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LETTER TO EDITOR
Year : 1998  |  Volume : 64  |  Issue : 5  |  Page : 250-251

Role of blood transfusion in the management of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)



Correspondence Address:
Sandipan Dhar


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Source of Support: None, Conflict of Interest: None


PMID: 20921787

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How to cite this article:
Dhar S. Role of blood transfusion in the management of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Indian J Dermatol Venereol Leprol 1998;64:250-1

How to cite this URL:
Dhar S. Role of blood transfusion in the management of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Indian J Dermatol Venereol Leprol [serial online] 1998 [cited 2019 Oct 18];64:250-1. Available from: http://www.ijdvl.com/text.asp?1998/64/5/250/4715



  To the Editor Top


Stevens - Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the two common emergencies encountered in day to day dermatology practice. [1, 2] In spite of taking all antiseptic and aseptic measures and providing barrier nursing, the mortality rate in such cases may be as high as 50%.[1-3] Early institution of systemic corticosteroid (s) may be helpful.[5], [6] However, often many patients report to the dermatologists quite late in the disease when, except barrier nursing, fluid and electolyte monitoring, there is not much to offer to them. At this stage institution of blood transfusion significantly alters the progress of the disease and modifies its outcome by curtailing the morbidity and reducing the mortality rate.

Over the last 2 1/2 years, I have treated 10 patients with SJS and 8 patients with TEN. In all these patients there was 60%-80% involvement of skin indicating a poor prognosis. In 8 patients (3 SJS, 5 TEN), systemic corticosteroid was given as they were brought within 3-4 days of development of skin lesion (S). In the rest 10 patients, corticosteroid was withheld since they were brought quite late. In all the 18 patients 2-3 units of blood was transfused after proper grouping and cross matching. Only two patients died, white 16 recovered without any complication(s).

The efficacy of blood transfusion in cases of SJS and TEN is probaly multimodal. First, the toxic metabolites of the incriminating drug viz, arene oxides get diluted by haemotransfusion resulting in its reduced action on target tissue e.g, skin and mucous membranes. Cytotoxic T cells and autoantibodies could also be getting diluted in similar ways. Secondly, freshly transfused blood supplies immunoglobulins to combat infections. Moreover, transfused blood prevents hypovolaemia resulting from the loss of blood from skin surfaces. It also supplies nutrients and electrolytes essential for the tissue perfusion and thereby indirectly help in the function of cardiovascular and renal system. Transfusion of blood, thus combats many complications and final outcome of the disease.



 
  References Top

1.Brice SL, Huff JC, Manstrom M, etal. Exudativum multiforme. Curr Probl Dermatol 1990;Jan-Feb:17-25.  Back to cited text no. 1    
2.Ruiz-Maldonado R. Acute disseminated epidermal necrosis types 1, 2 and 3: study of sixty cases. J Am Acad Dermatol 1985;13:623-635.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Heng MYC. Drug induced toxic epidermal necrolysis. Br J Dermatol 1985;113:597-600.  Back to cited text no. 3    
4.Demling FH, Ellerve S, Lowe NJ Burn unit management of toxic epidermal necrolysis. Arch Surg 1978;758-759.  Back to cited text no. 4    
5.Sharma VK, Dhar S. Clinical pattern of cutaneous drug eruptions among children and adolescents in north India. Pediatric Dermatol 1995;12:178-193.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Dhar S. Systemic corticosteroids in toxic epidermal necrolysis. Indian J Dermatol Venereol Leprol 1996;62:270.  Back to cited text no. 6    




 

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