SJS/TEN Teaching Pearls:

• SJS/TEN are severe mucocutaneous lesions
  • <10% of epidermal involvement categorized as SJS.
  • >30% of epidermal involvement categorized as TEN
  • 10-30% of epidermal involvement categorized as SJS/TEN
• Most commonly caused by:
  • Medications (allopurinol, anticonvulsants, sulfonamides, NSAIDS)
  • Infectious (mycoplasma pneumonia, CMV)
• Clinical Manifestations:
  • Prodrome of fever and flu-like symptoms 1-3 days
  • Development of mucocutaneous and skin lesions that start as erythematous macules.
  • Progress to vesicles and bullae formation within days prior to sloughing.
  • Mucocutaneous involvement occurs in >90% of patients (oral, ocular, urogenital).
• Complications
  • Fluid balance and electrolyte abnormalities
  • Infections
    • Staph Aureus and Pseudomonas
    • Fungemia
    • No role for empiric antibiotics.
  • Pulmonary
    • ARDS
    • Pneumonia
• Management
  • High level of suspicion as early withdrawal of medications important for treatment.
  • Symptomatic care
    • Consult ophtho, burn, and derm
    • Patient should be transferred to ICU burn care if moderate to high severity of disease.