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      Posible necrosis epidérmica tóxica inducida por deflazacort. A propósito de un caso Translated title: Posible deflazacort-induced toxic epidermic necrosis associated. A case report

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          Abstract

          RESUMEN Las denominadas reacciones adversas cutáneas graves son patologías potencialmente mortales asociadas a una significativa morbilidad y mortalidad. Mujer de 45 años de edad, sin antecedentes de importancia. Tras 28 días de tratamiento con delfazacort presenta lesiones pápulo-eritematosas confluentes y pruriginosas diseminadas por tronco, extremidades y cuero cabelludo compatible con diagnóstico de necrosis epidérmica tóxica.

          Translated abstract

          SUMMARY The severe cutaneous adverse reactions are life-threatening pathologies associated with significant morbidity and mortality. A 45-year-old woman with no relevant history. After 28 days of treatment the patient presented confluent and pruritic papulo-erythematous lesions disseminated by trunk, extremities and scalp with the diagnosis of toxic epidermal necrosis.

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          Toxic epidermal necrolysis.

          Toxic epidermal necrolysis (TEN) is an unpredictable, life-threatening drug reaction associated with a 30% mortality. Massive keratinocyte apoptosis is the hallmark of TEN. Cytotoxic T lymphocytes appear to be the main effector cells and there is experimental evidence for involvement of both the Fas-Fas ligand and perforin/granzyme pathways. Optimal treatment for these patients remains to be clarified. Discontinuation of the offending drug and prompt referral to a burn unit are generally agreed upon steps. Beyond that, however, considerable controversy exists. Evidence both pro and con exists for the use of IVIG, systemic corticosteroid, and other measures. There is also evidence suggesting that combination therapies may be of value. All the clinical data, however, is anecdotal or based on observational or retrospective studies. Definitive answers are not yet available. Given the rarity of TEN and the large number of patients required for a study to be statistically meaningful, placebo controlled trials are logistically difficult to accomplish. The absence of an animal model further hampers research into this condition. This article reviews recent data concerning clinical presentation, pathogenesis and treatment of TEN. At the conclusion of this learning activity, participants should have acquired a more comprehensive knowledge of our current understanding of the classification, clinical presentation, etiology, pathophysiology, prognosis, and treatment of TEN.
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            Toxic epidermal necrolysis: Part I. Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis.

            Toxic epidermal necrolysis is a life-threatening, typically drug-induced mucocutaneous disease. It is clinically characterized as a widespread sloughing of the skin and mucosa, including both external and internal surfaces. Histologically, the denuded areas show full thickness epidermal necrosis. The pathogenic mechanism involves antigenic moiety/metabolite, peptide-induced T cell activation, leading to keratinocyte apoptosis through soluble Fas ligand, perforin/granzyme B, tumor necrosis factor-alfa, and nitric oxide. Recent studies have implicated granulysin in toxic epidermal necrolysis apoptosis and have suggested that it may be the pivotal mediator of keratinocyte death.
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              Toxic epidermal necrolysis: review of pathogenesis and management.

              Toxic epidermal necrolysis (TEN) is a severe cutaneous drug reaction with a mortality rate of approximately 30%. The hallmark of TEN is widespread epidermal sloughing due to keratinocyte apoptosis. Multiple genetic associations between TEN and specific ethnic populations have been determined. The pathophysiology of TEN has yet to be fully elucidated; however, current pathogenic models implicate Fas ligand, granulysin, and reactive oxygen species. The value of current therapies, such as intravenous immunoglobulin and corticosteroids, remains under evaluation. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2020
                : 30
                : 2
                : 160-161
                Affiliations
                [1] Sevilla orgnameHospital Universitario Virgen del Rocío orgdiv1UG. Clínica Farmacia España
                [2] Sevilla orgnameHospital Universitario Virgen del Rocío orgdiv1UG. Clínica Cuidados Críticos España
                Article
                S1699-714X2020000200160 S1699-714X(20)03000200160
                10.4321/s1699-714x202000020020
                2b7a32ac-e7b8-4a67-a4b5-f484089fa168

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 09 April 2019
                : 17 April 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 2
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                necrosis,Stevens-Johnson,deflazacort,epidérmica,Epidermic,Necrólisis,Steven-Jonshon

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