與情緒穩定劑相關的 Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis：危險因子與處置

Risk Factors and Management of Mood Stabilizer-associated Stevens- Johnson Syndrome/Toxic Epidermal Necrolysis: A Mini-review

目的：瞭解情緒穩定劑引起的Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 之臨床治療及相關危險性。方法：本文藉由文獻回顧，來介紹由情緒穩定劑引起的皮膚過敏 炎症之治療及危險因子。結果：使用情緒穩定劑的病人有較高機率產生皮膚過敏反應，尤 其帶有HLA-B*1502 基因的漢人使用carbamezapine 有更高的危險性，越快停藥，對預後越 好。女性、物質濫用、新用者、高劑量及合併用藥者，危險性更高。HLA-B*1502 基因的篩 檢可能可以減少漢人併發症的發生。結論：早期診斷，早期治療。

Objectives: In this brief review, I am dealing with the management and risk of mood stabilizers associated Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods: I conducted a comprehensive review of 27 published articles on SJS/TEN management and the risk of mood stabilizer-induced SJS/TEN. Results: Mood-stabilizing agents such as carbamezapine, lithium carbonate, valproic acid, topiramate, lamotrigine, gabapentin, and oxcarbazepine have the highest incidence of SJS/TEN. Han Chinese who have the HLA-B*1502 allele are at a much increased risk of developing SJS/TEN when exposed to carbamazepine. Stopping the suspected drug and rapid initiation of supportive and symptomatic management remains the mainstay of SJS/TEN management. Females, substance abusers, and new users with an early or sudden high combined dosage of mood stabilizers have increased risk of SJS/TEN. Carbamazepine-induced SJS/TEN in Taiwan exhibits a 98.3% sensitivity rate for HLA-B*1502. Given the availability of other effective medications for similar indications, avoiding carbamazepine is likely prudent when patients have tested HLA-B*1502 screening positive. Conclusion: Early diagnosis is important and early treatment requirs optimal SJS/TEN management.