Stevens-Johnson and Lyell syndromes: Mucocutaneous and ocular sequels in 43 cases

Introduction: The ophthalmic sequelae of Stevens-Johnson and Lyell syndromes are deemed serious, and their mucocutaneous syndromes can adversely affect social and functional outcomes. The aim of this study is to describe these sequelae in Morocco. Methods: This retrospective study involved all patients hospitalized in the dermatology department of the Ibn Rochd University Hospital in Casablanca for toxic epidermal necrolysis or Stevens-Johnson syndrome (SJS). The study period lasted from January 1986 to December 2006. Mucosal, cutaneous and ocular sequelae of these diseases were identified during follow-up. Results: During this 21-year period, 43 cases of Lyell syndrome and SJS were analyzed. Twenty-five women and 18 men were included and the average age was 28 years. Clinical forms were as follow: Lyell's syndrome: 32 cases; SJS: six cases; intermediary Lyell-SJS form: five cases. Average follow-up was 3 years. Concerning mucocutaneous sequelae, 72% of patients had diffuse hyperchromic macules with scarring, photosensitivity was noted in 70% of cases, telogen effluvium was seen in 10 cases, abnormal sweating was noted in eight cases, nail loss was seen in eight cases, and vaginal bands were noted in two cases. In the chronic phase, 70% of patients had photophobia with chronic lacrimation. Eyelid malposition was noted in 21% of cases: ectropion (n = 6), entropion with trichiasis (n = 3) and symblepharon in 13 cases (30%). Corneal complications involving superficial punctate keratitis were noted in 42% of cases and were associated with corneal neovascularisation in five cases. Finally, bilateral dry eye syndrome was seen in 24 cases (56%). Conclusion: Our study confirms the reality of ocular, and mucocutaneous sequelae of Stevens-Johnson and Lyell syndromes. Ocular sequelae are dramatic, while cutaneous sequelae are unsightly. These sequelae have marked repercussions on the social and professional integration of our patients, most of whom were young. © 2010 Elsevier Masson SAS. All rights reserved.