Successful treatment of Stevens-Johnson syndrome with steroid pulse therapy at disease onset.

Abstract

PURPOSE:

To evaluate the visual prognosis of patients with Stevens-Johnson syndrome (SJS) and its severe variant, toxic epidermal necrolysis (TEN), followed by general and topical high-dose corticosteroids administration from disease onset.

DESIGN:

Prospective, observational case series.

METHODS:

Between May 1, 2003 and June 30, 2005, we enrolled 5 patients with SJS or TEN with ocular complications at the acute stage. Intravenous pulse therapy with methylprednisolone (steroid pulse therapy; 500 or 1000 mg/day for 3 to 4 days) was initiated within 4 days from disease onset. Topically, 0.1% betamethasone was applied over 5 times daily for at least 2 weeks. Visual acuity (VA) and slit-lamp microscopic appearance 1 year from disease onset were evaluated.

RESULTS:

At the first examination, corneal or conjunctival epithelial defects and pseudomembranous conjunctivitis were present in all cases. Skin eruptions dramatically improved after steroid pulse therapy. Although ocular inflammation increased for several days, pseudomembranes disappeared and corneal and conjunctival epithelium regenerated within 6 weeks. At the chronic stage, all eyes had clear corneas with the palisades of Vogt (POV), implying the presence of corneal epithelial stem cells. Best-corrected VA was 20/20 or better in all eyes. Five eyes showed superficial punctate keratopathy. No eye had cicatricial changes except for 1 with slight fornix shortening. No significant adverse effects of steroid occurred during all clinical courses.

CONCLUSIONS:

Steroid pulse therapy at disease onset is of great therapeutic importance in preventing ocular complications. Topical betamethasone also shows great promise for preventing corneal epithelial stem cell loss in the limbal region and cicatricial changes.

• Authors: Yayoi Araki, Chie Sotozono, Tsutomu Inatomi, Mayumi Ueta, Norihiko Yokoi, Eiichiro Ueda, Saburo Kishimoto, Shigeru Kinoshita
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 147 Issue 6 Pg. 1004-11, 1011.e1 (Jun 2009) ISSN: 1879-1891 [Electronic] United States
• PMID: 19285657 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Glucocorticoids
• Betamethasone
• Methylprednisolone

Topics

• Acute Disease
• Administration, Topical
• Adult
• Betamethasone (administration & dosage)
• Conjunctivitis (prevention & control)
• Corneal Diseases (prevention & control)
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Male
• Methylprednisolone (administration & dosage)
• Middle Aged
• Prospective Studies
• Pulse Therapy, Drug
• Stevens-Johnson Syndrome (drug therapy, physiopathology)
• Visual Acuity (physiology)