成人Stevens-Johnson综合征及中毒性表皮坏死松解症患者皮肤护理的最佳证据总结

doi:10.3761/j.issn.2096-7446.2025.07.019

Abstract

Abstract:

Objective To conduct a comprehensive search for evidence relating to skin care for adults with Stevens-Johnson syndrome and toxic epidermal necrolysis and summarize the best evidence. Methods Systematic search of domestic and international databases，guideline websites，and websites of dermatology-related societies was conducted for clinical decisions，guidelines，evidence summaries，expert consensus，systematic reviews，and original research on skin care for adults with Stevens-Johnson syndrome and toxic epidermal necrolysis. The search timeframe was from January 2014 to September 2024. Quality assessment of the literature and extraction of information was performed independently by 4 investigators. Results A total of 12 papers were included，including one clinical decision，five guidelines，two systematic reviews，three expert consensuses，and one original study. Thirty-nine pieces of evidence encompassing five topics were summarized，including formation of multidisciplinary teams，assessment and monitoring，skin barrier care，mucosal system care，health education and follow-up. Conclusion This study summarizes the best evidence for skin care in adults with Stevens-Johnson syndrome and toxic epidermal necrolysis，can provide an evidence-based basis for clinical implementation of skin care.

Key words: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Skin Care, Evidence Summary, Evidence-Based Nursing

ZHANG Yumei, WANG Hanmin, GUO Shuping, LANG Xiaoqing, WANG Lijuan, LI Li. Summary of the best evidence for skin care in adults with Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(7): 872-878.

Figures/Tables 3

References 32

[1]	Hsu DY, Brieva J, Silverberg NB, et al. Morbidity and mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis in United States adults[J]. J Invest Dermatol, 2016, 136(7):1387-1397. doi: S0022-202X(16)31012-0 pmid: 27039263
[2]	Chaby G, Maldini C, Haddad C, et al. Incidence of and morta-lity from epidermal necrolysis(Stevens-Johnson syndrome/toxic epidermal necrolysis) in France during 2003-16:a four-source capture-recapture estimate[J]. Br J Dermatol, 2020, 182(3):618-624. doi: 10.1111/bjd.18424 pmid: 31396952
[3]	Frey N, Jossi J, Bodmer M, et al. The epidemiology of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK[J]. J Investig Dermatol, 2017, 137(6):1240-1247
[4]	刘瑞, 张志彬, 杨科, 等. Stevens-Johnson综合征和中毒性表皮坏死松解症病死率及相关因素的Meta分析[J]. 中国皮肤性病学杂志, 2024, 38(1):65-73.
	Liu R, Zhang ZB, Yang K, et al. Meta-analysis of the case fatality rate and related factors of SJS and TEN[J]. Chin J Der-matovenereology, 2024, 38(1):65-73.
[5]	Lerch M, Mainetti C, Beretta-Piccoli BT, et al. Current perspec-tives on Stevens-Johnson syndrome and toxic epidermal necro-lysis[J]. Clin Rev Allergy Immunol, 2018, 54(1):147-176.
[6]	Hanson LM, Bettencourt AP. Stevens-Johnson syndrome and toxic epidermal necrolysis:a guide for nurses[J]. AACN Adv Crit Care, 2020, 31(3):281-295. doi: 10.4037/aacnacc2020634 pmid: 32866260
[7]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[8]	Dicenso A, Bayley L, Brian Haynes R. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. doi: 10.1136/ebn.12.4.99-b pmid: 19779069
[9]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advanc-ing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. doi: 10.1016/j.ypmed.2010.08.005 pmid: 20728466
[10]	Foster MJ, Shurtz S. Making the critical appraisal for sum-maries of evidence(CASE) for evidence-based medicine(EBM):critical appraisal of summaries of evidence[J]. J Med Libr Assoc, 2013, 101(3):192-198.
[11]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[12]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[13]	Lee HY, et al. Stevens-Johnson syn-drome and toxic epidermal necrolysis:Management,prognosis,and long-term sequelae[EB/OL].(2024-04-02)[2024-10-16]. https://www.uptodate.com/contents/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis-ma-nage-ment-prognosis-and-long-term-sequelae.
[14]	Ingen-Housz-Oro S, Matei I, Gaillet A, et al. French national protocol for diagnosis and management of epidermal necro-lysis in adults(Stevens-Johnson syndrome and toxic epidermal necrolysis)[J]. Ann Dermatol Venereol, 2024, 151(2):103282.
[15]	Areta KV, Adjunct RF, Arizona BC, et al. Stevens-Johnson syn-drome and toxic epidermal necrolysis[EB/OL].(2022-12-01)[2024-10-16]. https://bestpractice.bmj.com/topics/en-us/237.
[16]	Seminario-Vidal L, Kroshinsky D, Malachowski SJ, et al. Socie-ty of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults[J]. J Am Acad Dermatol, 2020, 82(6):1553-1567.
[17]	Creamer D, Walsh SA, Dziewulski P, et al. U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016[J]. Br J Dermatol, 2016, 174(6):1194-1227. doi: 10.1111/bjd.14530 pmid: 27317286
[18]	Gupta L, Martin A, Agarwal N, et al. Guidelines for the mana-gement of Stevens-Johnson syndrome/toxic epidermal necroly-sis:an Indian perspective[J]. Indian J Dermatol Venereol Lep-rol, 2016, 82(6):603.
[19]	Ingen-Housz-Oro S, Schmidt V, Ameri MM, et al. Post-acute phase and sequelae management of epidermal necrolysis:an inter-national,multidisciplinary DELPHI-based consensus[J]. Orpha-net J Rare Dis, 2023, 18(1):33.
[20]	中华医学会皮肤性病学分会药物不良反应研究中心. Stevens-Johnson综合征/中毒性表皮坏死松解症诊疗专家共识[J]. 中华皮肤科杂志, 2021, 54(5):376-381.
	Adverse Drug Reaction Research Center of Dermatology Branch of Chinese Medical Association. Expert consensus on the diagnosis and treat-ment of Stevens-Johnson syndrome/toxic epidermal necrolysis[J]. Chin J Dermatol, 2021, 54(5):376-381.
[21]	Brüggen MC, Le ST, Walsh S, et al. Supportive care in the acute phase of Stevens-Johnson syndrome and toxic epidermal ne-crolysis:an international,multidisciplinary Delphi-based con-sensus[J]. Br J Dermatol, 2021, 185(3):616-626. doi: 10.1111/bjd.19893 pmid: 33657677
[22]	Lee JS, Mallitt K, Fischer G, et al. An individual patient data meta-analysis of wound care in patients with toxic epidermal necrolysis[J]. 2024, 65(2):128-142.
[23]	Castillo B, Vera N, Ortega-Loayza AG, et al. Wound care for Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. J Am Acad Dermatol, 2018, 79(4):764-767.e1. doi: S0190-9622(18)30486-9 pmid: 29601936
[24]	Haravu PN, Gottlieb LJ, Vrouwe SQ. Antishear therapy for ste-vens-Johnson syndrome and toxic epidermal necrolysis:a follow-up study[J]. J Burn Care Res, 2021, 42(6):1152-1161.
[25]	Surowiecka A, Barańska-Rybak W, Strużyna J. Multidisciplinary treatment in toxic epidermal necrolysis[J]. Int J Environ Res Public Health, 2023, 20(3):2217.
[26]	胡丽, 黄琨, 俞仁涛. Stevens-Johnson综合征和中毒性表皮坏死松解症的疾病进展和治疗转归分析[J]. 中国皮肤性病学杂志, 2022, 36(3):290-294.
	Hu L, Huang K, Yu RT. Disease progression and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. Chin J Dermatovenereol, 2022, 36(3):290-294.
[27]	Strużyna J, Surowiecka A, Korzeniowski T, et al. Accuracy of SCORTEN in predicting mortality in toxic epidermal necro-lysis[J]. BMC Med Inform Decis Mak, 2022, 22(1):273.
[28]	中华医学会, 中华医学会杂志社, 中华医学会皮肤性病学分会, 等. 药疹基层诊疗指南(2022年)[J]. 中华全科医师杂志, 2022, 21(9):804-813.
	Chinese Medical Association, Chinese Medical Journals Publi-shing House, Dermatology Branch of Chinese Medical Associa-tion, et al. Guideline for primary care of drug eruption(2022)[J]. Chin J Gen Pract, 2022, 21(9):804-813.
[29]	中国老年医学学会烧创伤分会. 含银敷料在创面治疗中应用的全国专家共识(2018版)[J]. 中华烧伤杂志, 2018, 34(11):761-765.
	Burn and Trauma Branch of Chinese Geriatrics Society. National experts consensus on application of silver-contai-Ning dressings in wound therapy(2018 version)[J]. Chin J Burns, 2018, 34(11):761-765.
[30]	Revuz J, Penso D, Roujeau JC, et al. Toxic epidermal necroly-sis. Clinical findings and prognosis factors in 87 patients[J]. Arch Dermatol, 1987, 123(9):1160-1165. doi: 10.1001/archderm.123.9.1160 pmid: 3632000
[31]	何彦, 刘颖怡. Stevens-Johnson综合征及中毒性表皮坏死松解症的早期眼部诊疗管理[J]. 眼科, 2024, 33(4):245-248.
	He Y, Liu YY. The early ophthalmic diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis[J]. Ophthalmol China, 2024, 33(4):245-248.
[32]	Komatsu-Fujii T, Ogawa M, Nonoyama S, et al. Recurrence of nivolumab-induced Stevens-Johnson syndrome due to tegafur/gimeracil/oteracil(TS-1^R) after nivolumab discontinuation[J]. Eur J Dermatol, 2021, 31(1):98-99. doi: 10.1684/ejd.2020.3957 pmid: 33586655

Summary of the best evidence for skin care in adults with Stevens-Johnson syndrome and toxic epidermal necrolysis

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