AUTHOR=Ueta Mayumi , Inoue Chikara , Nakata Mitsuko , Sotozono Chie , Kim Mee Kum , Wakamatsu Tais , Jongkhajornpong Passara , Saeed Hajirah , Rauz Saaeha , Ma David Hui-Kang , Yoon Kyung Chul , Puangsricharern Vilavun , Bouchard Charles , Ahmad Sajjad , Seo Kyoung Yul , Joo Choun-Ki , Gomes Jose Alvaro Pereira , Chodosh James , Kinoshita Shigeru , Teramukai Satoshi 

TITLE=Severe ocular complications of SJS/TEN and associations among pre-onset, acute, and chronic factors: a report from the international ophthalmology collaborative group

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1189140

DOI=10.3389/fmed.2023.1189140

ISSN=2296-858X

ABSTRACT=We formed an international research collaboration which included Japan, South Korea, Brazil, Thailand, Taiwan, the U.K., and the U.S. (682 patients from 13 hospitals between 2005 and 2020), to better evaluate the role of race, ethnicity, and other risk factors in the pathophysiology of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Ophthalmologists often see SJS/TEN patients with severe ocular complications (SOC; frequency 50% SJS/TEN patients) when referred in the chronic stage after the acute stage has passed. Global data were collected using a Clinical Report Form capturing pre-onset factors, as well as acute and chronic ocular findings. Key conclusions  of this retrospective observational cohort study were: 1) ingestion of cold medications (acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) was significantly and positively correlated with trichiasis, symblepharon and/or conjunctivalization of the cornea in the chronic stage: 2) common cold symptoms prior to onset of SJS/TEN were significantly and positively correlated with acute conjunctivitis, and ocular surface erosions in the acute stage: and with trichiasis and symblepharon and/or conjunctivalization of the cornea in the chronic stage: 3) patients with SJS/TEN who presented with SOC tended to be female: 4) patients less than 30 years of age are more likely to develop SOC in the acute and chronic stages of SJS/TEN: 5) patients with acute severe conjunctivitis with ocular surface erosion and pseudomembrane formation in the acute stage are more likely to develop ocular sequelae in the chronic stage: 6) onychopathy in the acute stage was positively correlated with ocular sequelae in the chronic stage.
Our findings show that ingestion of cold medications, common cold symptoms prior to onset of SJS/TEN and young age might strongly contribute to develop SOC of SJS/TEN.