Browsing by Subject "Stevens-Johnson syndrome"

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    Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2C9 and HLA-B Genotypes and Phenytoin Dosing: 2020 Update
    (Wiley, 2021) Karnes, Jason H.; Rettie, Allan E.; Somogyi, Andrew A.; Huddart, Rachel; Fohner, Alison E.; Formea, Christine M.; Lee, Ming Ta Michael; Llerena, Adrian; Whirl-Carrillo, Michelle; Klein, Teri E.; Phillips, Elizabeth J.; Mintzer, Scott; Gaedigk, Andrea; Caudle, Kelly E.; Callaghan, John T.; Medicine, School of Medicine
    Phenytoin is an antiepileptic drug with a narrow therapeutic index and large interpatient pharmacokinetic variability, partly due to genetic variation in CYP2C9. Furthermore, the variant allele HLA-B*15:02 is associated with an increased risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in response to phenytoin treatment. We summarize evidence from the published literature supporting these associations and provide therapeutic recommendations for the use of phenytoin based on CYP2C9 and/or HLA-B genotypes (updates on cpicpgx.org).
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    Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults
    (Elsevier, 2020-06) Seminario-Vidal, Lucia; Kroshinsky, Daniela; Malachowski, Stephen J.; Sun, James; Markova, Alina; Beachkofsky, Thomas M.; Kaffenberger, Benjamin H.; Ergen, Elizabeth N.; Mauskar, Melissa; Bridges, Alina; Calhoun, Cody; Cardones, Adela R.; Chen, Steven T.; Chodosh, James; Cotliar, Jonathan; Davis, Mark D. P.; DeNiro, Katherine L.; Dominguez, Arturo R.; Eljure-Téllez, Juliana; Femia, Alisa; Fox, Lindy P.; Guda, Anisha; Mitchell, Caroline; Mostaghimi, Arash; Ortega-Loayza, Alex G.; Owen, Cindy; Pasieka, Helena; Rahnama-Moghadam, Sahand; Saeed, Hajirah N.; Saunderson, Rebecca B.; Shanbhag, Swapna; Sharon, Victoria R.; Strowd, Lindsay; Venkatesh, Samantha; Wanat, Karolyn A.; Wetter, David A.; Worswick, Scott; Micheletti, Robert G.; Dermatology, School of Medicine
    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.
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    Striking enhancement at the site of radiation for nivolumab-induced Stevens-Johnson syndrome
    (UC Davis, 2018) Shah, Kishan M.; Rancour, Elizabeth A.; Al-Omari, Ahmed; Dermatology, School of Medicine
    Stevens-Johnson syndrome is a rare adverse cutaneous drug reaction characterized by epidermal detachment of <10% body surface area with an average mortality rate of 1-5%. The mechanism of SJS is not fully understood. Nivolumab is a monoclonal antibody directed against programmed cell death-1 protein (PD-1), a receptor with immune checkpoint inhibitory and antineoplastic activities. We present a case of SJS in a patient being treated with anti-PD-1 therapy nivolumab for metastatic squamous cell carcinoma of the oropharynx. This case is unusual because of the severe accentuation with striking enhancement at his prior radiation site and in the cutaneous region with heavier tumor burden from his metastatic disease. This reaction may give insight to the underlying pathophysiology of SJS, suggesting that immune checkpoint inhibitors can activate T-cells to target keratinocytes and that external factors may be involved in creating distinct epitopes for T-cell recognition. We hope this case adds to the body of knowledge in the pathogenesis of Stevens-Johnson syndrome and cutaneous adverse events seen with checkpoint inhibitors.