Detecção Precoce e Estratégias de Tratamento para Doenças Dermatológicas Severas: Análise da Síndrome de Stevens-Johnson e da Necrólise Epidérmica Tóxica

• DOI: https://doi.org/10.22533/at.ed.73524131113

• Palavras-chave: "Síndrome de Stevens-Johnson", "Necrólise Epidérmica Tóxica", "Tratamento da SSJ/NET", "Reações cutâneas a medicamentos", "Desfechos de SSJ/NET"

• Keywords: "Stevens-Johnson syndrome", "toxic epidermal necrolysis", "SJS/TEN treatment", "cutaneous drug reactions", "SJS/TEN outcomes"

• Abstract: INTRODUCTION AND BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe reactions to medications and infections, leading to the destruction of skin and mucosal cells. SJS affects approximately 10% of the body surface, while TEN involves more than 30%. Both present with erythematous macules and painful ulcers, and are mediated by T cells and haptens. With rare incidences (2 to 7 cases per million worldwide), these conditions are more common in women and immunocompromised patients, with high hospital mortality, especially in TEN, making proper clinical management essential. Early recognition of these conditions is crucial for effective treatment. OBJECTIVE: This literature review on Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) highlights the importance of an evidence-based approach to managing these severe conditions, proposing clinical interventions that include essential supportive care and adjuvant therapies, as well as other approaches that still lack definitive consensus. METHODOLOGY: This integrative review examined 33 relevant studies on Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), published between 2019 and 2024 in the BVS, PUBMED, and MEDLINE databases, after filtering an initial 420 articles. DISCUSSION AND RESULTS: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are delayed hypersensitivity reactions mediated by T lymphocytes, primarily triggered by drugs. In these conditions, the drug acts as a hapten, forming a complex with the body’s proteins that is recognized as a pathogen by the immune system. The intense inflammatory response, mediated by cytotoxic T cells and pro-inflammatory cytokines, leads to keratinocyte apoptosis and the formation of characteristic skin and mucosal lesions. Supportive treatment and monitoring for SJS and TEN require a multidisciplinary approach, involving intensivists, dermatologists, and other specialists. This includes the immediate withdrawal of suspected drugs, fluid and nutritional management, skin care, and prevention of complications. Common laboratory alterations include electrolyte imbalances, anemia, and disseminated intravascular coagulation. Specific pharmacological therapies include intravenous immunoglobulin (IVIg), and occasionally corticosteroids and cyclosporine, to control the immune response. Early recognition of SJS and TEN is crucial to improving prognosis, allowing for the rapid discontinuation of the causal agent and the implementation of intensive treatment. Signs of infection and complications must be closely monitored to prevent adverse outcomes. New studies propose therapies such as cyclophosphamide, plasmapheresis, and TNF-α inhibitors. CONCLUSION: The treatment and monitoring of SJS and TEN require a multidisciplinary approach and close vigilance. Intensive supportive measures, such as fluid management, pain control, adequate nutrition, and wound care, are essential. Early identification of severity and infection prevention are key to therapeutic management. With a well-coordinated approach, mortality can be reduced, and clinical outcomes improved.