Stevens–Johnson syndrome - Knowledge (XXG)

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variant since screening of populations with extremely low incidences of expressing the variant is considered cost-ineffective. Individuals expressing the HLA allele associated with sensitivity to an indicated drug should not be treated with the drug. These recommendations include the following. Before treatment with carbamazepine, the Taiwan and USA Food and Drug Administrations recommend screening for HLA-B*15:02 in certain Asian groups. This has been implemented in Taiwan, Hong Kong, Singapore, and many medical centers in Thailand and Mainland China. Before treatment with allopurinol, the American College of Rheumatology guidelines for managing gout recommend HLA-B*58:01 screening. This is provided in many medical centers in Taiwan, Hong Kong, Thailand, and Mainland China. Before treatment with abacavir, the USA Food and Drug Administration recommends screening for HLA-B*57:01 in Caucasian populations. This screening is widely implemented. It has also been suggested that all individuals found to express this HLA serotype avoid treatment with abacovir. Current trials are underway in Taiwan to define the cost-effectiveness of avoiding phenytoin in SJS, SJS/TEN, and TEN for individuals expressing the CYP2C9*3 allele of CYP2C9.

424: 1133:(TEN). These conditions were first recognized in 1922. A classification first published in 1993, that has been adopted as a consensus definition, identifies Stevens–Johnson syndrome, toxic epidermal necrolysis, and SJS/TEN overlap. All three are part of a spectrum of severe cutaneous reactions (SCAR) which affect skin and mucous membranes. The distinction between SJS, SJS/TEN overlap, and TEN is based on the type of lesions and the amount of the body surface area with blisters and erosions. It is agreed that the most reliable method to classify EM, SJS, and TEN is based on lesion morphology and extent of epidermal detachment. Blisters and erosions cover between 3% and 10% of the body in SJS, 11–30% in SJS/TEN overlap, and over 30% in TEN. The skin pattern most commonly associated with SJS is widespread, often joined or touching (confluent), 408: 1014:, i.e. altered to encode proteins with different amino acid sequences, and since the human population may express more than 100 trillion different (i.e. different amino acid sequences) T-cell receptors while an individual express only a fraction of these, a drug's or its metabolite's ability to induce the DRESS syndrome by interacting with a T cell receptor is limited to those individuals whose T cells express a T cell receptor(s) that can interact with the drug or its metabolite. Thus, only rare individuals are predisposed to develop SJS in response to a particular drug on the bases of their expression of specific T-cell receptor types. While the evidence supporting this T-cell receptor selectivity is limited, one study identified the preferential presence of the 508:. Between 100 and 200 different drugs may be associated with SJS. No reliable test exists to establish a link between a particular drug and SJS for an individual case. Determining what drug is the cause is based on the time interval between first use of the drug and the beginning of the skin reaction. Drugs discontinued more than 1 month prior to onset of mucocutaneous physical findings are highly unlikely to cause SJS and TEN. SJS and TEN most often begin between 4 and 28 days after culprit drug administration. A published algorithm (ALDEN) to assess drug causality gives structured assistance in identifying the responsible medication. 931:(i.e. variation) in order to stimulate T cells. Since the human population expresses some 13,000 different HLA serotypes while an individual expresses only a fraction of them and since a SJS-inducing drug or metabolite interacts with only one or a few HLA serotypes, a drug's ability to induce SCARs is limited to those individuals who express HLA serotypes targeted by the drug or its metabolite. Accordingly, only rare individuals are predisposed to develop a SCARs in response to a particular drug on the bases of their expression of HLA serotypes: Studies have identified several 1084: 436: 397:, which is commonly misdiagnosed and therefore treated with antibiotics. SJS, SJS/TEN, and TEN are often heralded by fever, sore throat, cough, and burning eyes for 1 to 3 days. Patients with these disorders frequently experience burning pain of their skin at the start of disease. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips, but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. 1063:(i.e. CYP2c9*1) cytochrome, have increased blood levels of phenytoin and a high incidence of SJS (as well as SJS/TEN and TEN) when taking the drug. In addition to abnormalities in drug-metabolizing enzymes, dysfunctions of the kidney, liver, or GI tract which increase a SCARs-inducing drug or metabolite levels are suggested to promote SCARs responses. These ADME abnormalities, it is also suggested, may interact with particular HLA proteins and T cell receptors to promote a SCARs disorder. 1281:, which takes a number of prognostic indicators into account. It is helpful to calculate a SCORTEN within the first 3 days of hospitalization. Other outcomes include organ damage/failure, ocular morbidity, and blindness. Restrictive lung disease may develop in patients with SJS and TEN after initial acute pulmonary involvement. Patients with SJS or TEN caused by a drug have a better prognosis the earlier the causative drug is withdrawn. 927:) can bind to a T-cell receptor and thereby stimulate the receptor-bearing parent T cell to initiate attacks on self tissues. Alternatively, a drug or its metabolite may stimulate these T cells by inserting into the groove on a HLA protein to serve as a non-self epitope or bind outside of this groove to alter a HLA protein so that it forms a non-self epitope. In all these cases, however, a non-self epitope must bind to a specific HLA 2459: 423: 1168:

Screening individuals for certain predisposing gene variants before initiating treatment with particular SJS-, TEN/SJS-, or TEN-inducing drugs is recommended or under study. These recommendations are typically limited to specific populations that show a significant chance of having the indicated gene

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should be consulted immediately, as SJS frequently causes the formation of scar tissue inside the eyelids, leading to corneal vascularization, impaired vision, and a host of other ocular problems. Those with chronic ocular surface disease caused by SJS may find some improvement with PROSE treatment

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Chung WH, Chang WC, Lee YS, Wu YY, Yang CH, Ho HC, Chen MJ, Lin JY, Hui RC, Ho JC, Wu WM, Chen TJ, Wu T, Wu YR, Hsih MS, Tu PH, Chang CN, Hsu CN, Wu TL, Choon SE, Hsu CK, Chen DY, Liu CS, Lin CY, Kaniwa N, Saito Y, Takahashi Y, Nakamura R, Azukizawa H, Shi Y, Wang TH, Chuang SS, Tsai SF, Chang CJ,

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Lonjou C, Borot N, Sekula P, Ledger N, Thomas L, Halevy S, Naldi L, Bouwes-Bavinck JN, Sidoroff A, de Toma C, Schumacher M, Roujeau JC, Hovnanian A, Mockenhaupt M; Borot; Sekula; Ledger; Thomas; Halevy; Naldi; Bouwes-Bavinck; Sidoroff; De Toma; Schumacher; Roujeau; Hovnanian; Mockenhaupt; Regiscar

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Auquier-Dunant A, Mockenhaupt M, Naldi L, Correia O, Schröder W, Roujeau JC; Mockenhaupt; Naldi; Correia; Schröder; Roujeau; SCAR Study Group. Severe Cutaneous Adverse Reactions (2002). "Correlations between clinical patterns and causes of Erythema Multiforme Majus, Stevens-Johnson Syndrome, and

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Sassolas B, Haddad C, Mockenhaupt M, Dunant A, Liss Y, Bork K, Haustein UF, Vieluf D, Roujeau JC, Le Louet H; Haddad; Mockenhaupt; Dunant; Liss; Bork; Haustein; Vieluf; Roujeau; Le Louet (2010). "ALDEN, an algorithm for assessment of drug causality in Stevens-Johnson Syndrome and toxic epidermal

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Lonjou C, Thomas L, Borot N, Ledger N, de Toma C, LeLouet H, Graf E, Schumacher M, Hovnanian A, Mockenhaupt M, Roujeau JC; Thomas; Borot; Ledger; De Toma; Lelouet; Graf; Schumacher; Hovnanian; Mockenhaupt; Roujeau; Regiscar (2006). "A marker for Stevens–Johnson syndrome ...: Ethnicity matters".

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SJS is thought to arise from a disorder of the immune system. The immune reaction can be triggered by drugs or infections. Genetic factors are associated with a predisposition to SJS. The cause of SJS is unknown in one-quarter to one-half of cases. SJS, SJS/TEN, and TEN are considered a single

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In addition to acting through HLA proteins to bind with a T-cell receptor, a drug or its metabolite may bypass HLA proteins to bind directly to a T-cell receptor and thereby stimulate CD8 T or CD4 T cells to initiate autoimmune responses. In either case, this binding appears to develop only on

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Teraki Y, Shibuya M, Izaki S; Shibuya; Izaki (2010). "Stevens-Johnson syndrome and toxic epidermal necrolysis due to anticonvulsants share certain clinical and laboratory features with drug-induced hypersensitivity syndrome, despite differences in cutaneous presentations".

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Locharernkul C, Loplumlert J, Limotai C, Korkij W, Desudchit T, Tongkobpetch S, Kangwanshiratada O, Hirankarn N, Suphapeetiporn K, Shotelersuk V; Loplumlert; Limotai; Korkij; Desudchit; Tongkobpetch; Kangwanshiratada; Hirankarn; Suphapeetiporn; Shotelersuk (2008).

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The diagnosis of Stevens–Johnson syndrome is based on involvement of less than 10% of the skin. It is known as TEN when more than 30% of the skin is involved and considered an intermediate form when 10–30% is involved. SJS/TEN reactions are believed to follow a

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Like other SCARs-inducing drugs, SJS-inducing drugs or their metabolites stimulate CD8 T cells or CD4 T cells to initiate autoimmune responses. Studies indicate that the mechanism by which a drug or its metabolites accomplishes this involves subverting the

385:. Together with TEN, SJS affects 1 to 2 people per million per year. Typical onset is under the age of 30. Skin usually regrows over two to three weeks; however, complete recovery can take months. Overall, the risk of death with SJS is 5 to 10%. 4432: 4417: 4398: 1043:(SCARS) as well as other types of adverse drug reactions. These variations influence the levels and duration of a drug or its metabolite in tissues and thereby impact the drug's or metabolite's ability to evoke these reactions. For example, 1229:

is controversial. Early retrospective studies suggested corticosteroids increased hospital stays and complication rates. No randomized trials of corticosteroids have been conducted for SJS, and it can be managed successfully without them.

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found on the T cells in the blisters of patients with allopurinol-induced DRESS syndrome. This finding is compatible with the notion that specific types of T cell receptors are involved in the development of specific drug-induced SCARs.

672:(NSAIDs) are a rare cause of SJS in adults; the risk is higher for older patients, women, and those initiating treatment. Typically, the symptoms of drug-induced SJS arise within a week of starting the medication. Similar to NSAIDs, 1621:

Creamer, D.; Walsh, S.A.; Dziewulski, P.; Exton, L.S.; Lee, H.Y.; Dart, J.K.G.; Setterfield, J.; Bunker, C.B.; Ardern-Jones, M.R.; Watson, K.M.T.; Wong, G.A.E.; Philippidou, M.; Vercueil, A.; Martin, R.V.; Williams, G. (June 2016).

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SJS is a rare condition, with a reported incidence of around 2.6 to 6.1 cases per million people per year. In the United States, about 300 new diagnoses are made each year. The condition is more common in adults than in children.

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frequency of the B*5801 allele in Europeans is typically 3%). One study concluded: "Even when HLA-B alleles behave as strong risk factors, as for allopurinol, they are neither sufficient nor necessary to explain the disease."

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is only relevant for East Asians. This has clinical relevance as it is agreed upon that prior to starting a medication such as allopurinol in a patient of Chinese descent, HLA-B*58:01 testing should be considered.

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Alfirevic A, Jorgensen AL, Williamson PR, Chadwick DW, Park BK, Pirmohamed M; Jorgensen; Williamson; Chadwick; Park; Pirmohamed (2006). "HLA-B locus in Caucasian patients with carbamazepine hypersensitivity".

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Schwartz, RA; McDonough, PH; Lee, BW (August 2013). "Toxic epidermal necrolysis: Part I. Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis".

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The diagnosis is based on involvement of less than 10% of the skin. It is known as TEN when more than 30% of the skin is involved and an intermediate form with 10 to 30% involvement. A positive

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Hoetzenecker W, Nägeli M, Mehra ET, Jensen AN, Saulite I, Schmid-Grendelmeier P, Guenova E, Cozzio A, French LE (January 2016). "Adverse cutaneous drug eruptions: current understanding".

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occurs in about 30% of children who develop SJS. A rash of round lesions about an inch across arises on the face, trunk, arms and legs, and soles of the feet, but usually not the scalp.

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Maverakis, Emanual; Wang, Elizabeth A.; Shinkai, Kanade; Mahasirimongkol, Surakameth; Margolis, David J.; Avigan, Mark; Chung, Wen-Hung; Goldman, Jennifer; Grenade, Lois La (2017).

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Ciralsky, JB; Sippel, KC; Gregory, DG (July 2013). "Current ophthalmologic treatment strategies for acute and chronic Stevens-Johnson syndrome and toxic epidermal necrolysis".

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Ward KE, Archambault R, Mersfelder TL; Archambault; Mersfelder (2010). "Severe adverse skin reactions to nonsteroidal antiinflammatory drugs: A review of the literature".

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Trujillo C, Gago C, Ramos S; Gago; Ramos (2010). "Stevens-Jonhson syndrome after acetaminophen ingestion, confirmed by challenge test in an eleven-year-old patient".

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treatment has shown some promise in reducing the length of the reaction and improving symptoms. Other common supportive measures include the use of topical pain

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that attack self tissues. In particular, it is a type IV, subtype IVc, delayed hypersensitivity reaction dependent in part on the tissue-injuring actions of

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Shanbhag, Swapna S.; Sangwan, Virender S.; Singh, Aastha; Donthineni, Pragnya R.; Basu, Sayan; Srinivasan, Bhaskar; Agarwal, Shweta; Iyer, Geetha (2021).

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associated with development of SJS, SJS/TEN, or TEN in response to certain drugs. In general, these associations are restricted to the cited populations.

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Fagot JP, Mockenhaupt M, Bouwes-Bavinck JN, Naldi L, Viboud C, Roujeau JC; Mockenhaupt; Bouwes-Bavinck; Naldi; Viboud; Roujeau; Euroscar Study (2001).

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Other HLA associations with the development of SJS, SJS/TEN, or TEN and the intake of specific drugs as determined in certain populations are given in

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Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T (2017). "Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis".

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Chong HY, Mohamed Z, Tan LL, Wu DB, Shabaruddin FH, Dahlui M, Apalasamy YD, Snyder SR, Williams MS, Hao J, Cavallari LH, Chaiyakunapruk N (2017).

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Kocak S, Girisgin SA, Gul M, Cander B, Kaya H, Kaya E (2007). "Stevens-Johnson syndrome due to concomitant use of lamotrigine and valproic acid".

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Although SJS can be caused by viral infections and malignancies, the main cause is medications. A leading cause appears to be the use of

4763: 4447: 4154: 1958:"Profile and pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a general hospital in Singapore: Treatment outcomes" 3509:

Study (2008). "A European study of HLA-B in Stevens–Johnson syndrome and toxic epidermal necrolysis related to five high-risk drugs".

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on CD8 T cells or CD4 T cells. Those peptides expressing a drug-related, non-self epitope on one of their various HLA protein forms (

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organized a workshop entitled "Research Directions in Genetically-Mediated Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis".

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is helpful in the diagnosis of SJS and TEN. A skin biopsy is helpful, but not required, to establish a diagnosis of SJS and TEN.

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Wang CW, Dao RL, Chung WH (2016). "Immunopathogenesis and risk factors for allopurinol severe cutaneous adverse reactions".

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Medications that have traditionally been known to lead to SJS, erythema multiforme, and toxic epidermal necrolysis include

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Adwan MH (January 2017). "Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and the Rheumatologist".

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of around 5%. The mortality for toxic epidermal necrolysis (TEN) is 30–40%. The risk for death can be estimated using the

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Initially, treatment is similar to that for patients with thermal burns, and continued care can only be supportive (e.g.,

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which is a Type IV, Subtype IVb, hypersensitivity drug reaction dependent in part on the tissue-injuring actions of

4842: 4703: 3994:"Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India" 1242: 1130: 254: 176: 3196:

Chung WH, Hung SI, Hong HS, Hsih MS, Yang LC, Ho HC, Wu JY, Chen YT; Hung; Hong; Hsih; Yang; Ho; Wu; Chen (2004).

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to manage infections can make it difficult to identify if cases were caused by the infection or medicines taken.

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Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O (2017). "Severe cutaneous adverse reactions to drugs".

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with minimal associated inflammation. The acuity is apparent from the (normal) basket weave-like pattern of the

4688: 4458: 856: 824: 767: 339: 883:(APC) takes up these alter proteins; digests them into small peptides; places the peptides in a groove on the 4053:"Clinical manifestations and outcomes in 17 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis" 2917:"Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy" 2386: 4971: 4966: 4892: 4635: 1355: 884: 880: 459: 309: 81: 4238: 1506: 701: 4258: 2397: 1929: 1624:"U.K. guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in adults 2016" 1199: 631: 568: 290: 261:(SJS/TEN) overlap, they are considered febrile mucocutaneous drug reactions and probably part of the same 159: 98: 3337:"Association between HLA-B*1502 allele and antiepileptic drug-induced cutaneous reactions in Han Chinese" 1543: 1160:. Erythema multiforme, which is also within the SCAR spectrum, differs in clinical pattern and etiology. 4791: 4708: 4652: 3810: 3546: 3488: 3430: 3380: 3315: 3249: 2771: 2722: 2671: 2574: 2517: 2445: 2238: 2137: 1142: 939: 776: 706: 429:

Inflammation and peeling of the lips—with sores presenting on the tongue and the mucous membranes in SJS

318: 1823:"Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines" 4936: 4786: 4743: 4738: 4693: 4177: 3979: 3211: 2259:"Scientific conclusions and grounds for the variation to the terms of the marketing authorisation(s)" 2015: 2014:

Foster, C. Stephen; Ba-Abbad, Rola; Letko, Erik; Parrillo, Steven J.; et al. (August 12, 2013).

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system. The drug or metabolite covalently binds with a host protein to form a non-self, drug-related

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Recent upper respiratory tract infections have been reported by more than half of patients with SJS.

730: 4882: 4814: 4758: 4713: 4436: 3884:"Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation" 3651: 3341: 3276: 1369: 1195: 1157: 1146: 1015: 836: 781: 362: 266: 262: 2291: 688:

The second most common cause of SJS and TEN is infection, particularly in children. This includes

4753: 4748: 4698: 4618: 4133:"A new eruptive fever associated with stomatitis and ophthalmia; Report of two cases in children" 4088: 3958: 3736: 3534: 3476: 3368: 3303: 3237: 3127: 3037: 2994: 2897: 2858: 2619: 2505: 2226: 2125: 1896: 1853: 1603: 796: 74: 64: 1072: 4204: 2692: 2419: 4869: 4592: 4509: 4469: 4411: 4132: 4080: 4072: 4033: 4015: 3950: 3915: 3861: 3798: 3728: 3693: 3632: 3597: 3526: 3468: 3418: 3360: 3335:

Man CB, Kwan P, Baum L, Yu E, Lau KM, Cheng AS, Ng MH; Kwan; Baum; Yu; Lau; Cheng; Ng (2007).

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player. Bol died from complications of Stevens–Johnson syndrome as well as kidney failure.

1257: 1150: 1118: 1091: 1048: 1023: 892: 872: 800: 711: 382: 366: 323: 212: 200: 4150: 3215: 2420:"A case of bupropion-induced Stevens-Johnson syndrome with acute psoriatic exacerbation" 752:

In pediatric cases, Epstein–Barr virus and enteroviruses have been associated with SJS.

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Uzzaman A, Cho SH (2012). "Chapter 28: Classification of hypersensitivity reactions".

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Devi K, George S, Criton S, Suja V, Sridevi PK; George; Criton; Suja; Sridevi (2005).

2058:"The current understanding of Stevens–Johnson syndrome and toxic epidermal necrolysis" 1225:

Beyond this kind of supportive care, no treatment for SJS is accepted. Treatment with

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Bachelez H (January 2018). "Pustular psoriasis and related pustular skin diseases".

2623: 2509: 2230: 2129: 1900: 1607: 273:. A few days later, the skin begins to blister and peel, forming painful raw areas. 4926: 4848: 4209: 4112: 3480: 3241: 3131: 3041: 2998: 2474:"Nevirapine and the risk of Stevens–Johnson syndrome or toxic epidermal necrolysis" 1841: 1373: 1299: 719: 693: 608: 576: 540: 528: 414: 3652:"Reference SNP (refSNP) Cluster Report: rs1057910 ** With drug-response allele **" 2862: 2693:"Acetaminophen induced Steven Johnson syndrome-Toxic Epidermal Necrolysis overlap" 1107: 4463: 3946: 3566:

Garon SL, Pavlos RK, White KD, Brown NJ, Stone CA, Phillips EJ (September 2017).

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Alfirevic A, Pirmohamed M (January 2017). "Genomics of Adverse Drug Reactions".

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Bacterial infections linked to SJS include group A beta-hemolytic streptococci,

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SJS, like TEN and erythema multiforme, is characterized by confluent epidermal

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Chung WH, Wang CW, Dao RL (2016). "Severe cutaneous adverse drug reactions".

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SJS is named for Albert Mason Stevens and Frank Chambliss Johnson, American

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Toxic Epidermal Necrolysis results of an international prospective study".

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certain T cell receptors. Since the genes for these receptors are highly

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girl who lost the skin covering 95% of her body after taking children's

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variant of CYP2C9, which has reduced metabolic activity compared to the

350:(AGEP) and toxic epidermal necrolysis in a group of conditions known as 277:, such as the mouth, are also typically involved. Complications include 2655: 2283: 2175: 2158: 1938: 1382: 1319: 1315: 986: 970: 959: 876: 808: 789: 479: 463: 3847: 3583: 3076: 3059: 3025: 2363: 2076: 2057: 1760: 1639: 4421: 4402: 3756:"Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)" 3145:

Fan WL, Shiao MS, Hui RC, Su SC, Wang CW, Chang YC, Chung WH (2017).

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Adler NR, Aung AK, Ergen EN, Trubiano J, Goh MS, Phillips EJ (2017).

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SJS constitutes a dermatological emergency. Patients with documented

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Based on the Asian findings, similar studies in Europe showed 61% of

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showing full-thickness epidermal necrosis with a basket weave-like

1082: 963: 904: 900: 896: 746: 4485: 4452: 1380:" video and was Playmate of the Month in the July 1978 issue of 1362:

in 2003. In 2013, a jury awarded her $ 63M in a lawsuit against

1263:

prosthetic replacement of the ocular surface ecosystem treatment

1055:. Taiwanese, Japanese, and Malaysian individuals expressing the 1036: 676:(acetaminophen) has also caused rare cases of SJS. People with 483: 4550: 4170:"Ab-Soul's timeline: The rapper's life from 5 years old to now" 1218:

and surgeons tend to disagree about whether the skin should be

4234: 1927:

Tigchelaar, H.; Kannikeswaran, N.; Kamat, D. (December 2008).

1253:, maintaining a warm environment, and intravenous analgesics. 1331:, actress, model, television personality, and cookbook writer 1273:

SJS (with less than 10% of body surface area involved) has a

2335:"Clinical study of cutaneous drug eruptions in 200 patients" 680:

or HIV infections are more susceptible to drug-induced SJS.

1302:

who jointly published a description of the disorder in the

815:, protozoal infections, have also been reported as causes. 3764:((online version) 19th ed.). Whitehouse Station, NJ: 4354:"Stevens-Johnson syndrome and toxic epidermal necrolysis" 3198:"Medical genetics: A marker for Stevens–Johnson syndrome" 2793:"Stevens-Johnson syndrome and toxic epidermal necrolysis" 2691:

Khawaja A, Shahab A, Hussain SA; Shahab; Hussain (2012).

357:

Treatment typically takes place in hospital such as in a

2544:

Indian Journal of Dermatology, Venereology and Leprology

2340:

Indian Journal of Dermatology, Venereology and Leprology

891:(i.e. MHC); and presents the MHC-associated peptides to 326:, or the cause may remain unknown. Risk factors include 4302:"$ 63 million verdict in Children's Motrin case upheld" 3568:"Pharmacogenomics of off-target adverse drug reactions" 827:

reaction in which a drug or its metabolite stimulates

3147:"HLA Association with Drug-Induced Adverse Reactions" 1454:"Stevens-Johnson syndrome/toxic epidermal necrolysis" 958:-induced SJS is strongly associated with HLA-B*1502 ( 344:

drug reaction with eosinophilia and systemic symptoms

296:

The most common cause is certain medications such as

4380: 2199:

necrolysis: Comparison with case-control analysis".

1241:, but none have exhibited much therapeutic success. 4906: 4868: 4813: 4804: 4777: 4726: 4617: 4601: 4582: 4495: 4384: 2418:Surovik J, Riddel C, Chon SY; Riddel; Chon (2010). 2051: 2049: 2047: 2045: 2043: 2041: 2039: 2037: 2035: 2009: 2007: 2005: 2003: 2001: 1999: 1997: 1995: 1993: 1930:"Stevens–Johnson Syndrome: An intriguing diagnosis" 1708:

Evidence-Based Critical Care: A Case Study Approach

1129:Stevens–Johnson syndrome (SJS) is a milder form of 232: 222: 194: 186: 158: 145: 125: 113: 105: 80: 63: 51: 46: 3104:Current Opinion in Allergy and Clinical Immunology 1928: 1156:SJS, TEN, and SJS/TEN overlap can be mistaken for 1149:which may also join. These occur primarily on the 3882:Su SC, Hung SI, Fan WL, Dao RL, Chung WH (2016). 714:infections. The routine use of medicines such as 3064:International Archives of Allergy and Immunology 2637: 2635: 2633: 393:SJS usually begins with fever, sore throat, and 3877: 3875: 3097: 3095: 3053: 3051: 2964: 2962: 2828: 2826: 2824: 2822: 2024:. Roy, Hampton Sr. (article editor). Etiology. 662:) and trimethoprim. Combining lamotrigine with 2915:Feldmeyer L, Heidemeyer K, Yawalkar N (2016). 1672:Journal of the American Academy of Dermatology 729:Viral diseases reported to cause SJS include: 316:. Other causes can include infections such as 4562: 4352:Bentley, John; Sie, David (October 8, 2014). 4051:Wong, K. C.; Kennedy, P. J.; Lee, S. (1999). 3975: 2791:Bentley, John; Sie, David (October 8, 2014). 1922: 1920: 1918: 1916: 1914: 1912: 1910: 8: 4278:"Family awarded $ 63 million in Motrin case" 3815:: CS1 maint: multiple names: authors list ( 3551:: CS1 maint: multiple names: authors list ( 3493:: CS1 maint: multiple names: authors list ( 3435:: CS1 maint: multiple names: authors list ( 3385:: CS1 maint: multiple names: authors list ( 3320:: CS1 maint: multiple names: authors list ( 3254:: CS1 maint: multiple names: authors list ( 2776:: CS1 maint: multiple names: authors list ( 2727:: CS1 maint: multiple names: authors list ( 2676:: CS1 maint: multiple names: authors list ( 2579:: CS1 maint: multiple names: authors list ( 2522:: CS1 maint: multiple names: authors list ( 2450:: CS1 maint: multiple names: authors list ( 2243:: CS1 maint: multiple names: authors list ( 2142:: CS1 maint: multiple names: authors list ( 1580:Clinical Reviews in Allergy & Immunology 460:human leukocyte antigen (i.e. HLA) serotypes 236:1–2 per million per year (together with TEN) 3888:International Journal of Molecular Sciences 2921:International Journal of Molecular Sciences 1738: 1736: 1734: 1732: 1730: 1728: 1501: 1499: 455:disease with common causes and mechanisms. 4860:Acute generalized exanthematous pustulosis 4810: 4623: 4598: 4569: 4555: 4547: 4381: 2644:American Journal of Health-System Pharmacy 1538: 1536: 1534: 1532: 1497: 1495: 1493: 1491: 1489: 1487: 1485: 1483: 1481: 1479: 1448: 1446: 1444: 1442: 1440: 1438: 1436: 853:acute generalized exanthematous pustulosis 365:. Efforts may include stopping the cause, 348:acute generalized exanthematous pustulosis 259:Stevens–Johnson/toxic epidermal necrolysis 43: 4734:Acquired C1 esterase inhibitor deficiency 4027: 4009: 3909: 3899: 3855: 3687: 3591: 3354: 3289: 3223: 3172: 3162: 3075: 2942: 2932: 2556: 2491: 2362: 2352: 2333:Raksha MP, Marfatia YS; Marfatia (2008). 2174: 2075: 1973: 1768: 1573: 1571: 1569: 1434: 1432: 1430: 1428: 1426: 1424: 1422: 1420: 1418: 1416: 1051:; it metabolizes and thereby inactivates 486:) a drug are predisposed to develop SJS. 417:in a person with Stevens–Johnson syndrome 4138:American Journal of Diseases of Children 3572:British Journal of Clinical Pharmacology 2202:Clinical Pharmacology & Therapeutics 1304:American Journal of Diseases of Children 4290:from the original on September 5, 2017. 4057:The Australasian Journal of Dermatology 2717:from the original on December 30, 2014. 2698:Journal of Pakistan Medical Association 2322:from the original on December 11, 2013. 1412: 1233:Other agents have been used, including 403: 4314:from the original on October 31, 2016. 4203:Cartner-Morley, Jess (April 8, 2006). 4184:from the original on February 17, 2013 4120:from the original on December 3, 2013. 3808: 3544: 3486: 3428: 3378: 3313: 3247: 2769: 2720: 2669: 2572: 2515: 2443: 2236: 2135: 2028:from the original on January 22, 2013. 1544:"Orphanet: Toxic epidermal necrolysis" 1372:, a model and actress who appeared in 985:-induced SJS/TEN patients carried the 4787:Episodic angioedema with eosinophilia 4337:from the original on October 2, 2016. 4266:from the original on October 3, 2014. 4157:from the original on January 3, 2014. 4131:Stevens, A.M.; Johnson, F.C. (1922). 2807:from the original on October 12, 2014 2159:"Drug reaction, skin care, skin loss" 1945:from the original on August 17, 2012. 1816: 1814: 1812: 1810: 1808: 807:are also considered possible causes. 511:SJS may be caused by the medications 7: 4151:10.1001/archpedi.1922.04120120077005 2407:from the original on March 15, 2013. 2063:Expert Review of Clinical Immunology 1806: 1804: 1802: 1800: 1798: 1796: 1794: 1792: 1790: 1788: 1517:from the original on August 28, 2016 1183:infections can be treated with oral 1020:complementarity-determining region 3 670:Nonsteroidal anti-inflammatory drugs 342:mechanism. It is also included with 173:staphylococcal scalded skin syndrome 4764:Urticaria-like follicular mucinosis 1554:from the original on April 27, 2017 1464:from the original on April 27, 2017 258: 190:Hospitalization, stopping the cause 3836:The British Journal of Dermatology 3617:Trends in Pharmacological Sciences 3014:The British Journal of Dermatology 1749:The British Journal of Dermatology 1401:Food and Drug Administration (FDA) 1354:Samantha Reckis, a seven-year-old 1047:is an important drug-metabolizing 1041:severe cutaneous adverse reactions 973:. A study in Europe suggested the 352:severe cutaneous adverse reactions 25: 4168:Ramirez, Erika (August 8, 2012). 3670:Chang YS, Hung SI (August 2014). 2387:"Incivek prescribing information" 4671:Localized heat contact urticaria 4648:Secondary cold contact urticaria 4069:10.1046/j.1440-0960.1999.00342.x 3935:Current Opinion in Ophthalmology 3356:10.1111/j.1528-1167.2007.01022.x 3291:10.1111/j.1528-1167.2008.01719.x 2608:10.2165/00128071-200708020-00007 2493:10.1097/00002030-200109280-00014 2457: 2290:. April 29, 2008. Archived from 2114:10.1111/j.1365-2230.2009.03718.x 889:major histocompatibility complex 434: 422: 406: 4237:. June 19, 2010. Archived from 3754:Rehmus, W. E. (November 2013). 3058:Pichler WJ, Hausmann O (2016). 2425:Journal of Drugs in Dermatology 2316:US Food and Drug Administration 1322:recording artist and member of 835:(i.e. CD4 T cells) to initiate 496:List of SJS-inducing substances 458:Individuals expressing certain 4643:Primary cold contact urticaria 3151:Journal of Immunology Research 2878:Allergy and Asthma Proceedings 2306:"Provigil (modafinil) Tablets" 2288:New Zealand Ministry of Health 1842:10.1001/jamadermatol.2017.0160 1628:British Journal of Dermatology 887:(i.e. HLA) component of their 733:(possibly; is debated), AIDS, 265:, with SJS being less severe. 151:<10% of the skin involved, 73:, skin peeling, painful skin, 1: 4917:Necrolytic migratory erythema 4878:Erythema annulare centrifugum 4769:Chronic spontaneous urticaria 4252:Graff, Chad (July 31, 2013). 3511:Pharmacogenetics and Genomics 2983:10.1016/S0140-6736(16)30378-6 117:Certain medications, certain 4609:Urticarial allergic eruption 3947:10.1097/icu.0b013e3283622718 3523:10.1097/FPC.0b013e3282f3ef9c 3453:The Pharmacogenomics Journal 3116:10.1097/ACI.0000000000000286 2744:Allergol Immunopathol (Madr) 1956:Tan SK, Tay YK; Tay (2012). 1935:pediatricsconsultantlive.com 1873:Current Rheumatology Reports 1678:(2): 173.e1–13, quiz 185–6. 690:upper respiratory infections 678:systemic lupus erythematosus 482:(this combination is termed 332:systemic lupus erythematosus 169:staphylococcal epidermolysis 136:systemic lupus erythematosus 4898:Annular erythema of infancy 4225:"Manute Bol dies at age 47" 4106:Enerson, Ole Daniel (ed.), 3795:10.1001/archderm.138.8.1019 2835:Seminars in Immunopathology 2756:10.1016/j.aller.2009.06.009 999:HLA associations with SCARs 666:increases the risk of SJS. 379:intravenous immunoglobulins 217:intravenous immunoglobulins 4988: 4843:Toxic epidermal necrolysis 4704:Delayed pressure urticaria 4358:The Pharmaceutical Journal 4108:"Stevens-Johnson syndrome" 3758:. In Porter, R. S. (ed.). 3713:The Journal of Dermatology 3629:10.1016/j.tips.2016.11.003 2797:The Pharmaceutical Journal 2016:"Stevens-Johnson Syndrome" 1962:Acta Dermato-Venereologica 1684:10.1016/j.jaad.2013.05.003 1507:"Stevens-Johnson syndrome" 1243:Intravenous immunoglobulin 1131:toxic epidermal necrolysis 493: 255:toxic epidermal necrolysis 177:autoimmune bullous disease 33: 4942:Necrolytic acral erythema 4833:Erythema multiforme major 4828:Erythema multiforme minor 4684: 4661: 4626: 2880:. 33 Suppl 1 (3): S96–9. 2847:10.1007/s00281-015-0540-2 2266:European Medicines Agency 1885:10.1007/s11926-017-0626-z 1711:. Springer. p. 761. 1592:10.1007/s12016-017-8654-z 1206:) and symptomatic (e.g., 4838:Stevens–Johnson syndrome 4689:Dermatographic urticaria 4535:Stevens–Johnson syndrome 4327:"Karen Morton Biography" 4011:10.3389/fmed.2021.643955 3415:10.2217/14622416.7.6.813 3200:. Brief Communications. 2886:10.2500/aap.2012.33.3561 1705:Hyzy, Robert C. (2017). 969:of the broader serotype 825:type IV hypersensitivity 768:lymphogranuloma venereum 340:type IV hypersensitivity 243:Stevens–Johnson syndrome 47:Stevens–Johnson syndrome 34:Not to be confused with 4893:Erythema gyratum repens 3782:Archives of Dermatology 3725:10.1111/1346-8138.13430 2558:10.4103/0378-6323.16782 2354:10.4103/0378-6323.38431 1458:Genetics Home Reference 1356:Plymouth, Massachusetts 885:human leukocyte antigen 881:antigen presenting cell 831:(i.e. CD8 T cells) and 795:Fungal infections with 310:sulfonamide antibiotics 18:Steven Johnson syndrome 4577:Urticaria and erythema 4364:(7832). Archived from 4259:St. Paul Pioneer Press 4205:"Beautiful and Damned" 3689:10.1001/jama.2014.7859 3465:10.1038/sj.tpj.6500356 2398:Vertex Pharmaceuticals 2056:Mockenhaupt M (2011). 1110: 1094:and separation of the 782:rickettsial infections 291:multiple organ failure 249:) is a type of severe 160:Differential diagnosis 99:multiple organ failure 36:Dubin–Johnson syndrome 4792:Hereditary angioedema 4709:Cholinergic urticaria 4653:Reflex cold urticaria 4286:. February 13, 2013. 3998:Frontiers in Medicine 2215:10.1038/clpt.2009.252 1975:10.2340/00015555-1169 1364:Johnson & Johnson 1086: 942:populations studied ( 777:Mycoplasma pneumoniae 707:Mycoplasma pneumoniae 472:distribute to tissues 319:Mycoplasma pneumoniae 4937:Generalized erythema 4744:Autoimmune urticaria 4739:Adrenergic urticaria 4694:Vibratory angioedema 3901:10.3390/ijms17111890 3656:www.ncbi.nlm.nih.gov 3164:10.1155/2017/3186328 2977:(10106): 1996–2011. 2934:10.3390/ijms17081214 2318:. October 24, 2007. 869:antigen presentation 841:natural killer cells 837:autoimmune reactions 731:herpes simplex virus 4883:Erythema marginatum 4815:Erythema multiforme 4759:Schnitzler syndrome 4714:Aquagenic urticaria 4368:on October 12, 2014 3216:2004Natur.428..486C 2102:Clin. Exp. Dermatol 1370:Karen Elaine Morton 1158:erythema multiforme 363:intensive care unit 267:Erythema multiforme 263:spectrum of disease 4754:Galvanic urticaria 4749:Exercise urticaria 4699:Pressure urticaria 4619:Physical urticaria 4602:Allergic urticaria 4496:External resources 4310:. April 17, 2015. 3976:Foster et al. 2013 2656:10.2146/ajhp080603 2596:Am J Clin Dermatol 2176:10.4037/ccn2012340 2157:Cooper KL (2012). 2021:Medscape Reference 1204:parenteral feeding 1196:intravenous fluids 1111: 797:coccidioidomycosis 702:Epstein–Barr virus 389:Signs and symptoms 346:(DRESS syndrome), 4954: 4953: 4950: 4949: 4870:Figurate erythema 4800: 4799: 4722: 4721: 4544: 4543: 4241:on June 21, 2010. 3848:10.1111/bjd.15498 3584:10.1111/bcp.13294 3077:10.1159/000453265 3026:10.1111/bjd.16232 2400:. December 2012. 2077:10.1586/eci.11.66 1761:10.1111/bjd.15423 1640:10.1111/bjd.14530 1550:. November 2008. 829:cytotoxic T cells 271:flu-like symptoms 240: 239: 147:Diagnostic method 41:Medical condition 16:(Redirected from 4979: 4922:Erythema toxicum 4888:Erythema migrans 4854:Erythema nodosum 4811: 4624: 4599: 4571: 4564: 4557: 4548: 4382: 4377: 4375: 4373: 4339: 4338: 4322: 4316: 4315: 4307:The Boston Globe 4298: 4292: 4291: 4283:The Boston Globe 4274: 4268: 4267: 4249: 4243: 4242: 4221: 4215: 4214: 4200: 4194: 4193: 4191: 4189: 4165: 4159: 4158: 4128: 4122: 4121: 4103: 4097: 4096: 4048: 4042: 4041: 4031: 4013: 3989: 3983: 3973: 3967: 3966: 3930: 3924: 3923: 3913: 3903: 3879: 3870: 3869: 3859: 3842:(4): 1102–1112. 3827: 3821: 3820: 3814: 3806: 3775: 3769: 3768: 3761:The Merck Manual 3751: 3745: 3744: 3708: 3702: 3701: 3691: 3666: 3660: 3659: 3647: 3641: 3640: 3612: 3606: 3605: 3595: 3578:(9): 1896–1911. 3563: 3557: 3556: 3550: 3542: 3505: 3499: 3498: 3492: 3484: 3447: 3441: 3440: 3434: 3426: 3403:Pharmacogenomics 3397: 3391: 3390: 3384: 3376: 3358: 3332: 3326: 3325: 3319: 3311: 3293: 3266: 3260: 3259: 3253: 3245: 3227: 3193: 3187: 3186: 3176: 3166: 3142: 3136: 3135: 3099: 3090: 3089: 3079: 3070:(3–4): 166–179. 3055: 3046: 3045: 3009: 3003: 3002: 2966: 2957: 2956: 2946: 2936: 2912: 2906: 2905: 2873: 2867: 2866: 2830: 2817: 2816: 2814: 2812: 2788: 2782: 2781: 2775: 2767: 2739: 2733: 2732: 2726: 2718: 2688: 2682: 2681: 2675: 2667: 2639: 2628: 2627: 2591: 2585: 2584: 2578: 2570: 2560: 2534: 2528: 2527: 2521: 2513: 2495: 2469: 2463: 2462: 2461: 2455: 2449: 2441: 2415: 2409: 2408: 2406: 2391: 2383: 2377: 2376: 2366: 2356: 2330: 2324: 2323: 2302: 2296: 2295: 2294:on June 3, 2010. 2276: 2270: 2269: 2268:. April 6, 2017. 2263: 2255: 2249: 2248: 2242: 2234: 2195: 2189: 2188: 2178: 2154: 2148: 2147: 2141: 2133: 2096: 2090: 2089: 2079: 2053: 2030: 2029: 2011: 1988: 1987: 1977: 1953: 1947: 1946: 1932: 1924: 1905: 1904: 1868: 1862: 1861: 1830:JAMA Dermatology 1827: 1818: 1783: 1782: 1772: 1755:(5): 1234–1247. 1740: 1723: 1722: 1702: 1696: 1695: 1666: 1660: 1659: 1634:(6): 1194–1227. 1618: 1612: 1611: 1575: 1564: 1563: 1561: 1559: 1540: 1527: 1526: 1524: 1522: 1503: 1474: 1473: 1471: 1469: 1450: 1235:cyclophosphamide 1210:mouth rinse for 1024:T-cell receptors 1005:T-cell receptors 893:T-cell receptors 871:pathways of the 664:sodium valproate 438: 426: 410: 275:Mucous membranes 253:. Together with 44: 21: 4987: 4986: 4982: 4981: 4980: 4978: 4977: 4976: 4957: 4956: 4955: 4946: 4932:Palmar erythema 4902: 4864: 4818: 4796: 4773: 4727:Other urticaria 4718: 4680: 4676:Solar urticaria 4657: 4613: 4586: 4578: 4575: 4545: 4540: 4539: 4491: 4490: 4393: 4371: 4369: 4351: 4348: 4343: 4342: 4325:Morton, Karen. 4324: 4323: 4319: 4300: 4299: 4295: 4276: 4275: 4271: 4251: 4250: 4246: 4223: 4222: 4218: 4202: 4201: 4197: 4187: 4185: 4167: 4166: 4162: 4130: 4129: 4125: 4105: 4104: 4100: 4050: 4049: 4045: 3991: 3990: 3986: 3974: 3970: 3932: 3931: 3927: 3881: 3880: 3873: 3829: 3828: 3824: 3807: 3777: 3776: 3772: 3766:Merck & Co. 3753: 3752: 3748: 3710: 3709: 3705: 3668: 3667: 3663: 3649: 3648: 3644: 3614: 3613: 3609: 3565: 3564: 3560: 3543: 3507: 3506: 3502: 3485: 3449: 3448: 3444: 3427: 3399: 3398: 3394: 3377: 3334: 3333: 3329: 3312: 3284:(12): 2087–91. 3268: 3267: 3263: 3246: 3225:10.1038/428486a 3195: 3194: 3190: 3144: 3143: 3139: 3101: 3100: 3093: 3057: 3056: 3049: 3011: 3010: 3006: 2968: 2967: 2960: 2914: 2913: 2909: 2875: 2874: 2870: 2832: 2831: 2820: 2810: 2808: 2790: 2789: 2785: 2768: 2741: 2740: 2736: 2719: 2690: 2689: 2685: 2668: 2641: 2640: 2631: 2593: 2592: 2588: 2571: 2536: 2535: 2531: 2514: 2471: 2470: 2466: 2456: 2442: 2417: 2416: 2412: 2404: 2389: 2385: 2384: 2380: 2332: 2331: 2327: 2304: 2303: 2299: 2278: 2277: 2273: 2261: 2257: 2256: 2252: 2235: 2197: 2196: 2192: 2163:Crit Care Nurse 2156: 2155: 2151: 2134: 2098: 2097: 2093: 2055: 2054: 2033: 2013: 2012: 1991: 1955: 1954: 1950: 1926: 1925: 1908: 1870: 1869: 1865: 1825: 1820: 1819: 1786: 1742: 1741: 1726: 1719: 1704: 1703: 1699: 1668: 1667: 1663: 1620: 1619: 1615: 1577: 1576: 1567: 1557: 1555: 1542: 1541: 1530: 1520: 1518: 1505: 1504: 1477: 1467: 1465: 1452: 1451: 1414: 1409: 1393: 1312: 1296: 1287: 1271: 1258:ophthalmologist 1227:corticosteroids 1175: 1166: 1127: 1119:stratum corneum 1092:stratum corneum 1081: 1073:Nikolsky's sign 1069: 1049:cytochrome P450 1033: 1007: 821: 819:Pathophysiology 801:dermatophytosis 712:cytomegalovirus 686: 660:anticonvulsants 504:, particularly 498: 492: 452: 445: 439: 430: 427: 418: 411: 391: 383:corticosteroids 367:pain medication 324:cytomegalovirus 228:Mortality ~7.5% 213:corticosteroids 201:Pain medication 42: 39: 30: 23: 22: 15: 12: 11: 5: 4985: 4983: 4975: 4974: 4972:Rare syndromes 4969: 4967:Drug eruptions 4959: 4958: 4952: 4951: 4948: 4947: 4945: 4944: 4939: 4934: 4929: 4924: 4919: 4913: 4911: 4904: 4903: 4901: 4900: 4895: 4890: 4885: 4880: 4874: 4872: 4866: 4865: 4863: 4862: 4857: 4845: 4840: 4835: 4830: 4824: 4822: 4808: 4802: 4801: 4798: 4797: 4795: 4794: 4789: 4783: 4781: 4775: 4774: 4772: 4771: 4766: 4761: 4756: 4751: 4746: 4741: 4736: 4730: 4728: 4724: 4723: 4720: 4719: 4717: 4716: 4711: 4706: 4701: 4696: 4691: 4685: 4682: 4681: 4679: 4678: 4673: 4668: 4666:Heat urticaria 4662: 4659: 4658: 4656: 4655: 4650: 4645: 4640: 4639: 4638: 4631:Cold urticaria 4627: 4621: 4615: 4614: 4612: 4611: 4605: 4603: 4596: 4580: 4579: 4576: 4574: 4573: 4566: 4559: 4551: 4542: 4541: 4538: 4537: 4526: 4512: 4500: 4499: 4497: 4493: 4492: 4489: 4488: 4477: 4466: 4455: 4444: 4429: 4414: 4394: 4389: 4388: 4386: 4385:Classification 4379: 4378: 4347: 4346:External links 4344: 4341: 4340: 4317: 4293: 4269: 4244: 4216: 4195: 4160: 4123: 4098: 4063:(3): 131–134. 4043: 3984: 3968: 3925: 3871: 3822: 3789:(8): 1019–24. 3770: 3746: 3703: 3661: 3642: 3623:(1): 100–109. 3607: 3558: 3500: 3442: 3392: 3327: 3261: 3188: 3137: 3091: 3047: 3020:(3): 614–618. 3004: 2958: 2907: 2868: 2818: 2783: 2734: 2683: 2650:(3): 206–213. 2629: 2586: 2529: 2486:(14): 1843–8. 2464: 2410: 2394:package insert 2378: 2325: 2297: 2282:(data sheet). 2280:"Diflucan One" 2271: 2264:(data sheet). 2250: 2190: 2149: 2091: 2031: 1989: 1948: 1906: 1863: 1836:(6): 587–592. 1784: 1724: 1717: 1697: 1661: 1613: 1586:(1): 147–176. 1565: 1528: 1475: 1411: 1410: 1408: 1405: 1392: 1389: 1388: 1387: 1378:867-5309/Jenny 1367: 1352: 1342: 1332: 1326: 1311: 1308: 1295: 1292: 1286: 1283: 1275:mortality rate 1270: 1267: 1216:Dermatologists 1174: 1171: 1165: 1162: 1147:large blisters 1143:small blisters 1126: 1125:Classification 1123: 1080: 1077: 1068: 1065: 1035:Variations in 1032: 1029: 1006: 1003: 845:DRESS syndrome 833:T helper cells 820: 817: 813:trichomoniasis 805:histoplasmosis 735:coxsackievirus 685: 682: 642:(antibiotic), 491: 488: 462:(i.e. genetic 451: 448: 447: 446: 442:Conjunctivitis 440: 433: 431: 428: 421: 419: 412: 405: 399:Conjunctivitis 390: 387: 371:antihistamines 238: 237: 234: 230: 229: 226: 220: 219: 205:antihistamines 198: 192: 191: 188: 184: 183: 162: 156: 155: 149: 143: 142: 129: 123: 122: 115: 111: 110: 107: 103: 102: 84: 78: 77: 67: 61: 60: 55: 49: 48: 40: 28: 24: 14: 13: 10: 9: 6: 4: 3: 2: 4984: 4973: 4970: 4968: 4965: 4964: 4962: 4943: 4940: 4938: 4935: 4933: 4930: 4928: 4925: 4923: 4920: 4918: 4915: 4914: 4912: 4910: 4905: 4899: 4896: 4894: 4891: 4889: 4886: 4884: 4881: 4879: 4876: 4875: 4873: 4871: 4867: 4861: 4858: 4855: 4851: 4850: 4846: 4844: 4841: 4839: 4836: 4834: 4831: 4829: 4826: 4825: 4823: 4821: 4820:drug eruption 4816: 4812: 4809: 4807: 4803: 4793: 4790: 4788: 4785: 4784: 4782: 4780: 4776: 4770: 4767: 4765: 4762: 4760: 4757: 4755: 4752: 4750: 4747: 4745: 4742: 4740: 4737: 4735: 4732: 4731: 4729: 4725: 4715: 4712: 4710: 4707: 4705: 4702: 4700: 4697: 4695: 4692: 4690: 4687: 4686: 4683: 4677: 4674: 4672: 4669: 4667: 4664: 4663: 4660: 4654: 4651: 4649: 4646: 4644: 4641: 4637: 4634: 4633: 4632: 4629: 4628: 4625: 4622: 4620: 4616: 4610: 4607: 4606: 4604: 4600: 4597: 4594: 4590: 4585: 4581: 4572: 4567: 4565: 4560: 4558: 4553: 4552: 4549: 4536: 4532: 4531: 4527: 4525: 4522: 4518: 4517: 4513: 4511: 4507: 4506: 4502: 4501: 4498: 4494: 4487: 4483: 4482: 4478: 4476: 4472: 4471: 4467: 4465: 4461: 4460: 4456: 4454: 4450: 4449: 4445: 4443: 4439: 4438: 4434: 4430: 4428: 4424: 4423: 4419: 4415: 4413: 4409: 4405: 4404: 4400: 4396: 4395: 4392: 4387: 4383: 4367: 4363: 4359: 4355: 4350: 4349: 4345: 4336: 4332: 4328: 4321: 4318: 4313: 4309: 4308: 4303: 4297: 4294: 4289: 4285: 4284: 4279: 4273: 4270: 4265: 4261: 4260: 4255: 4248: 4245: 4240: 4236: 4232: 4231: 4226: 4220: 4217: 4212: 4211: 4206: 4199: 4196: 4183: 4179: 4175: 4174:billboard.com 4171: 4164: 4161: 4156: 4152: 4148: 4145:(6): 526–33. 4144: 4140: 4139: 4134: 4127: 4124: 4119: 4115: 4114: 4109: 4102: 4099: 4094: 4090: 4086: 4082: 4078: 4074: 4070: 4066: 4062: 4058: 4054: 4047: 4044: 4039: 4035: 4030: 4025: 4021: 4017: 4012: 4007: 4003: 3999: 3995: 3988: 3985: 3981: 3977: 3972: 3969: 3964: 3960: 3956: 3952: 3948: 3944: 3940: 3936: 3929: 3926: 3921: 3917: 3912: 3907: 3902: 3897: 3893: 3889: 3885: 3878: 3876: 3872: 3867: 3863: 3858: 3853: 3849: 3845: 3841: 3837: 3833: 3826: 3823: 3818: 3812: 3804: 3800: 3796: 3792: 3788: 3784: 3783: 3774: 3771: 3767: 3763: 3762: 3757: 3750: 3747: 3742: 3738: 3734: 3730: 3726: 3722: 3719:(7): 758–66. 3718: 3714: 3707: 3704: 3699: 3695: 3690: 3685: 3682:(5): 525–34. 3681: 3677: 3673: 3665: 3662: 3657: 3653: 3646: 3643: 3638: 3634: 3630: 3626: 3622: 3618: 3611: 3608: 3603: 3599: 3594: 3589: 3585: 3581: 3577: 3573: 3569: 3562: 3559: 3554: 3548: 3540: 3536: 3532: 3528: 3524: 3520: 3517:(2): 99–107. 3516: 3512: 3504: 3501: 3496: 3490: 3482: 3478: 3474: 3470: 3466: 3462: 3458: 3454: 3446: 3443: 3438: 3432: 3424: 3420: 3416: 3412: 3408: 3404: 3396: 3393: 3388: 3382: 3374: 3370: 3366: 3362: 3357: 3352: 3349:(5): 1015–8. 3348: 3344: 3343: 3338: 3331: 3328: 3323: 3317: 3309: 3305: 3301: 3297: 3292: 3287: 3283: 3279: 3278: 3273: 3265: 3262: 3257: 3251: 3243: 3239: 3235: 3231: 3226: 3221: 3217: 3213: 3210:(6982): 486. 3209: 3205: 3204: 3199: 3192: 3189: 3184: 3180: 3175: 3170: 3165: 3160: 3156: 3152: 3148: 3141: 3138: 3133: 3129: 3125: 3121: 3117: 3113: 3110:(4): 339–45. 3109: 3105: 3098: 3096: 3092: 3087: 3083: 3078: 3073: 3069: 3065: 3061: 3054: 3052: 3048: 3043: 3039: 3035: 3031: 3027: 3023: 3019: 3015: 3008: 3005: 3000: 2996: 2992: 2988: 2984: 2980: 2976: 2972: 2965: 2963: 2959: 2954: 2950: 2945: 2940: 2935: 2930: 2926: 2922: 2918: 2911: 2908: 2903: 2899: 2895: 2891: 2887: 2883: 2879: 2872: 2869: 2864: 2860: 2856: 2852: 2848: 2844: 2840: 2836: 2829: 2827: 2825: 2823: 2819: 2806: 2802: 2798: 2794: 2787: 2784: 2779: 2773: 2765: 2761: 2757: 2753: 2750:(2): 99–100. 2749: 2745: 2738: 2735: 2730: 2724: 2716: 2712: 2708: 2704: 2700: 2699: 2694: 2687: 2684: 2679: 2673: 2665: 2661: 2657: 2653: 2649: 2645: 2638: 2636: 2634: 2630: 2625: 2621: 2617: 2613: 2609: 2605: 2602:(2): 107–11. 2601: 2597: 2590: 2587: 2582: 2576: 2568: 2564: 2559: 2554: 2550: 2546: 2545: 2540: 2533: 2530: 2525: 2519: 2511: 2507: 2503: 2499: 2494: 2489: 2485: 2481: 2480: 2475: 2468: 2465: 2460: 2453: 2447: 2439: 2435: 2432:(8): 1010–2. 2431: 2427: 2426: 2421: 2414: 2411: 2403: 2399: 2395: 2388: 2382: 2379: 2374: 2370: 2365: 2360: 2355: 2350: 2346: 2342: 2341: 2336: 2329: 2326: 2321: 2317: 2313: 2312: 2307: 2301: 2298: 2293: 2289: 2285: 2281: 2275: 2272: 2267: 2260: 2254: 2251: 2246: 2240: 2232: 2228: 2224: 2220: 2216: 2212: 2208: 2204: 2203: 2194: 2191: 2186: 2182: 2177: 2172: 2168: 2164: 2160: 2153: 2150: 2145: 2139: 2131: 2127: 2123: 2119: 2115: 2111: 2107: 2103: 2095: 2092: 2087: 2083: 2078: 2073: 2070:(6): 803–15. 2069: 2065: 2064: 2059: 2052: 2050: 2048: 2046: 2044: 2042: 2040: 2038: 2036: 2032: 2027: 2023: 2022: 2017: 2010: 2008: 2006: 2004: 2002: 2000: 1998: 1996: 1994: 1990: 1985: 1981: 1976: 1971: 1967: 1963: 1959: 1952: 1949: 1944: 1940: 1936: 1931: 1923: 1921: 1919: 1917: 1915: 1913: 1911: 1907: 1902: 1898: 1894: 1890: 1886: 1882: 1878: 1874: 1867: 1864: 1859: 1855: 1851: 1847: 1843: 1839: 1835: 1831: 1824: 1817: 1815: 1813: 1811: 1809: 1807: 1805: 1803: 1801: 1799: 1797: 1795: 1793: 1791: 1789: 1785: 1780: 1776: 1771: 1766: 1762: 1758: 1754: 1750: 1746: 1739: 1737: 1735: 1733: 1731: 1729: 1725: 1720: 1718:9783319433417 1714: 1710: 1709: 1701: 1698: 1693: 1689: 1685: 1681: 1677: 1673: 1665: 1662: 1657: 1653: 1649: 1645: 1641: 1637: 1633: 1629: 1625: 1617: 1614: 1609: 1605: 1601: 1597: 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July 2015. 1459: 1455: 1449: 1447: 1445: 1443: 1441: 1439: 1437: 1435: 1433: 1431: 1429: 1427: 1425: 1423: 1421: 1419: 1417: 1413: 1406: 1404: 1402: 1398: 1395:In 2015, the 1390: 1385: 1384: 1379: 1375: 1371: 1368: 1365: 1361: 1357: 1353: 1350: 1347:, three-time 1346: 1343: 1340: 1336: 1333: 1330: 1329:Padma Lakshmi 1327: 1325: 1321: 1317: 1314: 1313: 1310:Notable cases 1309: 1307: 1305: 1301: 1300:pediatricians 1293: 1291: 1284: 1282: 1280: 1279:SCORTEN scale 1276: 1268: 1266: 1264: 1259: 1254: 1252: 1248: 1244: 1240: 1236: 1231: 1228: 1223: 1221: 1217: 1213: 1209: 1205: 1201: 1197: 1192: 1190: 1186: 1182: 1181: 1172: 1170: 1163: 1161: 1159: 1154: 1152: 1148: 1144: 1140: 1136: 1132: 1124: 1122: 1120: 1116: 1109: 1108:H&E stain 1105: 1101: 1097: 1093: 1089: 1085: 1078: 1076: 1074: 1066: 1064: 1062: 1058: 1054: 1050: 1046: 1042: 1038: 1030: 1028: 1025: 1021: 1017: 1013: 1004: 1002: 1000: 995: 992: 988: 984: 979: 976: 972: 968: 965: 961: 957: 953: 952:carbamazepine 949: 945: 941: 936: 934: 933:HLA serotypes 930: 926: 922: 918: 914: 910: 906: 902: 898: 894: 890: 886: 882: 878: 874: 873:innate immune 870: 864: 862: 858: 854: 850: 846: 842: 838: 834: 830: 826: 818: 816: 814: 810: 806: 802: 798: 793: 791: 787: 783: 779: 778: 773: 769: 765: 761: 756: 753: 750: 748: 744: 740: 736: 732: 727: 725: 721: 717: 713: 709: 708: 703: 699: 695: 691: 683: 681: 679: 675: 671: 667: 665: 661: 657: 653: 649: 646:(sedatives), 645: 641: 638:antibiotics, 637: 634:antibiotics, 633: 628: 626: 622: 618: 614: 613:carbamazepine 610: 606: 602: 601:pyrimethamine 598: 594: 590: 586: 582: 581:oxcarbazepine 578: 574: 570: 566: 562: 558: 554: 550: 546: 542: 538: 534: 530: 526: 522: 518: 514: 509: 507: 503: 497: 489: 487: 485: 481: 477: 473: 469: 465: 461: 456: 449: 443: 437: 432: 425: 420: 416: 409: 404: 402: 400: 396: 388: 386: 384: 380: 376: 372: 368: 364: 360: 355: 353: 349: 345: 341: 335: 333: 329: 325: 321: 320: 315: 311: 307: 303: 302:carbamazepine 299: 294: 292: 288: 284: 280: 276: 272: 268: 264: 260: 256: 252: 251:skin reaction 248: 244: 235: 231: 227: 225: 221: 218: 214: 210: 206: 202: 199: 197: 193: 189: 185: 182: 178: 174: 170: 166: 163: 161: 157: 154: 150: 148: 144: 141: 137: 133: 130: 128: 124: 120: 116: 112: 108: 104: 100: 96: 92: 88: 85: 83: 82:Complications 79: 76: 72: 71:skin blisters 68: 66: 62: 59: 56: 54: 50: 45: 37: 32: 27: 19: 4927:Erythroderma 4849:panniculitis 4847: 4837: 4528: 4514: 4503: 4479: 4468: 4457: 4446: 4431: 4416: 4397: 4370:. Retrieved 4366:the original 4361: 4357: 4330: 4320: 4305: 4296: 4281: 4272: 4257: 4247: 4239:the original 4228: 4219: 4210:The Guardian 4208: 4198: 4186:. Retrieved 4173: 4163: 4142: 4136: 4126: 4111: 4101: 4060: 4056: 4046: 4001: 3997: 3987: 3971: 3941:(4): 321–8. 3938: 3934: 3928: 3894:(11): 1890. 3891: 3887: 3839: 3835: 3825: 3811:cite journal 3786: 3780: 3773: 3760: 3749: 3716: 3712: 3706: 3679: 3675: 3664: 3655: 3645: 3620: 3616: 3610: 3575: 3571: 3561: 3547:cite journal 3514: 3510: 3503: 3489:cite journal 3459:(4): 265–8. 3456: 3452: 3445: 3431:cite journal 3409:(6): 813–8. 3406: 3402: 3395: 3381:cite journal 3346: 3340: 3330: 3316:cite journal 3281: 3275: 3264: 3250:cite journal 3207: 3201: 3191: 3154: 3150: 3140: 3107: 3103: 3067: 3063: 3017: 3013: 3007: 2974: 2970: 2924: 2920: 2910: 2877: 2871: 2841:(1): 75–86. 2838: 2834: 2809:. Retrieved 2800: 2796: 2786: 2772:cite journal 2747: 2743: 2737: 2723:cite journal 2705:(5): 524–7. 2702: 2696: 2686: 2672:cite journal 2647: 2643: 2599: 2595: 2589: 2575:cite journal 2551:(5): 325–8. 2548: 2542: 2532: 2518:cite journal 2483: 2477: 2467: 2446:cite journal 2429: 2423: 2413: 2381: 2344: 2338: 2328: 2309: 2300: 2292:the original 2274: 2253: 2239:cite journal 2206: 2200: 2193: 2166: 2162: 2152: 2138:cite journal 2108:(7): 723–8. 2105: 2101: 2094: 2067: 2061: 2019: 1965: 1961: 1951: 1934: 1876: 1872: 1866: 1833: 1829: 1752: 1748: 1707: 1700: 1675: 1671: 1664: 1631: 1627: 1616: 1583: 1579: 1556:. Retrieved 1547: 1519:. Retrieved 1510: 1466:. Retrieved 1457: 1394: 1381: 1374:Tommy Tutone 1303: 1297: 1288: 1285:Epidemiology 1272: 1255: 1232: 1224: 1193: 1178: 1176: 1167: 1155: 1128: 1112: 1070: 1034: 1008: 996: 980: 937: 865: 822: 794: 775: 772:mycobacteria 757: 754: 751: 728: 720:antipyretics 705: 694:otitis media 687: 668: 644:barbiturates 629: 609:ethosuximide 577:azithromycin 569:sulfonamides 565:barbiturates 541:isotretinoin 529:levofloxacin 510: 499: 457: 453: 415:desquamation 392: 356: 336: 317: 295: 246: 242: 241: 127:Risk factors 31: 29:Skin disease 26: 4505:MedlinePlus 4188:December 7, 4113:Whonamedit? 3157:: 3186328. 2927:(8): 1214. 2209:(1): 60–8. 2169:(4): 52–9. 1968:(1): 62–6. 1345:Gene Sauers 1324:Black Hippy 1318:, American 1251:antiseptics 1247:anesthetics 1239:ciclosporin 1212:mouth ulcer 1200:nasogastric 1189:doxycycline 983:allopurinol 975:gene marker 944:Han Chinese 861:neutrophils 855:which is a 849:eosinophils 764:brucellosis 716:antibiotics 698:pharyngitis 674:paracetamol 648:lamotrigine 632:sulfonamide 593:lamotrigine 561:penicillins 557:oseltamivir 553:sitagliptin 545:fluconazole 521:allopurinol 513:rivaroxaban 506:sulfa drugs 502:antibiotics 490:Medications 375:antibiotics 306:allopurinol 298:lamotrigine 279:dehydration 209:antibiotics 153:skin biopsy 109:Age < 30 106:Usual onset 87:Dehydration 58:Dermatology 4961:Categories 4779:Angioedema 4530:Patient UK 4470:DiseasesDB 4372:October 8, 4004:: 643955. 2811:October 8, 2364:1807/48058 1939:UBM Medica 1521:August 26, 1407:References 1335:Manute Bol 1180:Mycoplasma 1164:Prevention 1141:) or flat 1088:Micrograph 940:East Asian 760:diphtheria 724:analgesics 684:Infections 636:penicillin 621:telaprevir 597:nevirapine 585:zonisamide 549:valdecoxib 537:etravirine 533:diclofenac 517:vancomycin 494:See also: 476:metabolize 314:nevirapine 257:(TEN) and 196:Medication 165:Chickenpox 119:infections 4584:Urticaria 4521:emerg/555 4516:eMedicine 4481:SNOMED CT 4178:Billboard 4077:0004-8380 4020:2296-858X 3980:Prognosis 3963:205671529 3342:Epilepsia 3277:Epilepsia 2902:207394296 2347:(1): 80. 1858:205110875 1648:0007-0963 1558:April 26, 1468:April 26, 1386:Magazine. 1337:, former 1306:in 1922. 1269:Prognosis 1208:analgesic 1185:macrolide 1173:Treatment 1100:epidermis 1079:Pathology 1067:Diagnosis 1061:wild type 1053:phenytoin 991:phenotype 956:phenytoin 823:SJS is a 786:tularemia 743:hepatitis 739:influenza 652:phenytoin 617:bupropion 605:ibuprofen 589:modafinil 573:phenytoin 525:valproate 359:burn unit 354:(SCARs). 287:pneumonia 233:Frequency 224:Prognosis 187:Treatment 121:, unknown 95:pneumonia 53:Specialty 4909:erythema 4806:Erythema 4636:Familial 4524:derm/405 4486:73442001 4335:Archived 4331:imdb.com 4312:Archived 4288:Archived 4264:Archived 4230:FanHouse 4182:Archived 4155:Archived 4118:archived 4093:10575403 4085:10439522 4038:34513854 3955:23680755 3920:27854302 3866:28346659 3803:12164739 3741:45524211 3733:27154258 3698:25096692 3650:snpdev. 3637:27955861 3602:28345177 3539:35512622 3531:18192896 3473:16415921 3423:16981842 3373:34728720 3365:17509004 3308:23063530 3300:18637831 3234:15057820 3183:29333460 3124:27362322 3086:27960170 3034:29333670 2991:28476287 2953:27472323 2894:22794701 2855:26553194 2805:Archived 2803:(7832). 2764:19875224 2715:Archived 2711:22755330 2664:20101062 2624:36720720 2616:17428116 2567:16394456 2510:25014092 2502:11579247 2438:20684153 2402:Archived 2373:18193504 2320:Archived 2311:MedWatch 2231:11611291 2223:20375998 2185:22855079 2130:12561369 2122:19874350 2086:22014021 2026:Archived 1984:21710108 1943:Archived 1901:10549742 1893:28138822 1879:(1): 3. 1850:28296986 1779:28256714 1692:23866878 1656:27317286 1608:46796285 1600:29188475 1552:Archived 1548:Orphanet 1515:Archived 1462:Archived 1399:and the 1391:Research 1349:PGA Tour 1220:debrided 1187:or oral 1115:necrosis 1057:CYP2C9*3 967:serotype 938:In some 929:serotype 656:Dilantin 640:cefixime 625:nystatin 413:Mucosal 328:HIV/AIDS 181:Smallpox 140:genetics 132:HIV/AIDS 75:red 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