Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis
Abstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap (SJS/TEN), collectively referred to SJS/TEN, form a spectrum of severe life-threatening adverse drug reactions whose pathomechanism is not fully understood. The article "Photodistributed Stevens–Johns...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-01-01
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| Series: | European Journal of Medical Research |
| Online Access: | https://doi.org/10.1186/s40001-024-01652-7 |
| _version_ | 1797275346362433536 |
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| author | Bukiwe N. Thwala Nadine Teixeira Eddy Zitha Aneliswa Mpungose Thuraya Isaacs Jonathan G. Peter Rannakoe J. Lehloenya |
| author_facet | Bukiwe N. Thwala Nadine Teixeira Eddy Zitha Aneliswa Mpungose Thuraya Isaacs Jonathan G. Peter Rannakoe J. Lehloenya |
| author_sort | Bukiwe N. Thwala |
| collection | DOAJ |
| description | Abstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap (SJS/TEN), collectively referred to SJS/TEN, form a spectrum of severe life-threatening adverse drug reactions whose pathomechanism is not fully understood. The article "Photodistributed Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Proposal for a New Diagnostic Classification" by McKinley et. al., discusses a distinct distribution of epidermal necrosis in SJS/TEN, attributable to preceding exposure to ultraviolet radiation (UVR), and relative sparing of photo-protected areas. After reviewing numerous cases within the Immune-mediated Adverse drug Reactions in African HIV endemic setting Register and Biorepository (IMARI-SA) at the University of Cape Town with a similar clinical pattern as those published by McKinley et. al., we propose that the relative sparing of some areas giving an impression of photo-distribution is due to localised increase in skin pressure that reduces the blood supply in that area below a critical threshold. A dip in blood supply below this critical threshold quantitively limited T lymphocytes and cytokines that drive SJS/TEN to reach and damage the skin. |
| first_indexed | 2024-03-07T15:13:01Z |
| format | Article |
| id | doaj.art-5e1125c240514d64bd6c194302206c06 |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-07T15:13:01Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-5e1125c240514d64bd6c194302206c062024-03-05T18:04:44ZengBMCEuropean Journal of Medical Research2047-783X2024-01-012911310.1186/s40001-024-01652-7Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysisBukiwe N. Thwala0Nadine Teixeira1Eddy Zitha2Aneliswa Mpungose3Thuraya Isaacs4Jonathan G. Peter5Rannakoe J. Lehloenya6Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and University of Cape TownDivision of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and University of Cape TownDivision of Dermatology, Department of Medicine, Groote Schuur Hospital and University of Cape TownDivision of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and University of Cape TownDivision of Dermatology, Department of Medicine, Groote Schuur Hospital and University of Cape TownDivision of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and University of Cape TownDivision of Dermatology, Department of Medicine, Groote Schuur Hospital and University of Cape TownAbstract Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap (SJS/TEN), collectively referred to SJS/TEN, form a spectrum of severe life-threatening adverse drug reactions whose pathomechanism is not fully understood. The article "Photodistributed Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Proposal for a New Diagnostic Classification" by McKinley et. al., discusses a distinct distribution of epidermal necrosis in SJS/TEN, attributable to preceding exposure to ultraviolet radiation (UVR), and relative sparing of photo-protected areas. After reviewing numerous cases within the Immune-mediated Adverse drug Reactions in African HIV endemic setting Register and Biorepository (IMARI-SA) at the University of Cape Town with a similar clinical pattern as those published by McKinley et. al., we propose that the relative sparing of some areas giving an impression of photo-distribution is due to localised increase in skin pressure that reduces the blood supply in that area below a critical threshold. A dip in blood supply below this critical threshold quantitively limited T lymphocytes and cytokines that drive SJS/TEN to reach and damage the skin.https://doi.org/10.1186/s40001-024-01652-7 |
| spellingShingle | Bukiwe N. Thwala Nadine Teixeira Eddy Zitha Aneliswa Mpungose Thuraya Isaacs Jonathan G. Peter Rannakoe J. Lehloenya Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis European Journal of Medical Research |
| title | Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis |
| title_full | Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis |
| title_fullStr | Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis |
| title_full_unstemmed | Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis |
| title_short | Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis |
| title_sort | comment on proposal for a new diagnostic classification of photodistributed stevens johnson syndrome and toxic epidermal necrolysis |
| url | https://doi.org/10.1186/s40001-024-01652-7 |
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