SJS and TEN

Question 1

What is SJS and TEN?

Answer 1

Stevens-Johnson syndrome (SJS) is a severe skin detachment with mucocutaneous complications, caused by immune reaction to foreign antigens.

SJS is a more severe form of erythema multiforme major and a less severe manifestation of toxic epidermal necrolysis (TEN).

Question 2

What % of body is affected in SJS and TEN?

Answer 2

SJS: < 10%

TEN: > 30%

Question 3

What are Sx of SJS and TEN

Answer 3

Usually get URTI symptoms initially (usually a few weeks after starting a new mediation) and then a rash

* Painful erythematous macules evolving to form target lesions
* Severe mucosal ulceration of >2 surfaces e.g. conjunctiva, mouth, labia, urethra

Question 4

What are common causative drugs?

Answer 4

• Sulphonamides
	• Anti-epileptics 
	• Penicillin
	• NSAIDs
	• Antibiotics 
	• Allopurinol. 
Cephalosporins

Question 5

What Ix for SJS and TEN?

Answer 5

Clinical diagnosis, but skin biopsy is definitive: showing keratinocyte apoptosis adn detachment of epidermis from dermis.

Also important to do routine bloods (fluid balance), blood cultures and swabs if possible infection

Nikolsky sign: blisters and erosions appearing when the skin is rubbed gently

Question 6

What scoring system if used to predict mortality in SJS and TEN?

Answer 6

The SCORTEN criteria are:

* Age > 40 years
* Presence of malignancy 
* Heart rate > 120
* Initial percentage of epidermal detachment > 10%
* Serum urea level > 10 mmol/L
* Serum glucose level > 14 mmol/L
* Serum bicarbonate level < 20 mmol/L.

Question 7

What is Rx for SJS and TEN?

Answer 7

Stop drug!!!

Fluid balance

Dressing changes with analgesia

Emollients

Likely need ICU burns unit with temperature control to 28 degrees

Eye and lip care

Enoxaparin

PPI to prevent ulceration

Question 8

What specialites need involved?

Answer 8

Eyes: lubricant eye drops, assess involvement

Dermatology nurses

Dietician