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SJS Patients at Risk for Recurrence

Filed June 4th, 2014 Eric


People who are hospitalized for the severe skin conditions Stevens-Johnson syndrome and toxic epidermal necrolysis are at an elevated risk of recurrence, according to a new study.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are painful, life-threatening conditions that typically occur as a response to certain drugs. The conditions often result in upper layers of the skin detaching from the lower layers, reported. Patients suffering from SJS can also experience blistering in the mouth, eyes and vagina, and patchy areas of rash.

Prior to the study, recurrence rates have been unknown, according to background information in the article.

Yaron Finkelstein, M.D., of the Hospital for Sick Children, Toronto, and a team of researchers took on a study that featured data of all Ontario residents hospitalized for a first episode of Stevens-Johnson syndrome or toxic epidermal necrolysis between April 2002 and March 2011. Patients were tracked from admission until March 31, 2012, or death. The researchers identified 708 individuals hospitalized for a first episode of SJS. That number included 127 (17.9 percent) children younger than 18 years.

Researchers found that Forty-two patients (7.2 percent) were hospitalized for a second episode of SJS or toxic epidermal necrolysis, while eight patients (1.4 percent) experienced multiple recurrences. The median time to first recurrence was 315 days, researchers found.

“In light of the reported incidence of SJS and TEN in the general population (1.0-7.2 cases/1 million individuals/year), 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. We speculate that this increased risk reflects individual susceptibility. Genetic predisposition has been identified for several medications in association with specific genotypes …” the authors write, according to

The authors believe the findings are relevant to physicians who care for patients with a history of SJS or TEN. Since most episodes are drug-induced, the high risk of recurrence should be recognized, and the benefits of drug therapy weighed carefully against the potential risks, the authors wrote. SJS and TEN can be caused by a reaction to non-steroidal anti-inflammatory drugs (NAIDs), antibiotics, barbiturates, anticonvulsants and the drug allopurinol.

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