Derm - Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Question 1

What is stevens-Johnson syndrome and toxic epidermal necrolysis?

Answer 1

Disproportional immune response causes epidermal necrosis resulting in blistering and shedding of the top layer of skin

Question 2

What is the difference between SJS and TEN?

Answer 2

SJS affects less than 10% of the body surface

TEN affects more than 10% of the body surface

Question 3

What causes SJS and TEN?

Answer 3

Medications
Anti-epileptics
Antibiotics
Allopurinol
NSAIDs

Infections
Herpes simplex
Mycoplasma pneumoniae
CMV
HIV

Question 4

How does SJS and TEN present?

Answer 4

Some cases are mild while other cases are very severe and can be fatal

Non-specific symptoms of fever, cough, sore throat, sore mouth, sore eyes and itchy skin

Purple or red rash then develops and spreads across the skin and starts to blister

After a few days blistering starts, the skin starts to break away and shed leaving raw tissue underneath

Pain, erythema, blistering and shedding can also happen to lips and mucuous membranes

Eyes become inflamed and ulcerated

Question 5

How is SJS and TEN managed?

Answer 5

Medical emergencies
Admission to dermatology or burns unit

Good supportive care :
- Nutritional care
- Antiseptics
- Analgesia
- Opthalmology input
- Steroids
- Immunoglobulins
- Immunosuppressants

Question 6

What are the complications of SJS and TEN?

Answer 6

Secondary infection
Breaks in skin lead to secondary bacterial infection
Cellulitis
Sepsis

Permanent skin damage
Scarring and damage to skin, hair, nails, lungs and genitals

Visual complications
Sore eyes to severe scarring and blindness