Clinical Epidemiological Investigation And Retrospective Study Of Severe Drug Eruption And Evaluation Of Diagnostic Criteria For Drug Hypersensitivity Syndrome

Eruption is inflammation occurring in the skin and mucous membranes caused by drug which is through various means, such as oral, injection, inhalation, topical, etc. into the body. Severe drug eruption is the disease with fast progression, extensive skin lesions and associated with symptoms of systemic poisoning and visceral involvement, including Stevens-Johnson syndrome (SJS), Toxic Epidermal Necrolysis (TEN), the drug-induced hypersensitivity syndrome (DRESS or DIHS), etc. It is adverse drug reaction whose pathogenesis caused by immune system involved. Severe drug eruption is associated with symptoms of systemic poisoning and multiple organ involvement with extensive skin lesions whose condition is serious. It is usually complicated by a variety of complications and its mortality rate is higher. For SJS, the incidence varies from1-6cases per million people per year and the mortality rate is about5%. TEN occurs at an estimated incidence of0.4-1.2cases per million people per year,2-5with an appreciable mortality rate of20%-30%. The incidence of DRESS is estimated to vary from one case among1,000to10,000drug exposures. The mortality rate is about10%to20%. Severe drug eruption belongs to life-threatening dermatoses with higher morbidity and mortality, so it is very important to study the epidemiology, prevention and treatment of severe drug eruption which is important part of prevention and treatment of life-threatening dermatoses.There are three sections for this study. Section one is a multi-aspect comparative7year study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis from China. Cases of TEN and SJS admitted to our hospital between January2006and December2012were reviewed. The result is that there are differences in the clinical characteristics and treatment responses to corticosteroids and intravenous immunoglobulin(IVIG) between SJS and TEN. Section two is the research of lymphocyte subsets of the peripheral blood in the treatment of severe drug eruption. Fluorescent flow cytometry was used to analyze the percentage of lymphocyte subsets of peripheral blood in21patients with severe drug eruption. The main results were that different lymphocyte subsets of the peripheral blood in different types of severe drug eruption and the different lymphocyte subsets of the peripheral blood in different types of severe drug eruption have different effects on the maximum dosage of corticosteroids. Section three is a retrospective study to evaluate current clinical criteria for the differential diagnosis of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. Data for16cases of DRESS syndrome and40cases of SJS/TEN between2009and2013were retrospectively collected and we evaluate the sensitivity and specificity of the current diagnostic criteria using statistical methods. The results were the RegiSCAR scoring system was the most consistent for clinical diagnosis of DRESS syndrome and showed the best balance of sensitivity and specificity, In contrast, RegiSCAR inclusion criteria was feasible because it was simple and valid. Therefore, we propose that the RegiSCAR inclusion criteria be adopted be considered as a criterion in the differential diagnosis of DRESS syndrome.