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).
- Fluid balance and electrolyte abnormalities
- Staph Aureus and Pseudomonas
- No role for empiric antibiotics.
- 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.
Erythroderma, swelling, maculopapular rash
|Vesicle/bullae formation followed by sloughing|
Diffuse, usually involves the face.
|Diffuse; often spares the palms/soles, and scalp|
Occurs 2-8 weeks after medication intake
|Occurs 3-21 days after medication intake|
|Internal Organ Involvement||
Lymphadenopathy, renal (AIN), hepatitis
|Due to result of complication from SJS/TEN|
|Systemic signs||Fever, malaise, fatigue
|Fever, malaise, odynophagia|
|Lymphopenia, rarely eosinophilia|