To perform a comprehensive review of Stevens-Johnson syndrome and toxic epidermal
A MEDLINE search was performed for the years 1975 to 2003 using the keywords Stevens-Johnson
syndrome and toxic epidermal necrolysis to identify relevant articles published in
English in peer-reviewed journals.
All clinical studies that reported on 4 or more patients, review articles, and experimental
studies that concerned disease mechanisms were selected and further analyzed. Clinical
reports that included fewer than 4 patients were selected only if they were believed
to carry a significant message about disease mechanism or therapy.
Stevens-Johnson syndrome and toxic epidermal necrolysis seem to be variants of the
same disease with differing severities. A widely accepted consensus regarding diagnostic
criteria and therapy does not exist at present. Despite the recent experimental studies,
the pathogenic mechanisms of these diseases remain unknown. Although progress in survival
through early hospitalization in specialized burn units has been made, the prevalence
of life-long disability from the ocular morbidity of Stevens-Johnson syndrome and
toxic epidermal necrolysis has remained unchanged for the past 35 years. Further progress
depends on modification of the acute phase of the disease rather than continuation
of supportive care. The available published evidence indicates that a principal problem
in the pathogenesis is immunologic and that immunomodulatory intervention with short-term,
high-dose intravenous steroids or intravenous immunoglobulin holds the most promise
for effective change in survival and long-term morbidity.
The results of this review call for a widely accepted consensus on diagnostic criteria
for Stevens-Johnson and toxic epidermal necrolysis and multicenter collaboration in
experimental studies and clinical trials that investigate disease mechanisms and novel
therapeutic interventions, respectively.