Antiepileptic Drugs are the Most Common Causative Agents of TEN and TEN/SJS Overlap

Several drugs that have emerged since 1990 are a cause of toxic epidermal necrolysis (TEN) and TEN and Stevens-Johnson syndrome (SJS) overlap, according to a recent study published in Pediatric Dermatology.

“We sought to investigate and report the experience with pediatric SJS and TEN in our center, identifying associated medications,” explained the study authors.

Researchers performed a retrospective review from 1990 to 2015 to identify patients diagnosed with SJS, SJS/TEN overlap, and TEN. Demographic characteristics, medical history, physical exam, treatment, and outcome data were collected.

The most common causative agents for SJS/TEN or TEN were trimethoprim-sulfamethoxazole, phenytoin, and lamotrigine used concomitantly with valproic acid. Among the agents approved after 1990, the most common causative agents included lamotrigine, clobazam, and zonisamide.

“Three drugs introduced into the market since 1990 have emerged as causes of SJS/TEN overlap and TEN: iamotrigine, clobazam, and zonisamide,” concluded the study authors. “It is also important for clinicians to be aware of the extremely commonly used medications such as amoxicillin, tetracyclines, [nonsteroidal anti-inflammatory drugs], and acetaminophen that can rarely cause SJS and TEN,” they added.

Reference
Gleghorn KL, Voigt C, Kelly B. Toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap in pediatric patients with a focus on newer antiepileptic drugs: a 25-year retrospective study at a single tertiary care center. Pediatr Dermatol. Published online May 31, 2021. doi:10.1111/pde.14598