Risk Factors and Management of Mood Stabilizer-associated Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Mini-review

與情緒穩定劑相關的Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis：危險因子與處置

林金堂(Gen-Tang Lin)

《台灣精神醫學》 25卷3期 (2011/09) Pp. 140-144

https://doi.org/10.29478/TJP.201109.0003

並列摘要

Objectives: In this brief review, I am dealing with the management and risk of mood stabilizers associated Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods: I conducted a comprehensive review of 27 published articles on SJS/TEN management and the risk of mood stabilizer-induced SJS/TEN. Results: Mood-stabilizing agents such as carbamezapine, lithium carbonate, valproic acid, topiramate, lamotrigine, gabapentin, and oxcarbazepine have the highest incidence of SJS/TEN. Han Chinese who have the HLA-B(superscript *)1502 allele are at a much increased risk of developing SJS/TEN when exposed to carbamazepine. Stopping the suspected drug and rapid initiation of supportive and symptomatic management remains the mainstay of SJS/TEN management. Females, substance abusers, and new users with an early or sudden high combined dosage of mood stabilizers have increased risk of SJS/TEN. Carbamazepine-induced SJS/TEN in Taiwan exhibits a 98.3% sensitivity rate for HLA-B(superscript *)1502. Given the availability of other effective medications for similar indications, avoiding carbamazepine is likely prudent when patients have tested HLA-B(superscript *)1502 screening positive. Conclusion: Early diagnosis is important and early treatment requirs optimal SJS/TEN management.

並列關鍵字

Management ； risk ； mood stabilizers ； Stevens-Johnson syndrome SJS

參考文獻

Roujeau, JC,Kelly, JP,Naldi, L(1995).Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis.N Engl J Med.333,1600-1607.

Ghislain, PD,Roujeau, JC(2002).Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome.Dermatol Online J..8,5.

Howard, GM(1963).The Stevens-Johnson syndrome, ocular prognosis, and treatment.Am J Ophthalmol.55,893-900.

Boe, J,Dalgaard, JB,Scott, D(1958).Mucocutaneous-ocular syndrome with intestinal involvement.Am J Med.25,857-867.

Wolf, R,Wolf, D,Davidovici, B(2007).In the pursuit of classifying severe cutaneous adverse reactions.Clin Dermatol.25,348-349.