Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment
Vulvovaginal manifestations in Stevens-Johnson syndrome and toxic epidermal necrolysis: Prevention and treatment
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DOI：
10.1016/j.jaad.2019.08.031
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发表时间：
2021-07-08
影响因子：
13.8
通讯作者：
Pasieka, Helena B.
中科院分区：
文献类型：
--
作者：
O'Brien, Kathleen F.;Bradley, Sarah E.;Pasieka, Helena B.
中毒性表皮坏死松解急性外阴阴道受累的发生率可高达70%；高达28%的女性患者还会出现慢性外阴阴道后遗症。对于Stevens-Johnson综合征和中毒性表皮坏死松解症（SJS/TEN）的妇科后遗症的预防和治疗，目前还没有多少共识。我们回顾急性和慢性后遗症，包括糜烂，瘢痕形成，慢性皮肤变化，尿道并发症，腺病，恶性转化，外阴痛和性交困难。我们为成人和儿童SJS/TEN患者的急性和长期外阴阴道护理提供全面的建议。治疗应包括一种超强效的局部类固醇，然后在外阴和会阴病变处涂抹一种无刺激性的屏障霜。所有成年人（但应避免青春期前的青少年）在阴道受损伤的情况下，应在阴道扩张的同时阴道内使用类固醇。所有育龄患者应考虑抑制月经，直至外阴阴道病变愈合。最后，盆底物理治疗和外科亚专科的转诊应在个案基础上提供。本指南总结了目前可用的文献，并结合了治疗大量SJS/TEN患者的皮肤科医生和妇科医生的专家意见。[J] .中国生物医学工程学报，2013;22(5):526 - 526。
The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis can be as high as 70%; up to 28% of female patients will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecologic sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae, including erosions, scar formation, chronic skin changes, urethral complications, adenosis, malignant transformation, vulvodynia, and dyspareunia. We provide comprehensive recommendations for acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Treatment should include an ultrapotent topical steroid, followed by a nonirritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults (but should be avoided in prepubertal adolescents) with vaginal involvement. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Last, referrals for pelvic floor physical therapy and to surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients. ( J Am Acad Dermatol 2021;85:523-8.)