Risk Factors and Management of Mood Stabilizer-associated Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Mini-review

與情緒穩定劑相關的Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis：危險因子與處置

10.29478/TJP.201109.0003

林金堂(Gen-Tang Lin)

Management ； risk ； mood stabilizers ； Stevens-Johnson syndrome SJS

台灣精神醫學

25卷3期（2011 / 09 / 01）

140 - 144

英文

Objectives: In this brief review, I am dealing with the management and risk of mood stabilizers associated Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods: I conducted a comprehensive review of 27 published articles on SJS/TEN management and the risk of mood stabilizer-induced SJS/TEN. Results: Mood-stabilizing agents such as carbamezapine, lithium carbonate, valproic acid, topiramate, lamotrigine, gabapentin, and oxcarbazepine have the highest incidence of SJS/TEN. Han Chinese who have the HLA-B(superscript *)1502 allele are at a much increased risk of developing SJS/TEN when exposed to carbamazepine. Stopping the suspected drug and rapid initiation of supportive and symptomatic management remains the mainstay of SJS/TEN management. Females, substance abusers, and new users with an early or sudden high combined dosage of mood stabilizers have increased risk of SJS/TEN. Carbamazepine-induced SJS/TEN in Taiwan exhibits a 98.3% sensitivity rate for HLA-B(superscript *)1502. Given the availability of other effective medications for similar indications, avoiding carbamazepine is likely prudent when patients have tested HLA-B(superscript *)1502 screening positive. Conclusion: Early diagnosis is important and early treatment requirs optimal SJS/TEN management.

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