Abstract
Aims: Epidermal necrolysis (EN) is a rare and severe condition
characterized by a diffuse skin and mucosal detachment, mainly induced
by drugs. Literature is scarce regarding the rate of recurrences and
drug re-exposure. The aim was to assess the rate of subsequent EN
recurrences such as re-exposure of high notoriety drugs in patients with
EN. Methods: We used the French Health system database and included all
EN patients. The primary outcome was the rate of EN recurrence.
Secondary outcomes were high notoriety drugs re-exposure or cross
exposure, i.e., exposure to a drug of the same family, after the acute
phase of EN, when initially suspected. Results: A total of 1,203/1,440
patients (83.5%) survived the acute phase, with 27 patients (2.2%
(CI95%: 1.5-3.2)) meeting the recurrence criteria. In patients with
allopurinol as suspected drug, 10/77 (13.0%) were cross exposed to
febuxostat, without recurrence. Similarly, in patients with
carbamazepine/oxcarbazepine as suspected drug, 2/26 (7.6%) were cross
exposed to lamotrigine, without recurrence. Conversely, 12/38 (31.5%)
and 16/37 (43.2%) patients were respectively re-exposed to pantoprazole
and esomeprazole when suspected, and 12/42 (28.6%) were re-exposed to
amoxicillin. Only one recurrence was noted in a pantoprazole re-exposed
patient. Conclusions: Among EN patients, the rate of recurrence seems
low, contrasting with several re-exposures among beta lactam antibiotics
and proton pump inhibitors, when suspected. Although we cannot exclude
that the suspected drugs were not the responsible ones for several
patients, future studies should assess the possible existence of
transient risk factors inducing EN.