Necrolysis, toxic epidermal

NSAIDs can induce a number of other adverse reactions, including bleeding disorders, anemia, thrombocytopenia, erythema nodosum, erythema multiforme, fixed drug eruptions, toxic epidermal necrolysis, Stevens-Johnson syndrome, leukocytocla-sitc vasculitis, recurrent fever with exanthema and, of course, the well-known gastric cytotoxicity. 

Erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis... 

Toxic epidermal necrolysis—a life-threatening skin disorder characterized by blistering and peeling of the top layer of skin. 

N-4 position and a substituted ring at the N-l position. Because of this different chemical structure, cross-allergenicity with the other sulfonamides may not occur. However, because this has not been well studied, if a patient has a reaction to a sulfonamide antibiotic, whether or not he or she will have a reaction to these other sulfonamides remains controversial. Predisposition to allergic reactions is a more likely reason than cross-reactivity between these differing molecules.14 The sulfonamide antibiotics are significant because they account for the largest percentage of antibiotic-induced toxic epidermal necrolysis and Stevens-Johnson syndrome cases.15... 

Severe life-threatening reactions not mediated by IgE, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, are absolute contraindications to testing, desensitization attempts, and readministration. 

Radimer GF, Davis JH, Ackerman AB. 1974. Fumigant-induced toxic epidermal necrolysis. Arch Dermatol 110 103-104. 

Toxic epidermal necrolysis Epidermal necrosis with skin detachment Present As above Supportive0... 

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used to treat HIV-infected patients that causes mild to severe skin rash and even Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) in a substantial proportion (16%) of patients. Nevirapine also induces hepatotoxicity. These adverse clinical symptoms may also occur in non-HIV subjects taking the drug as postoperative prophylaxis [15]. 

Chave, T.A. et al., Toxic epidermal necrolysis current evidence, practical management and future directions, Brit. J. Dermatol., 153, 241, 2005. 

Fagot, J.-P. et al., Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis, AIDS, 15, 1843, 2001. 

CNS Convulsions weakness malaise fatigue nervousness drowsiness depression dizziness disorientation confusion ataxia tremor tinnitus headache. Dermatologic Urticaria pruritus skin eruptions rash (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis) photosensitivity. 

Potentially fatal reactions to sulfonamides Fatalities have occurred, although rarely, as a result of severe reactions to sulfonamides (eg, zonisamide), including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias. 

Rare cases of toxic epidermal necrolysis or rash-related death have occurred, but their numbers are too few to permit a precise estimate of the rate. 

Dermatologic Severe dermatologic reactions, including toxic epidermal necrolysis (Lyell syndrome) and Stevens-Johnson syndrome, have been reported with carbamazepine. These reactions have been extremely rare however, a few fatalities have been reported. 

Dermafo/og/c. Alopecia, balanitis, erythema multiforme, erythema nodosum, fixed drug eruptions, hyperpigmentation of the nails, injection site erythema and injection site pain, maculopapular and erythematous rashes, photosensitivity, pruritus, skin and mucus membrane pigmentation, Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis. 

Hypersensitivity - Rare serious allergic reactions, including angioedema, anaphylaxis, and dermatologic reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have occurred in patients on azithromycin therapy. 

Nevirapine has been associated with severe, life-threatening rash (Stevens-Johnson syndrome, toxic epidermal necrolysis), which in some cases, has been fatal. When severe rash occurs, discontinue nevirapine. 

Skin - Severe, occasionally fatal dermatologic reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis, skin necrosis, and erythema multiforme, have been reported within days of methotrexate administration. 

Gastrointestinal disturbances are common. Its adverse reactions also include severe hemolytic anemia in people with G6PD deficiency. Skin reactions vary from erythema nodosum to toxic epidermal necrolysis. However its most serious adverse reaction is potentially fatal agranulocytosis. 

Nebulized pentamidine at the dosage of 300 mg every two weeks should be used in patients with a CD4-I- count less than 100 mm if systemic therapy cannot be tolerated. Sulfadoxine/pyrimethamine (Fansidar), one tablet given once or twice a week, is useful in patients in whom compliance is considered to be a problem. However, it has been associated with hepatotoxicity, Stevens-Johnson syndrome and toxic epidermal necrolysis. 

A variety of idiosyncratic reactions may be seen shortly after therapy has begun. Skin rashes, usually morbilliform in character, are most common. Exfoliative dermatitis or toxic epidermal necrolysis (Lyellis syndrome) has been observed but is infrequent. Other rashes occasionally have been reported, as have a variety of blood dyscrasias and hepatic necrosis. 

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