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- Presentation
Nail Observations in Survivors of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
Description
In a presentation discussing nail observations in survivors of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN), a 68-year-old male patient with a history of seizures presented with severe skin symptoms linked to an increased dosage of lamotrigine. Following a diagnosis of SJS/TEN and supportive care, he returned after six months with various nail issues including onychomadesis and erythronychia. A significant study from 2021 indicated that nearly 70% of survivors experience chronic nail changes, which correlate with the severity of their SJS/TEN. Common findings include Beau's lines, onychomadesis, and distal dyschromia, attributed to disruptions in nail production during the disease process. The presenter highlighted the pathology in the nail matrix, leading to various changes and discussed treatment options such as watchful waiting and urea applications for specific conditions. Patients were warned that some nail changes might be permanent, but the emphasis remained on their recovery from the severe condition.
View moreConclusions
- Nail changes are common in survivors of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), with up to 70% experiencing chronic alterations post-recovery.
- The severity of SJS/TEN correlates with the degree of nail changes observed, indicating a relationship between systemic disease severity and nail matrix dysfunction.
- Common nail findings in SJS/TEN survivors include Beau's lines, onychomadesis, distal dyschromia, onycholysis, and erythronychia, suggesting a broad spectrum of possible nail damage.
- Pathophysiological mechanisms behind nail changes are linked to damage in the nail matrix leading to disruption in nail production and growth patterns.
- Management of nail changes post-SJS/TEN primarily involves watchful waiting, though surgical or chemical avulsion may be warranted in symptomatic cases.
- Some nail changes, specifically those related to scarring or matrix damage, may be permanent, necessitating patient education on the potential for lasting effects.
- Lian SB, Oh CC, Yeo YW, Lee HY. Spectrum of nail sequalae in Stevens-Johnson syndrome and toxic epidermal necrolysis. JAMA Dermatol. 2021 Jan 1; 157(1):117-119.