Drugs causing Steven-Johnson Syndrome and Toxic Epidermal Necrolysis

Definition:

Steven-Johnson Syndrome (SJS) is defined as epidermal detachment less than 10 %

Toxic Epidermal Necrolysis (TEN) is when the detachment is greater than 30 %

SJS and TEN are of variants of the same pathophysiology. They are usually drug -induced ^[1] and are characterized by:

• severe mucosal erosions 
• widespread erythematous, cutaneous macules
• blistering and erosion of skin

Although many drugs ^[2] can cause SJS or the more counterpart TEN, not all are well known. However, some are as below ^[3] :

• AED: Carbamazepine ^{[4] [2]} , Phenytoin, Phenobarbital, Lamotrigine
• Antibacterials: Sulfonamides, clotrimoxazole
• NSAIDs: drugs in the 'oxicam' family
• Antiretroviral: Nevirapine
• Others: Allopurinol

References:

1. Roujeau JC et al. Medication use and the risk of Steven-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med 1995; 333: 1600-8. available at: http://www.nejm.org/doi/full/10.1056/NEJM199512143332404

2. Kamaliah et al. Erythema multiforme, Steven-Johnson syndrome and toxic epidermal necrolysis in northeastern Malaysia. Int J Dermatol 1998; 37:520-3. Available at: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-4362.1998.00490.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

3. Lonjou C et al. A marker for Steven-Johnson syndrome: ethnicity matters. Nature 2006; 6: 265-8. Available at: http://www.nature.com/tpj/journal/v6/n4/full/6500356a.html

4. Chang CC et al. Association of HLA-R*1502 allele with carbamazepine-induced toxic epidermal necrolysis and Steven-Johnson syndrome in the multi ethnic Malaysian population. Int J Dermatol 2011; 50 (2): 221-4. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2010.04745.x/abstract;jsessionid=6762444CFAEE35EB15580705370211C9.f01t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false