THE INCIDENCE OF ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, AND TOXIC EPIDERMAL NECROLYSIS - A POPULATION-BASED STUDY WITH PARTICULAR REFERENCE TO REACTIONS CAUSED BY DRUGS AMONG OUTPATIENTS
THE INCIDENCE OF ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, AND TOXIC EPIDERMAL NECROLYSIS - A POPULATION-BASED STUDY WITH PARTICULAR REFERENCE TO REACTIONS CAUSED BY DRUGS AMONG OUTPATIENTS
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DOI：
10.1001/archderm.126.1.43
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发表时间：
1990-01-01
影响因子：
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通讯作者：
WALKER, AM
中科院分区：
文献类型：
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作者：
CHAN, HL;STERN, RS;WALKER, AM
我们进行了一项研究，以估计需要住院治疗的多形性红斑（EM）、史蒂文斯约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）的发生率，并确定哪些药物治疗与这些反应相关。我们回顾了从1972年到1986年在华盛顿州西雅图普吉特湾的团体健康合作社（GHC）因这些出院诊断住院的所有患者的临床记录。在这14年期间，平均约有260，000人，其人口特征与一般人口相似，接受了GHC的护理，每年约有25，000人入住GHC医院。根据国际疾病分类-适应性编码，从计算机化出院文件中共识别出61例EM、SJS或TEN疑似病例。根据记录审查和统一诊断标准的应用，共有37例患者（61%）被分类为EM、SJS或TEN。其中，16例（43%）归因于这些患者在住院前接受的药物。全因EM、SJS或TEN住院的总发生率为4.2/106人-年。全因单独TEN的发生率为0.5/106人-年。在年龄小于20岁、20 - 64岁和65岁及以上的人群中，与药物使用相关的EM、SJS或TEN的发生率分别为7.0、1.8和9.0/106人-年。反应率超过1/100，000暴露个体的药物治疗包括苯巴比妥（20/100，000）、呋喃妥因（7/100，000）、磺胺甲恶唑和甲氧苄啶、氨苄西林（均为3/100，000）和阿莫西林（2/100，000）。总体而言，我们的数据表明，严重到需要住院治疗的EM、SJS和TEN病例在使用完善药物治疗的门诊患者中并不常见。一个持续的挑战是评价这些与新上市或不太频繁处方的药物治疗相关的重度皮肤反应。
We carried out a study to estimate the incidence of erythema multiforme (EM), Stevens Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) requiring hospitalization and to determine which drug therapies were associated with these reactions. We reviewed the clinical records of all patients who were hospitalized with these discharge diagnoses at Group Health Cooperative (GHC) of Puget Sound, Seattle, Wash, from 1972 through 1986. During this 14-year period, an average of about 260,000 persons, with demographic characteristics similar to those of the general population, received their care from GHC, and there were about 25,000 admissions to hospitals per year at the GHC hospitals. Based on International Clasification of Diseases-Adapted coding, a total of 61 suspect cases of EM, SJS, or TEN were identified from the computerized hospital discharge file. Based on record review and the application of a uniform set of diagnostic criteria, a total of 37 patients (61%) were classified as having EM, SJS, or TEN. Of these, 16 cases (43%) were attributed to drugs administered to these patients prior to hospitalization. The overall incidence of hospitalization for EM, SJS, or TEN due to all causes was 4.2 per 106 person-years. The incidence to TEN alone due to all causes was 0.5 per 106 person-years. The incidence of EM, SJS, or TEN associated with drug use were 7.0, 1.8, and 9.0 per 106 person-years, respectively, for persons younger than 20 years to age, 20 to 64 years of age, and 65 years of age and older. Drug therapies with reaction rates in excess of 1 per 100,000 exposed individuals include phenobarbital (20 per 100,000), nitrofurantoin (7 per 100,000), sulfamethoxazole and trimethoprim, and ampicillin (both 3 per 100,000), and amoxicillin (2 per 100,000). Overall, our data suggest that cases of EM, SJS, and TEN sufficiently severe to require hospitalization are infrequent among outpatients using well-establishing drug therapies. A continuing challenge is the evaluation of these severe cutaneous reactions that are associated with newly marketed or less frequently prescribed drug therapies.