In the setting of a severe mucocutaneous (skin and mucous membrane) rash with evidence of epidermal detachment, a provider should consider a drug reaction.
The authors did a retrospective chart review (American Journal of Medicine, 2016) to identify triggers for Stevens-Johnson syndrome (10% body surface affected) and toxic epidermal necrolysis (greater than 30% skin involvement). Although this can be fatal, it is fortunately a rare skin reaction to medications and early recognition is vital to remove the trigger drug. 21.8% of patients died in hospital due to complications. Caucasians made up 44% of patients with a mortality of 14%. However, while 23% of patients were Chinese, the mortality in this group was 47%. There are known genetic associations between Han Chinese and HLA-B*5801 and allopurinol, as well as a relationship between East Asian individuals, HLA-B*1502 and carbamazepine. A high mortality rate was also identified in Native North Americans.
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