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Recurrences and rechallenges of suspected drugs in epidermal necrolysis patients
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  • Thomas Bettuzzi,
  • Bénédicte Lebrun-Vignes,
  • Haudrey Assier,
  • Laura Pina Vegas,
  • Saskia Ingen-Housz-Oro,
  • Emilie Sbidian
Thomas Bettuzzi
Hôpital Henri Mondor

Corresponding Author:thomas.bettuzzi@aphp.fr

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Bénédicte Lebrun-Vignes
Hopitaux Universitaires Pitie Salpetriere-Charles Foix
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Haudrey Assier
Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
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Laura Pina Vegas
Service de Rhumatologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Créteil, France
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Saskia Ingen-Housz-Oro
Henri-Mondor Hospital
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Emilie Sbidian
Hopital Henri Mondor
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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.