SJS-TEN

Question 1

Mr. XX is a 48 yo chinese F who presents with generalised rashes, fever for the past 5 days (Tmax 38.7), chills and rigours and painful oral ulcers. Nikolsky sign positive. She was diagnosed with SJS. She is on the following medications:

1. Allopurinol 300 mg OD (started 1 year ago)
2. Metformin XR 500 mg BD (started 8 weeks ago)
3. Glipizide 5 mg BD (started 2 weeks ago)
4. Enalapril 10 mg BD (started 5 years ago)
5. Amlodipine 5 mg OD (started 5 years ago)
6. Rosuvastatin 10 mg ON (started 5 years ago)
7. Co-trimoxazole double-strength, 1 tablet BD (started 1 week ago for infection)

Which of her medications is most likely to have caused the SJS?

Answer 1

Co-trimoxazole

Question 2

Patient presents with blisters and lesions that affects 15% BSA. Patient has been diagnosed with SJS. Classify the patient’s SJS (SJS, or SJS-TEN overlap, or TEN?)

Answer 2

SJS-TEN overlap

• <10% BSA: SJS
• 10-30%: SJS-TEN overlap
• > 30%: TEN

Question 3

Besides skin symptoms and nikolsky positive, what are the other symptoms of SJS/TEN?

(Note: rashes will start on the face, arms and legs before spreading to mucous membrane and trunk

Answer 3

1. Fever > 39
2. Flu-like symptoms

Question 4

Suitable wound dressing for patients with broken skin in SJS-TEN?

Answer 4

Silver dressing (possess antibiotic properties)

Question 5

Management of blisters in SJS-TEN

Answer 5

Burst them and aspirate the fluid

Question 6

Property that must be present in the wound dressing used to cover denuded dermis in SJS-TEN?

Answer 6

Non-adhesive

Question 7

Dressing for exudative wounds in TEN

Answer 7

Burn dressing (collect exudate)

Question 8

What solution(s) can be used to clean wound in patients with SJS-TEN?

Answer 8

1. Warm sterile or saline solution
2. Mild antiseptic solutions (e.g. chlorhexidine 0.05%)

Question 9

Can topical antibiotics be used in patients with SJS-TEN?

Answer 9

Yes, but only to sloughy areas only

Question 10

In patients with SJS-TEN, what is the most common blood abnormalities?

Answer 10

1. Anemia
2. Lymphopenia

Question 11

If the eyes are involved in SJS-TEN, how to manage?

Answer 11

1. Lubricant q2h (preservative free)
2. Occular hygiene to remove inflammed debris and conjunctiva adhesions
3. Broad spectrum topical antibiotics

Question 12

General principle of managing pain in patients with SJS-TEN

Answer 12

Give painkillers according to WHO pain ladder
- Paracet
- NSAIDs
- Tramadol
- Opioids

Question 13

How to manage mouth involvement in patients with SJS-TEN?

Answer 13

1. Barrier cream on lips q2h
2. Anti-inflammatory oral rinse q3h
3. Warm saline mouthwash/sponge OD
4. Antiseptic oral rinse BD
5. Mucoprotectant mouthwash TDS
6. Topical anaesthetic (e.g. lidocaine gel)

• Topical corticosteroids QDS can be considered if inflammation is severe

Question 14

What can be done to prevent strictures in urethra for patients with urogenital involvement in SJS-TEN?

Answer 14

Catheterise urine