Toxic epidermal necrolysis (TEN, or Lyell's syndrome) and Stevens-Johnson syndrome (SJS) are serious cutaneous drug reactions which can be fatal. Early recognition with prompt discontinuation of the causative medication can be life saving. The authors are from Pontevedra and Santiago de Compostela in Spain and Creteil in France.


Parameters affecting survival:

(1) half –life of the drug

(2) early discontinuation of the causative medication

(3) age of the patient (worse in the elderly)

(4) extent of skin detachment (worse with extensive skin detachment)


A drug with a half-life >= 24 hours had an odds ratio of 4.94 (95% confidence interval 1.30 to 18.91) relative to a drug with a half-life < 24 hours.

• A person with an underlying disease such as renal failure that decreases significantly drug excretion could be at increased risk.


Early discontinuation of the causative drug (stopping the causative medication on or before the same day that a definitive clinical sign of TEN or SJS appeared) was protective for drugs with a short half-life (< 24 hours).

(1) Definitive clinical signs were blisters and/or skin erosions.

(2) The beneficial effect of early withdrawal was not as apparent for drugs with long half-lives.


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