on this subject based on the ideXlab platform.
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stevens johnson syndrome and Toxic Epidermal Necrolysis
Chemical immunology and allergy, 2012Co-Authors: Thomas Harr, Lars E FrenchAbstract:Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but severe adverse cutaneous drug reactions that are to be considered medical emergencies. The average reported mortality r
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Skin Detachment and Regrowth in Toxic Epidermal Necrolysis
Case reports in dermatology, 2010Co-Authors: Laurence Feldmeyer, Thomas Harr, Lars E French, Antonio Cozzio, Alexander A. NavariniAbstract:Toxic Epidermal Necrolysis is a rare but clinically well-described dermatological pathology. However, clinical pictures of this disorder in text books do not reflect its dynamic evolution. Usually, the desquamative post-bullous stage is represented, neglecting the initial bullous stage as well as the skin healing. With one clinical case, we provide a day-after-day illustration of the evolution of a patient suffering from Toxic Epidermal Necrolysis. During one month, a skin area of a limb was regularly photo-documented.
