Parents Need To Be Aware Of These Two Serious And Potentially Fatal Skin Reactions Which Are Associated With Certain Medications
(Posted by Tom Lamb at DrugInjuryWatch.com)
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two rare but life-threatening skin reactions.
SJS and TEN are regarded as variants within a continuous spectrum, and have been distinguished by the extent of the skin area involved. Generally, when less than 10% of the total body surface is involved, the condition is defined as SJS; when more than 30% is involved, it is defined as TEN; and, the cases between 10% and 30% are defined as SJS/TEN–overlap.
The mortality risk is high for TEN cases insofar that greater than 40% are fatal, with sepsis being the most important cause.
In January 2009 the medical journal Pediatrics published online the early release of a report, "Medications as Risk Factors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Children: A Pooled Analysis", which informed us about a study that examined which drugs were most often associated with SJS and TEN in children under the age of 15-years old. This report was published (print version) in the February 2009 edition of the Pediatrics journal.
From the "Conclusions" section of that Pediatrics article we get this summary of the study findings:
SJS and TEN are rare diseases among children with a mortality rate estimated at 7.5%. In our study, children had mucous membrane lesions in 95% of cases and the median percentage of skin detachment was 20% of the body surface (10% to 40%). We did not confirm any suspected nonmedication risk factors. We confirmed 4 highly suspected drugs in children, antiinfective sulfonamides, phenobarbital, carbamazepine, and lamotrigine. Among other suspected drugs, we assume that acetaminophen may substantially increase the risk of SJS/TEN in children.
Concerning the anti-infective sulfonamides mentioned above as the first of these suspected drugs, according to the web site MedicineNet.com:
The sulfonamide family includes sulfadiazine, sulfamethizole (brand name: Thiosulfil Forte), sulfamethoxazole (Gantanol), sulfasalazine (Azulfidine), sulfisoxazole (Gantrisin), and various high-strength combinations of three sulfonamides.
In turn, phenobarbital is available as a generic medication.
The drug carbamazepine is sold under the brand names Tegretol, Tegretol XR , Equetro, and Carbatrol.
Then there is lamotrigine which is marketed as Lamictal; and, acetaminophen is the generic name for Tylenol products.
A February 6, 2009 Reuters Health article, "Medications Tied to Stevens-Johnson Syndrome in Children", that provided us with some insights from the one author of this report:
Dr. Jean-Claude Roujeau of INSERM, Creteil, France, and colleagues came to this conclusion after studying pooled data from two international studies of adverse cutaneous reactions.
"Our study combined the results because the conditions are rarer than in adults," Dr. Roujeau told Reuters Health. Even so, he added, "The present study on drug causality in children had a lower statistical power than each of the prior studies done on a whole population."...
The researchers say they confirmed the role of anti-infective sulfonamides, phenobarbital, carbamazepine, and lamotrigine. "Among other suspected drugs, we assume that acetaminophen may substantially increase the risk."
However, added Dr. Roujeau, "this latter result still needs confirmation."
This study was conducted in France, Germany, Italy, Portugal, the Netherlands, Austria, and Israel.