Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

McKinley, Blake Jeffrey; Allen, Mitchell Edger; Michels, Nicole

doi:10.1186/s40001-023-01142-2

Table 3 ALDEN Drug causality assessment of drugs in individual cases of photodistributed Steven's–Johnson syndrome and toxic epidermal necrolysis

From: Photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis: a systematic review and proposal for a new diagnostic classification

Reference to study	[28]	[22]	[29]	[30]	[31]	[32]	[33]	[34]	[35]	[36]	[37]	[38]	[39]
Delay from initial drug component intake to onset of reaction (index day)^a	+3	+3	+3	−1	+3^b	−1	+3	+3^b	+3	+1	N/A	+3	+3
Drug present in the body on index day^c	0	0	0	0	0	0	0	0	0	0	0	0	-3
Prechallenge/rechallenge^d	0	0	0	0	+4	0	0	+1	0	0	N/A	0	0
Dechallenge^e	0	0	0	0	0	0	0	0	0	0	0	0	0
Type of drug (notoriety)^f	+3	+3	+3	+3	+3	+3	+3	+3	+3	+3	+3	+3	+2
Other cause^g	0	0	0	0	0	0	0	0	0	0	0	0	0
Final Score^h	6	6	6	2	10	2	6	7	6	4	N/A	6	2

^aSuggestive (5 to 28 days) = +3, Compatible (29 to 56 days) = +2, Likely (1 to 4 days) = +1, Unlikely (>56 days) = −1, Excluded (drug started on or after the index day = −3
^bIn case of previous reaction to the same drug, only changes for: Suggestive (1 to 4 days) = +3 Likely (5 to 56 days) = +1
^cDefinite (Drug continued up to index day or stopped at a time point less than five times the elimination half-life before the index day) = 0; doubtful (Drug stopped at a time point prior to the index day by more than five times the elimination half-life but liver or kidney function alterations or suspected drug interaction are present) = −1; Excluded (Drug stopped at a time point prior to the index day by more than five times the elimination half-life, without liver or kidney function alterations or suspected drug interactions) = −3
^dPositive specific for disease and drug (SJS/TEN after use of same drug) = 4; Positive specific for disease or drug (SJS/TEN after use of similar drug or other reaction with same drug) = 2; Positive unspecific (Other reaction after use of similar drug) = 1; Not done/unknown (No known previous exposure to this drug) = 0; Negative (Exposure to this drug without any reaction, before or after reaction) = −2
^eNeutral (Drug stopped or unknown) = 0; Negative (Drug continued without harm) = −2
^fStrongly associated (Drug of the “high-risk” list according to previous case–control studies) = 3; Associated (Drug with definite but lower risk according to previous case–control studies) = 2; Suspected (Several previous reports, ambiguous epidemiology results - drug “under surveillance”) = 1; Unknown (All other drugs including newly released ones) = 0; Not suspected = −1 (No evidence of association from previous epidemiology study with sufficient number of exposed controls)
^gPossible (Rank all drugs from highest to lowest intermediate score. If at least one has an intermediate score >3, subtract 1 point from the score of each of the other drugs taken by the patient. “another cause is more likely”) = −1
^hFinal Score: Range: -12 - 10; Very unlikely <0, unlikely 0–1, possible 2–3, probable 4–5, very probable ≥6
For further details on how to assign scores, see “Table 5 Details of the algorithm of drug causality for epidermal necrolysis (ALDEN)” from Sassolas et al. [40]
SJS Stevens–Johnson syndrome, TEN toxic epidermal necrolysis, ALDEN algorithm of drug causality for epidermal necrolysis

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