Der Hautarzt

, Volume 65, Issue 5, pp 415–423 | Cite as

Schwere arzneimittelinduzierte Hautreaktionen

Stevens-Johnson-Syndrom und toxisch epidermale Nekrolyse
Leitthema

Zusammenfassung

Stevens-Johnson-Syndrom (SJS) und toxisch epidermale Nekrolyse (TEN) zeichnen sich durch z. T. ausgedehnte Blasenbildung der Haut und Schleimhaut aus und werden als eine Krankheitsentität von verschieden schwerer Ausprägung angesehen. Sie sind selten, aber potenziell lebensbedrohlich und gehen mit hoher Letalität einher. Erst nach einer klaren Diagnosestellung können spezifische therapeutische Maßnahmen folgen, wobei der supportiven Therapie die wichtigste Rolle zukommt. Um das auslösende Arzneimittel identifizieren und absetzen zu können, muss eine sehr detaillierte und gründliche Arzneimittelanamnese erhoben werden. Zu den hochverdächtigen Auslösern gehören Allopurinol, antibakterielle Sulfonamide, nichtsteroidale Antirheumatika vom Oxicam-Typ, verschiedene Antiepileptika und Nevirapin. Sie allein erklären mehr als die Hälfte aller Fälle von SJS/TEN. Nicht immer ist ein Arzneimittel ursächlich, in ca. 75 % der Fälle aber sehr wahrscheinlich. Aber auch Infekte kommen als Auslöser infrage.

Schlüsselwörter

Blasenbildung Letalität Risikofaktoren Prognose Therapie 

Severe drug-induced skin reactions

Stevens-Johnson syndrome and toxic epidermal necrolysis

Abstract

Stevens-Johnson syndrome (SJS) and Toxic epidermal necrolysis (TEN) are characterized by extensive blistering of the skin and mucosa; they are considered as one disease entity with varying severity. They are rare but potentially life-threatening and accompanied by high mortality. A clear clinical diagnosis is needed to direct specific therapy, but supportive therapy remains most important. In order to identify and withdraw the inducing drug, a very detailed and thorough medication history has to be obtained. Among the highly suspected (strongly associated) agents are allopurinol, antibacterial sulfonamides, non-steroidal anti-inflammatory drugs of the oxicam type, various anti-epileptics and nevaripine. Together they account for more than half of the cases of SJS/TEN. Although a drug is not always the cause, it is considered very like in approximately 75% of cases. Infections have also to be considered as etiologic factors.

Keywords

Blistering Mortality Risk factors Prognosis Therapy 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Dokumentationszentrum schwerer Hautreaktionen (dZh)Klinik für Dermatologie und Venerologie, Universitätsklinikum FreiburgFreiburgDeutschland

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