Publication:

Stevens-Johnson syndrome and toxic epidermal necrolysis prevalence and causative factors at Khartoum dermatology teaching hospital (2010-2020)

Background Cutaneous drug reactions mainly Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) and their overlap are rare but potentially fatal reactions endangers patient’s life, they are characterized by epidermal necrosis which causes erosions of the mucous membranes, extensive detachment of the epidermis. Drugs are the major causes of SJS\TEN. The types of the drugs depend on the prevalent diseases in the country and the protocols of management in that country. The aim of this study was to determine prevalence, causative factors and their correlation with SJS / TEN and their overlap, among patients admitted to Khartoum Dermatology and Venereology Hospital from January 2010 to September 2020.

Methods This retrospective cross-sectional study investigated 295patients with severe cutaneous reactions. Information collected included participants’ socio-demographic variables, clinical characteristics of the disease and the possible triggers. Data were analyzed using SPSS version 23.0.

Results The main age distribution was between 20-40 years in (42.7%), 48.8% of the cases had SJS, 44.4% had TEN and only 6.8% had SJS\TEN overlap. Seventy-two percent of the patients had no past history of similar condition. Sixty-six percent of the patients developed cutaneous symptoms from first till the seventh day after drugs intake. Drugs were determined to be the causative agent in 90.5% followed by other risk factors 7.5% mainly; chicken pox and dukhan dermatitis, (2%) of cases were idiopathic. The most common drugs implicated were antibiotics (75.6%), followed by NSAIDs (37.6 %). Patients who passed away during the study period were 24/295 cases (8.1%), 16 patients due to TEN, 6 patients with SJS and 2 patients with SJS/TEN overlap.

Conclusions SJS was the most common subtype of SJS/TEN in Khartoum Dermatology Hospital but most deaths occur among TEN patients. Women and persons aged 21–40 years were the most affected groups and was attributed to use of drugs, especially antibiotics (Ciprofloxacin), followed by NSAIDs (Diclofenac sodium).