Steven-Johnson's Syndrome

Question 1

What are characteristics of SJS?

Answer 1

Several life threatening reactions
Extensive necrosis
Epidermis detachment

Question 2

What does SJS start with?

Answer 2

macular and target lesions –> epidermal detachment

Question 3

Where does SJS affect?

Answer 3

skin and mucous (oral, nasal, eyes, vagina, urethra, GI and LRT)

Question 4

How do you differentiate SJS from TEN?

Answer 4

Epidermal Detachment- % BSA

SJS: 30%

Question 5

What are the two presentations in toxic epidermal necrolysis?

Answer 5

Macular/Target lesions (50% of cases)

Diffuse erythema to immediate necrosis

Question 6

What are the most common drugs for SJS?

Answer 6

NSAIDs
Antibiotics- sulfonamides, PCN
Anticonvulsants
Allopurinol

Question 7

What are the most common infectious causes?

Answer 7

Mycoplasma pneumoniae, viral infections, immunizations

Question 8

What is teh epi of EJE/TEN?

Answer 8

more common >40 yo
M=F
TEN less common than SJS

Question 9

When is the onset of SJS?

Answer 9

1-3 wks

Question 10

What is the prodrom of SJS?

Answer 10

fever, malaise, arthralgias

Question 11

What are the clinical manifestations of SJS?

Answer 11

Skin tenderness/burning
Conjunctival burning
Painful/tender mouth lesions

Question 12

What is the work up for SJS?

Answer 12

None needed

Question 13

What is the treatment of SJS/TEN?

Answer 13

Remove offending agent
Fluid resuscitation
ICU/Burn Unit
\+/- systemic glucocorticoids
? IV immunoglobins
Skin Care
Ocular manifestations

Question 14

How long does it take for lesions to heal?

Answer 14

1-2 weeks

Question 15

What does SCORTEN score?

Answer 15

severity of illness, mortality rate

Question 16

What is the mortality of SJS/TEN?

Answer 16

30% skin sloughing- 25-35%

Question 17

SJS vs TEN

Answer 17

Epidermal Detachment- % BSA

SJS: 30%