Table 3.
Summary of epidemiological studies on severe cutaneous adverse reactions (SCAR)
| Year | Author | Type of study | Period of study | Country | Number of cases | Age (range) | Sex F : M | Systemic manifestations | Causes | Outcome measures |
|---|---|---|---|---|---|---|---|---|---|---|
| 1986 | Guillaume et al. [6] | Prospective, TEN | 13 years | France | 87 | Unknown | Unknown | Unknown | Sulfonamides (20.7%) – sulfamethoxazole/trimethoprim (67%)Anticonvulsants (8%) – barbiturates and carbamazepine only NSAIDs (33.3%) -phenylbutazone, oxicam derivatives Allopurinol (3.4%) Chlormezanone (3.4%) | Unknown |
| 1990 | Chan et al. [79] | Retrospective, EM/SJS/TEN | 14 years | United States | 37 EM/SJS /TEN | Unknown | Unknown | Unknown | 43% attributed to drugs Drug therapies with reaction rates in excess of 1 per 100 000 exposed individuals include phenobarbital (20 per 100 000), nitrofurantoin (7 per 100 000), sulfamethoxazole and trimethoprim, and ampicillin (both 3 per 100 000), and amoxicillin (2 per 100 000). | Incidence of TEN alone due to all causes was 0.5 per 106 person-years. Incidence of EM, SJS, or TEN associated with drug use were 7.0, 1.8, and 9.0 per 106 person-years, respectively, for persons younger than 20 years of age, 20 to 64 years of age, and 65 years of age and older. |
| 1990 | Schopf et al.[81] | Retrospective, SJS/TEN | 5 years | Germany | 259 TEN 315 SJS | Mean age 63 years (TEN); 25 years (SJS) | TEN: 2:1; SJS: 1:2 | Unknown | Antibiotics (TEN, 40%; SJS, 34%) Analgesics (TEN, 23%; SJS, 33%) | TEN: Annual risk of 0.93 per million, mortality 34%SJS: Annual risk 1.1 per million, mortality 1% |
| 1990 | Roujeau et al.[82] | Retrospective, TEN | 5 years | France | 399 TEN | Unknown | Unknown | Unknown | Sulfadiazine Isoxicam Oxyphenbutazone Phenytoin Fenbufen Cotrimoxazole | Incidence 1.2 cases per million per year |
| 1993 | Leenutaphong et al.[84] | Retrospective, SJS and TEN | 9 years | Thailand | Total = 7858 SJS, 20 TEN | Unknown | Unknown | Unknown | Antibiotics (41%) – penicillin, sulfonamides, tetracycline, erythromycin Anticonvulsants (11.5%) – phenytoin, carbamazepine barbiturates Antitubercular drugs (10.3%) – thiacetazone | Mortality rate 14%; 40% TEN, 5% SJS |
| 1995 | Roujeau et al. [85] | Retrospective, Case-control study | 4 years | France, Germany, Italy, and Portugal | Total = 245 SJS 89 SJS-TEN overlap 76 TEN 80 | Unknown | Unknown | Unknown | Sulfonamides, trimethoprim-sulfamethoxazole Carbamazepine Oxicam NSAIDs Chlormezanone Phenytoin Allopurinol | Unknown |
| 1996 | Rzany et al. [86] | Retrospective, dZh German population-based registry for severe skin reactions. | 2 years 8 months | Germany | SJS 139 SJS-TEN overlap 95 TEN 56 | Unknown | Unknown | Unknown | Unknown | Incidence of SJS/TEN Up to 1.89 per 1 million inhabitants per year |
| 1998 | Kamaliah et al. [87] | Retrospective, EM/SJS/TEN (EM excluded in this table) | 8 years | East Malaysia | Total = 2522 SJS, 3 TEN | 19 adult and 6 paediatric Paed: 10 month–12 years Adult: 15–65 years | 0.73:1 | Fever (62.1%) Leukocytosis (34.5%) Hepatitis (31%) | Antibiotics (36%) Cotrimoxazole Ampicillin/amoxicillin Anticonvulsants (32%) Allopurinol (4%) | Mortality: TEN 37.3%, SJS 4.5% |
| 1999 | Wong et al. [87] | Retrospective, SJS/TEN | 12 years | Australia | Total = 1710 SJS, 7 TEN | Mean age 61.5 years | 0.5:1 | Unknown | Betalactam antibiotics (52.9%) | Mortality: 28.6% TEN 10% SJS |
| 2007 | Gerdts et al. [89] | Retrospective | 15 years | The Netherlands | 19 | Adult and paediatric Mean age 45.6 ± 23.9 years (5–70) | 1.6:1 | Unknown | Anticonvulsants – phenytoin/ carbamazepine (36.8%) Amoxicillin (10.5%) | Mortality (15.8%) |
| 2007 | Yamane et al. [90] | Retrospective, all cases published from Japan | 6 years | Japan | Total = 11752 SJS, 65 TEN | SJS: mean 45.2 years TEN: mean 45.7 years | SJS 1.7:1 TEN | Hepatitis (55.6%) Respiratory (25.6%) Renal dysfunction (19.7%) | Anticonvulsants (17.9%) Antibiotics (17.1%) NSAIDs (12.8%) | Mortality: SJS 1.9% TEN 6.2% |
| 2008 | Sharma et al. [91] | Retrospective | 3 years | India | Total = 3015 TEN, 9 SJS-TEN overlap and 6 SJS | Paediatric and adult Mean age 22.3 ± 15.4 years (4–65) | 1.2:1 | Haematological (86.7%) Hepatitis (36.7%) Renal (13.3%) Pnemonitis (10%) | Anticonvulsants (35.1%) – phenytoin 45%, carbamazepine 30%Antibiotics (33.3%) – cephalosporins 26% NSAIDS (24.6%). | Mortality 16.7% 13.3% TEN, 3.3% SJS-TEN overlap |
| 2008 | Mockenhaupt et al. [92] | Retrospective, case-control (EuroSCAR) | Unknown | Europe | Total = 379 134 SJS, 136 SJS/TEN-overlap, 109 TEN | Paediatric and adult Median 50 years (IQR 28–68) (1–95) | 1.6:1 | Unknown | Nevirapine Lamotrigine Carbamazepine Phenytoin Phenobarbital Cotrimoxazole and other anti-infective sulfonamides Sulfasalazine Allopurinol Oxicam-NSAIDs | Unknown |
| 2010 | Wetter et al. [93] | Retrospective | 8 years | United States | 27 SJS | Paediatric and adult Mean 28.1 ± 22.3 years | 0.7:1 | Fever (70%) Hepatitis (37%) Leukocytosis (22%) | 74% drug related Antibiotics (35%) – cotrimoxazole Anticonvulsants (35%) – phenytoin, lamotrigine NSAID (10%) | Mortality 5% |