Steven Johnson syndrome and Toxic epidermal necrolysis are types of severe adverse cutaneous reactions. Though they are rare, they are potentially fatal reactions endangering a patient's life. This retrospective study was done to detect the probable drugs implicated in SJS-TEN is our hospital and their clinical outcome. SJS-TEN is seen to occur among most commonly prescribed drugs. All patients of either sex, with the clinical diagnosis of SJS, SJS-TEN overlap or TEN (according to Bastuji et al criteria), who were admitted in the Dermatology department from April 2010 till August 2017 were included in the study. All relevant data including demographics of patient, symptoms, drug intake, duration of rash, reaction time (time taken for the reaction to appear since the last exposure to the drug), previous history or family history regarding drug allergy, history of complications arising, details of clinical examination at the time of presentation, along with significant systemic findings and clinical outcome were noted in a proforma. Baseline investigations, if done at the time of presentation, were noted down in the proforma. Drug(s) that had been taken within four weeks preceding the onset of symptoms were considered as ‘’culprit drugs’’. If the patient had taken more than one drug, all of them were considered culprit drugs. Nonsteroidal anti-inflammatory drugs (NSAIDs) (33.9%) was the most common causative drug group followed by antimicrobials (32.03%), xanthine oxidase inhibitors (13.6%) and antiepileptic drugs (5.83%) in this study. Early identification of the causative drug will help in prompt withdrawal of the drug thus reducing the morbidity and mortality among patients with SJS-TEN. This study aims to create awareness among the treating physicians about the drugs implicated in life threatening reactions to facilitate the judicious use of these drugs in future.

Key words: SJS, TEN, SJS-TEN overlap, drugs.

1. Svensson CK, Cowen EW, Gaspari AA. Cutaneous Drug Reactions. Pharmacolo-gical Reviews. 2001;53(3):357-79.
2. Sharma VK, Sethuraman G, Minz A. Steven Johnson Syndrome, toxic epidermal necrolysis and SJS-TEN overlap: A retrospective study for causative drugs and clinical outcome. Indian J Dermatol Venereol Leprol 2008;74:238-40.
3. Patel T, Thakkah S, Sharmar D. Cutaneous adverse drug reactions in Indian population: a systematic review. Indian Dermatol Online J. 2014;5:76-86.
4. Choon S, Lai N. An epidemiological and clinical analysis of cutaneous adverse drug reactions in a tettiary hospital in Johor, Malaysia. Indian J Dermatol Venerol Leprol 2012; 78: 734-9.
5. Wolkenstein P, Revuz J. Drug induced severe skin reactions. Incidence, management and prevention. Drug Saf. 1995;13(1):56-68.
6. Khambaty MM, Hsu SS. Dermatology of the patient with HIV. Emerg Med Clin Am 2010;28:355-68.
7. Roujeau JC. The spectrum of Steven-Johnson syndrome and toxic epidermal necrolysis: a clinical classification. J Invest Dermatol 1994; 102:285-30.
8. Mokenhaupt M. Schopf E. Epidemiology of drug induced severe skin reactions. Semin Cutan Med Surg. 1996;15(4):236-243.
9. Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of casesof toxic epidermal necrolysis, Steven-Johnson syndromeand erythema multiforme. Arch Dermatol 1993; 129:92-6.
10. Lyell A, Toxic epidermal necrolysis: An eruption resembling scalding of the skin. Br J Dermatol 1956;68:355-61.
11. Saha K. Toxic epidermal necrolysis: Current concepts in pathogenesis and treatment. Indian Dermatol Venereol Leprol. 2000;66(1):10-7.
12. Naveen KN, Pai VV, Rai V, Athanikar SB. Retrospective analysis of Steven Johnson Syndrome and toxicepidermal necrolysis over a period of 5 years from northern Karnataka, India. Indian J Pharmacol. 2013;45(1):80-2.
13. Patel TK, Barvaliya MJ, Sharma D, Tripathi C. A systemic review of the drug-induced Steven-Johnson syndrome and toxic epidermal necrolysis in Indian population. Indian J Dermatol Venereol Leprol 2013;79:389-98.
14. Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, BouwesBavinck Jn, et al. Steven-Johnson syndrome and toxic epidermal necrolysis: Assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 2008;128:35-44.
15. Schopf E, Stuhmer A, Rzany B, Victor N, Zentgraf R, Kapp JF. Toxic epidermal necrolysis and Stevens-Johnson syndrome: An epidemiologic study from West Germ-any. Arch Dermatol 1991;127:839-42.
16. Devi K, George S, Criton S, Suja V, Sridevi PK. Carbamazepine--the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: A study of 7 years. Indian J Dermatol Venereol Leprol 2005;71:325-8. 
17. Roujeau JC, Guillaume JC, Fabre JP, Penso DP, Fletchet ML, Girre JP. Toxic epidermal necrolysis(Lyells syndrome). Arch Dermatol 1990;126:37-42.  
18. Naveen KN, Pai VV, Rai V, Athanikar SB. Retrospective analysis of Steven Johnson syndrome and toxic epidermal necrolysis over a period of 5 years from northern Karnataka, India. Indian J Pharmacol. 2013 Jan 1;45(1):80.
19. Yamane Y, Aihara M, Ikezawa Z. Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Japan from 2000 to 2006 Allergol Int 2007;56:419-25.
20. Wong KC, Kennedy JP, Lee S. Clinical manifestations and outcome in 17 patients of Steven Johnson Syndrome and Toxic Epidermal Necrolysis. Australas J Dermatol 1999;40:131-4.
21. Saka B, Kombaté K, Mouhari-Toure A, Akakpo S, Tchangaï-Walla K, Pitché P. Stevens-Johnson syndrome and toxic epidermal necrolysis in a teaching hospital in Lomé, Togo: Retrospective study of 89 cases. Med Trop (Mars) 2010;70:255-8.
22. Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bouwes Bavinck JN, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: Assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study. J Invest Dermatol 2008;128:35-44.
23. Levi N, Bastuji-Garin S, Mockenhaupt M, Roujeau JC, Flahault A, Kelly JP, et al. Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: A pooled analysis. Pediatrics 2009;123:e297-304.
24. Noel MV, Sushma M, Guido S. Cutaneous adverse drug reactions in hospitalized patients in a tertiary care center. Indian J Pharmacol 2004;36:292-5.
25. Ward KE, Archambault R, Mersfelder TL. Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: A review of the literature. Am J Health Syst Pharm 2010;67:206-13.
26. Kardaun SH, Jonkman MF. Dexameth-asone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol 2007;87:144-8.

Dr Emy A. Thomas

Telephone number: 7087282878, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.