Vulvovaginal Manifestations in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Prevention and Treatment.

MedStar author(s):
Citation: Journal of the American Academy of Dermatology. 85(2):523-528, 2021 Aug.PMID: 31437544Institution: MedStar Washington Hospital CenterDepartment: Dermatology | Obstetrics and Gynecology/UrogynecologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Stevens-Johnson Syndrome/co [Complications] | *Vaginal Diseases/et [Etiology] | *Vaginal Diseases/th [Therapy] | *Vulvar Diseases/et [Etiology] | *Vulvar Diseases/th [Therapy] | Female | Humans | Practice Guidelines as Topic | Stevens-Johnson Syndrome/di [Diagnosis] | Vaginal Diseases/pc [Prevention & Control] | Vulvar Diseases/pc [Prevention & Control]Year: 2021Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0190-9622
Name of journal: Journal of the American Academy of DermatologyAbstract: The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis may be as high as 70%; up to 28% of females will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecological sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae including erosions, scar formation, chronic skin changes, urethral complications, adenosis and malignant transformation, vulvodynia and dyspareunia. We provide comprehensive recommendations on acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Acutely, vulvovaginal treatment should include ultrapotent topical steroid, followed by a non-irritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults with vaginal involvement, but should be avoided in pre-pubertal adolescents. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Finally, referrals to pelvic floor physical therapy and surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature, combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients. Copyright (c) 2019. Published by Elsevier Inc.All authors: Bradley SE, Cardis MA, Mauskar MM, Mitchell CM, O'Brien KF, Pasieka HBOriginally published: Journal of the American Academy of Dermatology. 2019 Aug 19Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier: Date added to catalog: 2019-10-10
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 31437544 Available 31437544

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis may be as high as 70%; up to 28% of females will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecological sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae including erosions, scar formation, chronic skin changes, urethral complications, adenosis and malignant transformation, vulvodynia and dyspareunia. We provide comprehensive recommendations on acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Acutely, vulvovaginal treatment should include ultrapotent topical steroid, followed by a non-irritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults with vaginal involvement, but should be avoided in pre-pubertal adolescents. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Finally, referrals to pelvic floor physical therapy and surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature, combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients. Copyright (c) 2019. Published by Elsevier Inc.

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