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Stevens-Johnson syndrome/toxic epidermal necrolysis successfully treated with Chinese herbal medicine Pi-Yan-Ning: A case report

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Journal of Integrative Medicine 2021年第6期19卷 555-560页

作者： Shu-yi Chen Qun-wei Chen Liu-mei Shou Hong Pan Shan-ming Ruan Zhe-hao Liang Qi-jin Shu Department of Oncology the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310006Zhejiang ProvinceChina Department of Medical Ultrasonics the First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhou 310006Zhejiang ProvinceChina

Stevens-Johnson syndrome/toxic epidermal necrolysis(SJS/TEN)is a rare adverse cutaneous reaction with a low incidence and high *** posing a serious threat to patients’health and lives,there is no high-quality evidence for a standard treatment *** we report the case of a 62-year-old man with stage IV pancreatic cancer who experienced immunotherapy-induced SJS/*** consensus-based regular treatments at a local hospital,his symptoms became ***,he consented to receive Chinese herbal medicine(CHM)*** affected parts of the patient were treated with the CHM Pi-Yan-Ning which was applied externally for 20 min twice a *** 7 days of treatment,the dead skin began peeling away from the former lesions that had covered his hands,feet,and lips,indicating that skin had *** 12 days of treatment,the patient’s skin was completely *** this case,SJS/TEN was successfully treated with Pi-Yan-Ning,suggesting that there might be tremendous potential for the use of Pi-Yan-Ning in the treatment of severe skin reactions to drug *** basic investigations and clinical trials to explore the mechanism and efficacy are needed.

关键词： Chinese herbal medicine Immunotherapy Stevens-Johnson syndrome toxic epidermal necrolysis Case report

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Cohort study of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in China:evaluation of risk models and new predictor of pulmonary consolidation on computed tomography

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Frontiers of Medicine 2021年第4期15卷 585-593页

作者： Yanhong Shou Lu Yang Yongsheng Yang Xiaohua Zhu Feng Li Bo Yin Yingyan Zheng Jinhua Xu Department of Dermatology Huashan HospitalFudan UniversityShanghai 200040China Department of Radiology Huashan HospitalFudan UniversityShanghai 200040China Shanghai Institute of Dermatology Shanghai 200040China

Stevens-Johnson syndrome(SJS)and toxic epidermal necrolysis(TEN)are rare but severe *** study aimed to validate the predictive ability of risk models in patients with SJS/TEN and propose possible refinement in *** in the Department of Dermatology of Huashan Hospital from January 2008 to January 2019 were *** showed that the severity-of-illness score for TEN(SCORTEN)had a good discrimination(area under the receiver operating characteristic curve(AUC),0.78),and it was superior to auxiliary score(AS)and ABCD-10,which indicates age,bicarbonate level,cancer,dialysis,and 10%involved body surface area(AUC,0.69 and 0.68,respectively).The calibration of SCORTEN(Hosmer-Lemeshow goodness-of-fit test,P=0.69)was also better than that of AS(P=0.25)and ABCD-10(P=0.55).SCORTEN and ABCD-10 were similar(Brier score(BS),0.04 and 0.04)in terms of accuracy of *** addition,the imaging appearance of pulmonary consolidation on computed tomography was associated with high *** models were formed using the variables and this imaging *** refined AS and ABCD-10 models were similar in discrimination compared with the original SCORTEN(0.74 vs.0.78,P=0.23;0.74 vs.0.78,P=0.30,respectively).Therefore,SCORTEN showed good discrimination performance,calibration,and accuracy,and refined AS or ABCD-10 model may be an option when SCORTEN variables are not available.

关键词： Stevens-Johnson syndrome toxic epidermal necrolysis auxiliary score ABCD-10 pulmonary consolidation

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toxic epidermal necrolysis after percutaneous coronary intervention： which drug is the culprit？

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Chinese Medical Journal 2011年第3期124卷 467-468页

作者： HOU Xu-min WU Wen-yu Department of Cardiology Shanghai Chest Hospital Shanghai Jiao Tong University Shanghai 200030 China Department of Dermatology Huashan Hospital Fudan UniversityShanghai 200040 China Department of Dermatology and Venerology Shanghai Medical College Fudan UniversityShanghai 200032 China

toxic epidermal necrolysis （TEN） is a serious, usually drug-induced, dermatosis characterized by extensive erythema,necrosis, bullous detachment of the epidermis, constitutional symptoms, and visceral involvement. We report a 62-year-old man who was diagnosed TEN after percutaneous coronary intervention （PCI）. After consulting with a cardiologist, all pre-hospital medication was discontinued except clopidogrel. With supportive care, the patient recovered.

关键词： toxic epidermal necrolysis percutaneous coronary intervention drug allergy

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Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury:A case report

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World Journal of Clinical Cases 2021年第7期9卷 1646-1653页

作者： Dong-Dong Xue Ling Zhou Yong Yang Si-Yuan Ma Southwest Hospital Institute of Burn ResearchChongqing 400038China

BACKGROUND toxic epidermal necrolysis(TEN)is often associated with skin wounds affecting large *** of this type of wound is difficult because of pressure,infection and other *** can increase the length of hospital stay and result in wound sepsis and even *** SUMMARY A 49-year-old woman developed a skin lesion covering 80%of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back;she developed life-threatening wound sepsis and septic ***-resistant Staphylococcus aureus,carbapenem-resistant Acinetobacter baumannii,carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue,deep venous catheter and blood *** cilastatin sodium,tigecycline and teicoplanin were used for anti-infection ***,the patient was transferred to the burn department because of severe wound *** the burn intensive care unit,pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test *** three operations within 2 wk,the wound healed and sepsis *** TEN patients with large areas of skin injury may develop wound infection and life-threatening wound *** scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients,and it leaves no scar at the donor site.

关键词： toxic epidermal necrolysis Wound sepsis Autologous skin grafting Scalp Burn Case report

Successful treatment after toxic epidermal necrolysis induced by AZD-9291 in a patient with non-small cell lung cancer:A case report

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World Journal of Clinical Cases 2021年第29期9卷 8846-8851页

作者： Wen Li Xiang He Hui Liu Jiong Zhu Hui-Min Zhang Department of Dermatology Shuguang Hospital Affiliated to Shanghai University of TCMShanghai 201203China Department of Oncology Shuguang Hospital Affiliated to Shanghai University of TCMShanghai 201203China

BACKGROUND toxic epidermal necrolysis and Stevens-Johnson syndrome are acute lifethreatening skin ***9291 has been developed as a third-generation epidermal growth factor receptor(EGFR)-tyrosine kinase inhibitor(TKI)with activity against T790M *** SUMMARY Herein we report a 68-year-old woman who developed a large area of skin necrosis and was diagnosed with toxic epidermal necrolysis after AZD-9291 *** the best of our knowledge,this is the first case reported in patients with EGFR T790M mutation in non-small cell lung cancer(NSCLC).Cabozantinib combined with erlotinib had clinically meaningful effectiveness,with additional toxicity that was generally *** Treatment with AZD-9261 is effective in regressing the growth of the NSCLC and can bring some hope to despairing *** hope that more research will be carried out on the association between severe rashes and EGFR-TKIs,and more safe and effective drugs can be developed.

关键词： toxic epidermal necrolysis AZD-9291 Osimertinib epidermal growth factor receptor-tyrosine kinase inhibitors Non-small cell lung cancer Case report

Combination therapy(toripalimab and lenvatinib)-associated toxic epidermal necrolysis in a patient with metastatic liver cancer:A case report

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World Journal of Clinical Cases 2022年第11期10卷 3478-3484页

作者： Kai-Kai Huang Shan-Shan Han Li-Ya He Lin-Lin Yang Bao-Ying Liang Qing-Yu Zhen Zi-Bo Zhu Cai-Yun Zhang Hong-Yi Li Ying Lin Department of Dermatology the Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of Dermatology the Second Clinical Medical College of Guangzhou University of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases Guangzhou 510120Guangdong ProvinceChina

BACKGROUND Both programmed cell death-1(PD-1)inhibitors and lenvatinib,which have a synergistic effect,are promising drugs for tumor *** is generally believed that combination therapy with a PD-1 inhibitor and lenvatinib is safe and ***,we report a case of toxic epidermal necrolysis(TEN),a grade 4 toxicity,after this combination *** SUMMARY A 39-year-old male presented with erythema,blisters and erosions on the face,neck,trunk and limbs 1 wk after receiving combination therapy with lenvatinib and toripalimab,a PD-1 *** skin injury covered more than 70%of the body surface *** was previously diagnosed with liver cancer with cervical vertebra ***,prominent necrotic keratinocytes,hyperkeratosis,liquefaction of basal cells and acantholytic bullae were observed in the *** vessels in the dermis were infiltrated by lymphocytes and *** immunofluorescence staining was ***,the diagnosis was confirmed to be TEN(associated with combination therapy with toripalimab and lenvatinib).Full-dose and long-term corticosteroids,high-dose intravenous immunoglobulin and targeted antibiotic drugs were *** rashes gradually faded;however,as expected,the tumor ***, sorafenib and regorafenib were given in succession, and the patient was still alive at the10-mo *** attention should be given to rashes that develop after combination therapy with PD-1inhibitors and lenvatinib. Large-dose and long-course glucocorticoids may be crucial for thetreatment of TEN associated with this combination treatment.

关键词： toxic epidermal necrolysis Toripalimab Lenvatinib Programmed cell death-1 inhibitor Liver cancer Case report

Double plasma molecular adsorption system for Stevens–Johnson syndrome/toxic epidermal necrolysis:A case report

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World Journal of Clinical Cases 2024年第7期12卷 1371-1377页

作者： You-Wen Tan Li-Ping Liu Kai Zhang Department of Hepatology The Third Hospital of Zhenjiang Affiliated Jiangsu UniversityZhenjiang 212003Jiangsu ProvinceChina

BACKGROUND Stevens–Johnson syndrome and toxic epidermal necrolysis(SJS/TEN)are very serious skin allergies,with an etiology related to infections and *** the coronavirus disease 2019(COVID-19)pandemic,severe acute respiratory syndrome coronavirus-2 has also been considered to cause SJS/*** SUMMARY We report the case of a woman in her thirties who took acetaminophen after contracting *** 3 d of fever relief,she experienced high fever and presented with SJS/TEN symptoms,accompanied by intrahepatic *** days of corticosteroid treatment did not alleviate the skin damage;therefore,double plasma molecular adsorption system(DPMAS)therapy was initiated,with treatment intervals of 48 *** skin symptoms improved gradually and were resolved after seven DPMAS *** DPMAS therapy is beneficial for abrogating SJS/TEN because plasma adsorption and perfusion techniques reduce the inflammatory mediators(e.g.,tumor necrosis factor-alpha and interleukin-10 and-12)speculated to be involved in the pathology of the skin conditions.

关键词： Stevens-Johnson toxic epidermal necrolysis COVID-19 Double plasma molecular adsorption system SARS-CoV-2 Case report

Efficacy of borneol-gypsum in skin regeneration and pain control in toxic epidermal necrolysis:A case report

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World Journal of Clinical Cases 2024年第7期12卷 1290-1295页

作者： Lu-Wei Yang Li-Juan Zhang Bin-Bin Zhou Xin-Yu Lin Yu-Ting Chen Xiao-Yu Qin Hui-Ying Tian Li-Li Ma Ying Sun Lin-Di Jiang Department of Rheumatology Zhongshan Hospital(Xiamen)Fudan UniversityXiamen 361100Fujian ProvinceChina Department of Dermatology Zhongshan Hospital(Xiamen)Fudan UniversityXiamen 361100Fujian ProvinceChina Department of Ophthalmology Zhongshan Hospital(Xiamen)Fudan UniversityXiamen 361100Fujian ProvinceChina Department of Nursing Zhongshan Hospital(Xiamen)Fudan UniversityXiamen 361100Fujian ProvinceChina Department of Rheumatology Zhongshan HospitalFudan UniversityShanghai 200030China

BACKGROUND toxic epidermal necrolysis(TEN)is a life-threatening dermatological emergency mainly induced by drug hypersensitivity *** management includes discontinuation of culprit drug and application of immunomodulatory ***,mortality remains high due to complications like septic shock and multiorgan *** approaches for skin care are *** report introduces borneol-gypsum,a traditional Chinese drug but a novel dressing serving as an adjuvant of TEN therapy,might significantly improve skin conditions and patient outcomes in *** SUMMARY A 38-year-old woman diagnosed with eosinophilic granulomatosis with polyangiitis experienced gangrenous complications and motor nerve *** initial treatment of high-dose corticosteroids and cyclophosphamide,symptom of foot drop improved,absolute eosinophil counts decreased,while limb pain *** was added to alleviate her ***,TEN *** topical application of borneol-gypsum dressing not only protected the skin lesions from infection but also significantly eased localized *** approach demonstrated its merit in TEN management by promoting skin healing and potentially reducing infection *** Borneol-gypsum dressing is a promising adjuvant that could significantly improve TEN management,skin regeneration,and patient comfort.

关键词： toxic epidermal necrolysis Eosinophilic granulomatosis with polyangiitis Duloxetine Borneol Gypsum Case report

Stevens–Johnson syndrome and toxic epidermal necrolysis: Updates in pathophysiology and management

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中华医学杂志(英文版) 2024年第19期137卷 2294-2307页

作者： Hasegawa Akito Abe Riichiro Division of Dermatology Niigata University Graduate School of Medical and Dental Sciences Niigata-8510 Japan

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions characterized by extensive detachment of the epidermis and mucous membranes. These severe disorders carry a high mortality rate, and their pathogenesis remains largely unclear. Furthermore, optimal therapeutic strategies for SJS/TEN remain a subject of ongoing debate. Early diagnosis of SJS/TEN is challenging, and reliable biomarkers for diagnosis or severity prediction have not been firmly established. Certain drugs, such as carbamazepine and allopurinol, have shown a strong association with specific human leukocyte antigen (HLA) types. Recently, the potential benefits of HLA screening prior to administering these drugs to reduce the incidence of SJS/TEN have been explored. epidermal cell death in SJS/TEN lesions is caused by extensive apoptosis, primarily through the Fas–Fas ligand (FasL) and perforin/granzyme pathways. Our findings suggest that necroptosis, a form of programmed necrosis, also contributes to epidermal cell death. Annexin A1, released from monocytes, interacts with the formyl peptide receptor 1 to induce necroptosis. Several biomarkers, such as CC chemokine ligand (CCL)-27, interleukin-15, galectin-7, receptor-interacting protein kinases 3 (RIP3), and lipocalin-2, have been identified for diagnostic and prognostic purposes in SJS/TEN. Supportive care is recommended for treating SJS/TEN, but the efficacy of various therapeutic options–including systemic corticosteroids, intravenous immunoglobulin, cyclosporine, and tumor necrosis factor-α antagonists–remains controversial. Recent studies have investigated the potential benefits of tumor necrosis factor-α antagonists. In this review, we discuss recent advances in the understanding and management of SJS/TEN.

关键词： Stevens-Johnson syndrome toxic epidermal necrolysis Necroptosis Apoptosis