• Journal of Oral Medicine and Pain
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• v.22 no.1
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• pp.23-29
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• 1997

A 49 years old male patient was referred from the Department of Medicine, KNUH for the management of painful oral lesions. The patient had disability of food and drug intake due to multiple intraoral ulcers. Extraoral findings showed upper and lower lip swelling, crust formation on the lips. The lesions were diagnosed as Stevens-Johnson syndrome based on clinical and hematologic findings. The patient was treated with saline irrigation and pulsed Nd:YAG laser irradiation. After 5 daily treatment, the lesions decreased in size and severity, and the patient became more comfortable for food intake and speeching. It was suggested from the results of this clinical trial that a pulsed Nd:YAG laser therapy would be helpful for the symptoms associated with Stevens-Johnson syndrome.

• IMMUNE NETWORK
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• v.16 no.4
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• pp.256-260
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• 2016

An association between drug treatment for viral infections and severe cutaneous adverse reactions has been noted. We investigated six patients diagnosed with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) after being prescribed acetaminophen for suspected viral illnesses. Multiplex analysis was performed to measure cytokine levels in sera before and after treatment. IL-2Ra levels significantly decreased during the convalescence phase. Although acetaminophen is relatively safe, the drug can trigger SJS/TEN in patients with suspected viral infections. T-cells and monocytes may be key components of the link between viral infection and acetaminophen-induced SJS/TEN.

• Childhood Kidney Diseases
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• v.18 no.2
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• pp.123-127
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• 2014

Erythema multiforme (EM) is an acute mucocutaneous disorder involving the skin, mouth, eyes, and genital organs. It is classified into EM minor and EM major according to the involvement of the mucosal membrane. Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN) belong to EM major. Compared to EM minor, SJS presents with more severe and progressive symptoms, and has a higher mortality rate. Corticosteroids are used in the treatment of EM. We report three cases of EM (two cases of EM minor and one case of SJS) that developed during treatment with oral corticosteroid (deflazacort; $Calcort^{(R)}$) in children with nephrotic syndrome.

• Korean Journal of Clinical Pharmacy
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• v.23 no.4
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• pp.344-364
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• 2013

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-complex-mediated hypersensitivity reactions that predominantly involve skin and mucous membranes. Despite the low incidence, both are considered medical emergencies as the mortality rate has been estimated at 30-50%. Although as many as half of cases are idiopathic, several drugs have been implicated as main cause of SJS/TEN. This review therefore aimed to identify drugs that were potentially associated with SJS/TEN and compare the relative risk of the medications. Method: A comprehensive search was performed using MEDLINE, EMBASE and 5 Korean databases. We defined study drugs as non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, antiepileptics, and allopurinol. Only epidemiologic studies investigating associations between the above drugs and drug-induced SJS/TEN were included. Two reviewers independently selected and evaluated candidate papers and extracted odds ratios or incidence rates. Meta-analysis was performed only for drugs that were reported from 4 or more studies. Results: We found 8 case-control studies, 3 cohort studies and 1 RCT. The ranges of adjusted ORs were 0.6-34.0 for NSAIDs, 1.6-302.0 for antiepileptics, 0.3-10.0 for antibiotics and 1.0-187.0 for allopurinol. The drug with the highest incidence of SJS/TEN was carbamazepine (40 persons/1,000 DDD). Conclusion: Finally, the risk was highest in first 8 weeks after onset of treatment in all drugs.

• Journal of Oral Medicine and Pain
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• v.36 no.2
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• pp.99-105
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• 2011

The vermilion zone of the lips is mucocutaneous junction between the skin and the oral mucosa of lips. Diseases of the vermilion zone may be related to a local or systemic condition, and can be manifestation of a systemic disease. In this cases, we introduced patients with hemorrhagic, ulcerative lesions on the vermilion zone and reported plasma cell cheilitis and lesion of the vermilion zone related to Stevens-Johnson syndrome(SJS).

• Journal of the korean academy of Pediatric Dentistry
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• v.44 no.4
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• pp.455-460
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• 2017

Stevens-Johnson syndrome (SJS), an extremely severe acute hypersensitivity reaction, causes extensive necrosis on the skin and the mucous membrane. SJS is a disease of unknown cause that can occur in all age groups. It is thought to be caused by drug allergy or induced by bacterial infection. Epidermal surface invasion of less than 10 percent is called SJS, and invasion of more than 30 percent is called toxic epidermal necrolysis. Although it is rare with an incidence of 1 - 2 cases per million people per year, it has effects on tooth development and therefore on children who are in a growth phase. The purpose of this case report is to examine the effect of SJS on tooth development in children. In general, eruption of the upper and lower 1st molars and lower central incisors starts at 6 - 7 years of age. Root development also occurs at this time. In the case reported here, SJS occurred in a 6-year-old patient. Although the patient's SJS was completely cured, he still suffers from aftereffects. Developmental abnormalities in the patient's teeth were observed only in teeth for which root development had been completed at the time. The purpose of this case report is to illustrate how to diagnose such systemic diseases by intra-oral features and to recognize and resolve tooth development problems associated with the disease.

• Journal of Interdisciplinary Genomics
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• v.3 no.1
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• pp.7-12
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• 2021

Adverse drug reactions (ADRs) is a hypersensitivity reactions to specific medications, and remain a common and major problem in healthcare. ADRs suchc as drug-induced liver injury and life-threatening severe cutaneous adverse drug reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms can be occurred by uncontrolled expansion of oligoclonal T cells according to genetically predisposing HLA. In this review, I summarized the alleles of HLA genes which have been proposed to have association with ADRs caused by different drugs.

• Journal of Korean society of Dental Hygiene
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• v.8 no.4
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• pp.31-41
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• 2008

Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis(TEN) are severe mucocutaneous reaction which are most frequently caused by drugs. Although the incidence of SJS and TEN is known to be relatively low, outcomes may be fatal. A systematic approach is required because morbidity rate is currently increasing and oral lesion is frequent. We investigated the clinical features and outcomes of 6 patients diagnosed as SJS and TEN and referred from the department of dermatology, Chonnam National University Hospital for oral care. Ketoconazol, Ofloxacin, Chlorphenesin, Amoxicillin, Pontal, Harnal, and Ciprofloxacin were suspected as the causative drugs. Average treatment period was 3.2 weeks, and two patients were referred to 'burn-patients' hospital. Most of oral lesion were cured be normal tissue, but scares with discoloration were observed. For intraoral management, antibiotic disinfection and steroid application were performed according to systemic treatment principles. Additionally, ingestion of zinc, antioxidants, and vitamin was recommended. The establishment of oral treatment principles is demanded because it has not been yet. Also, through investigation of drug side effect and careful prescription are required.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.17 no.3
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• pp.254-260
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• 2007

Trichloroethylene(TCE) is widely used as a degreasing solvent in workplaces. TCE is primarily toxic to the nervous system, however, systemic disorder like Stevens-Johnson syndrome has been recently reported in small-scale factories, where the government has had limited information of chemical use. A survey was performed to investigate the actual condition of using TCE and to provide practical information to occupational health service agencies and professionals. This survey was carried out on 103 factories out of 430 factories which were conducted periodic work environment measurement for TCE. Degreasing was the most popular reason for using TCE in Korea, which reached to 94%. TCE was also used as a solvent for rubber in the coating or molding process, and adhesives in the bonding process. Metal fabrication was the most common as 23%, followed by assembling automobile parts (17%), and machinery (12%). Workers exposed to TCE during full-shift were 52% while 48% were exposed during short period of the shift or intermittently. Manual or semi-automatic work occupied 87% while automatic work was just 13%. Though automatic work by a closed system was generally lower exposed to TCE, compared to manual work, it can cause a high exposure when the maintenance system is improper. Semi-automatic work especially like open-top degreasing process can cause a high exposure when local exhaust system with condensing and refrigerating coils in the degreaser does not work well. In conclusion, the survey showed nationwide status of TCE exposure in various aspects. It can be used to monitor workplaces and workers exposed to TCE to prevent occupational diseases.

• Clinical and Experimental Pediatrics
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• v.53 no.3
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• pp.437-441
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• 2010

Toxic epidermal necrolysis (TEN) and Stevens Johnson syndrome (SJS) are rare, life-threatening mucocutaneous -diseases, usually attributable to drugs and infections. Corticosteroids have been used in the management of TEN for the last 30 years. This remains controversial and is still much debated. TEN can occur despite administration of high doses of systemic corticosteroids. The psychiatric side effects of corticosteroids can include headache, insomnia, depression, and mood disorders with or without psychotic episodes. Steroid-induced psychosis is dealt with by tapering or discontinuing the steroid; antipsychotics are also sometimes used. We report a case of an 11-year-old boy who was admitted with TEN. He had also been diagnosed as having nephrotic syndrome in the past. Remission was achieved through induction therapy and by maintaining the use of steroids. After a full-dose intravenous dexamethasone for TEN, he showed psychotic symptoms. We diagnosed him as having steroid-induced psychosis. We tapered the steroid use and initiated an atypical antipsychotic medication, olazapine and intravenous immunoglobulin (IV-IG). His symptoms dramatically improved and he was discharged.