pyrazolone and Stevens-Johnson-Syndrome

The nonsteroidal anti-inflammatory drugs are one of the most commonly prescribed classes of drugs used in medical practice. This review discusses the diverse cutaneous reactions associated with nonsteroidal anti-inflammatory drugs. Adverse cutaneous reactions occur most frequently with benoxaprofen, piroxicam, sulindac, meclofenamate sodium, zomepirac sodium, and phenylbutazone. The most serious adverse cutaneous reactions, Stevens-Johnson syndrome and toxic epidermal necrolysis, appear to be most often associated with sulindac and phenylbutazone. Tolmetin and zomepirac sodium, two structurally similar pyrrole derivatives, have been associated with a disproportionate number of cases of anaphylactoid reactions. Among the currently marketed nonsteroidal anti-inflammatory drugs, piroxicam appears to have the highest rate of phototoxic reactions. This phototoxic eruption is most often vesiculobullous.

Topics: Acetates; Anti-Inflammatory Agents; Aspirin; Drug Eruptions; Humans; Ibuprofen; Indomethacin; ortho-Aminobenzoates; Piroxicam; Propionates; Pruritus; Pyrazoles; Pyrazolones; Salicylates; Skin; Skin Diseases; Stevens-Johnson Syndrome; Thiazines

Five patients with severe drug-induced toxic epidermal necrolysis improved rapidly after one to two plasma exchanges. The improvement of all five patients treated with plasmapheresis contrasts with the disease's mortality rate of up to 50%, as reported in the literature and as observed among our previously treated patients. Since there is no effective treatment for toxic epidermal necrolysis, a controlled clinical trial to evaluate the effectiveness of plasma exchange would seem worthwhile.

Topics: Adolescent; Adult; Aged; Diclofenac; Female; Humans; Male; Plasmapheresis; Pyrazoles; Pyrazolones; Stevens-Johnson Syndrome; Sulfonamides