Steroids may slow progression of life-threatening skin reactions

By Lauretta Ihonor

Multi-national study results show that the progression of Steven Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) may be lengthened if corticosteroids are used prior to the onset of either condition.

But, the mortality risk and disease severity associated with both conditions does not appear to be altered by such drug use, write the authors in the British Journal of Dermatology.

Study participants were obtained from two multi-national studies conducted in Austria, France, Germany, Israel, Italy, and the Netherlands.

The period of time over which the condition progressed was compared between a group of 92 individuals who developed SJS or TEN and had a history of corticosteroid use prior to disease onset and another group of 321 SJS or TEN patients with no prior corticosteroid use (controls).

Disease severity and mortality rates were also assessed among both groups.

Reasons underlying prior steroid use included brain tumor, cerebral edema, autoimmune and connective tissue diseases, lung disease, and chemotherapy treatment for cancer.

Haur Lee (Singapore General Hospital) and co-authors report that the mean duration of disease progression was approximately 2 days longer among those with prior corticosteroid use than among controls.

Mean disease severity, defined as the maximum percentage of body surface area with skin detachment, showed no significant difference between corticosteroid-treated and corticosteroid-free patients, at 17.7% and 18.1%, respectively.

Multivariate analysis, in which results were adjusted for patient age, country, and disease history, revealed no significant inter-group difference in mortality rates.

A subgroup of 26 corticosteroid-treated and 86 corticosteroid-free SJS or TEN patients was assessed for differences in speed of disease onset after use of a drug known to carry a high risk for triggering SJS or TEN eg, allopurinol and phenytoin.

The findings of this additional analysis revealed that corticosteroids delayed the onset of SJS and TEN by 7 days in these high-risk patients.

Lee et al say that "there is some evidence that steroids have some impact on the course of the reaction in SJS/TEN patients."

"However, this further reinforces the need for a prospective randomized trial for conclusive evidence," conclude the authors.

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