An epidemiological study of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) throughout Japan from 2005 to 2007 was performed using registration forms. A total of 370 cases (258 cases of SJS and 112 cases of TEN) were included. The prevalence per million per year was 3.1 for SJS, 1.3 for TEN, and 4.4 for SJS plus TEN. The relative SJS to TEN ratio was 1 : 2.3. A small peak in the fourth and a large peak in the seventh decade of life were observed. The male to female ratio of SJS was 1 : 1.14, whereas that of TEN was 1 : 0.95. The mortality rate of SJS was 3%, but that of TEN was 19%.The most frequently suspected agents were antibiotics and nonsteroidal antiinflammatories (NSAIDs). The period from the start of anticonvulsant treatment to the onset of the rash was significantly longer than that of antibiotic treatment. The mean severity score of SJS was 5.0±2.0, whereas that of TEN was 8.3±2.7; the difference was statistically significant. Eye involvement was documented in 77% of TEN patients but in only 26% of SJS patients. Mucous membrane involvements, such as lip erosion with bloody crusting, extensive oral cavity erosion, genital erosion, and pulmonary mucous membranes was significantly more frequent in TEN than in SJS patients. Histological findings, including apoptosis and necrosis throughout the epidermis, were significantly less frequent in SJS than in TEN patients. This is the first epidemiological study of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) throughout Japan.
We utilized new advanced therapies for chemotherapy-resistant angiosarcoma in a case to treat a 57-year-old female, who had hemangiosarcoma of the scalp expanding to the face. After high-dose radiotherapy was performed in on the her entire scalp and right side of the face, a combination therapy with thalidomide and celecoxib, both at in a doses of 100 mg per day, respectively was given. There was no recurrence for 2 years. Then a distal metastasis was detected in the left lung as hemothorax. However thoraco-radiation therapy by at a total dose of 50 Gy improved her lung condition, and she survived 10 more months. One month before her death, the platelet count was extremely low, and a new hemothorax occurred in the right lung. To stop this condition, intra-thoracic chemotherapy with paclitaxel at 80 mg was resulted in recovery of the platelet.count Her clinical condition has was initially stage Ic (Kitasato classification), which indicates a tumor expanding to the face from angiosarcoma of the scalp; the average survival time in this stage is only 2 years and 4 months. The patient, however, survived 4 years and 3 months in spite of chemotherapy-resistant angiosarcoma. These new advanced therapies appeared to be effective in prolonging her life.
We have treated 8 cases of Ramsay Hunt Syndrome (RHS) and 117 cases of herpes zoster who had eruptions on the head and neck (April. 2006-March. 2009). The incidence of RHS in herpes zoster was 6.8%.The patients with herpes zoster who had eruptions only on their auricles were in the high risk group for RHS; more than 50% of them had facial nerve palsy which became apparent several days after the onset of the eruption. All of the patients who had difficulty in hearing or vertigo had auricular eruptions. The six cases which we could follow up were cured or almost cured whether or not steroids were administered.