A Comprehensive Assessment of Long-Term Complications in Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Long-term cardiovascular outcomes among adult survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis: a retrospective cohort study using TriNetX

BACKGROUND

The long-term sequelae of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are increasingly being recognized. However, few studies have evaluated the long-term risk of cardiovascular diseases in these patients.

OBJECTIVES

This study aimed to investigate the long-term cardiovascular outcomes in survivors of SJS/TEN.

METHODS

In total, 2738 SJS/TEN survivors and 2738 propensity-score-matched controls were enrolled from the US Collaborative Network in the TriNetX database. The primary outcome of this study was the development of a major cardiovascular event (MACE). Patients were followed up from 3 months after the index date until the first diagnosis of an outcome event, withdrawal from the database, or 5 January 2025.

RESULTS

We found that SJS/TEN survivors had a significantly elevated risk of MACE [hazard ratio (HR) 2.13], ischaemic heart disease (HR 1.57), cerebrovascular disease (HR 2.13) and mortality (HR 1.94) compared with the matched healthy controls. Additionally, the association remained significant in most stratifications, including female, different age groups, disease severity (SJS, SJS/TEN overlap syndrome and TEN) and initial hospitalization status.

CONCLUSIONS

Some potential confounders may not be acquired in the database. In addition, detection bias is another potential source of bias in this study. This study revealed that SJS/TEN survivors have a significantly higher long-term risk of developing MACE. Understanding these sequelae may provide insights for the holistic care of SJS/TEN survivors.

Cyclosporin for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN): a systematic review of observational studies and clinical trials focusing on single therapy, combination therapy, and comparative assessments

BACKGROUND

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe, and potentially life-threatening skin and mucous membrane disorders. They are characterized by widespread skin and mucosal detachment and necrosis, and are classified based on the percentage of total body surface area (TBSA) affected. Given the severe and often life-threatening nature of these conditions, the identification and implementation of effective treatments is crucial. Notably, cyclosporin has demonstrated efficacy in managing these challenging conditions.

METHODS

A systematic search was carried out through the PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases until May 2024. Additionally, a manual search was conducted through the reference lists of the included studies to minimize the risk of missing reports.

RESULTS

Overall, 17 studies involving 4761 patients were included in our analysis. The majority of the included studies suggested favorable outcomes for the use of cyclosporin in SJS/TEN patients. The use of cyclosporin was associated with improved survival rates, early arrest of disease progression, faster re-epithelialization, reduced length of hospital stays, and lower rates of multi-organ failure. However, a few studies did not find a survival advantage with cyclosporin and even reported an increased risk of mortality, as well as an increased TBSA detachment and risk of infection.

CONCLUSION

Most studies indicate positive outcomes with cyclosporin treatment in SJS/TEN patients. This is likely due to cyclosporin's immunomodulatory properties, which may help attenuate the severe inflammatory response associated with these conditions.

The Association Between Oral Mucosal Lesions and Oral Health-Related Quality of Life Using the Validated Indonesian Version of OHIP-14 Among People Living with HIV/AIDS

Background

Oral mucosal lesions in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients, posing a concern for healthcare professionals, impact their oral health-related quality of life (OHRQoL). This study aimed to evaluate the association between oral mucosal lesions and OHRQoL as measured by the validated Indonesian version of the oral health impact profile-14 questionnaire (OHIP-14) among people living with HIV/AIDS (PLWHA).

Methods

A cross-sectional study was conducted at the Central Referral Hospital in West Java, Indonesia. The validity of OHIP-14 was evaluated in 30 PLWHA using inter-item corrected correlation, while reliability was assessed through Cronbach's alpha and kappa coefficient agreement. Subsequently, a consecutive sample of 110 PLWHA self-completed the validated Indonesian version of OHIP-14 and underwent an oral examination. The association between oral mucosal lesions and OHRQoL was analyzed using the chi-squared test.

Results

The validity test of the OHIP-14 questionnaire produced a rcount > 0.189, meaning that all question items were valid and could be used to describe OHRQoL. The reliability test of the OHIP-14 questionnaire produced a Cronbach's alpha value of 0.960 (> 0.7), which means that overall, the OHIP-14 questionnaire is reliable and feasible to be used to assess OHRQoL. Among the 110 enrolled participants, 61.8% were female and 38.2% were male, with the mean age 23.5 years old, the majority of them (59.1%) had been taking antiretrovirals (ARV), and (81.5%) had good QoL. There was a statistically significant relationship between oral lesions and quality of life (p<0.05), particularly acute pseudomembranous candidiasis, angular cheilitis, recurrent intraoral herpes, and Stevens-Johnson syndrome.

Conclusion

This study indicated a significant association between oral mucosal lesions and OHRQoL in PLWHA. The successfully validated Indonesian version of the OHIP-14 questionnaire serves as a reliable and effective tool for assessing OHRQoL among PLWHA.