Steven Johnson Syndrome / Toxic Epidermal Necrolysis Flashcards
What are the potential infectious causes of SJS / TEN?
Upper RTIs including pharyngitis and otitis media Mycoplasma pneumoniae EBV Cytomegalovirus Herpes (Smallpox vaccination)
What drugs can classically cause SJS / TEN?
Anticonvulsants Antibiotics Azathipprine Sulfasalzine Analgesics NSAIDs Antifungals Corticosteroids Chemotherapy
How long does it typically take between exposure to a causative agent and development of SJS /TEN?
1-2 weeks
What non-specific symptoms may occur in SJS / TEN?
Malaise
Myalgia
Fever
Cough
Describe the typical rash appearance in SJS / TEN?
In early stages:
Maculopapular rash, diffuse erythema, flat target lesions, blistering, erosions,
affects both the skin and oral mucosa
Nikolsky’s sign is positive
In later stages:
Sloughing off of tissue (including in the mucosa (oral, GI and respiratory))
In SJS / TEN it is important to estimate the body surface area affected. How can this be estimated?
Using Wallace’s rule of nines
What is Nikolsky’s sign?
This is positive when light rubbing of the skin causes sloughing
What are the potential complications of SJS / TEN?
Secondary infection -> sepsis Dehydration -> AKI Acute liver failure GI bleeding Respiratory distress and complications Hypothermia Chronic skin scarring Compartment syndrome Occular complications Death
Describe the management of SJS / TEN?
Removal of precipitating agent Sterile wound care IV fluids +/- nutritional management Analgesia Prophylactic VTE PPIs Antihistamine IVIG Physio and OT
What is the name of the severity criteria for SJS / TEN?
SCORTEN severity criteria
(Age > 40 years Presence of malignancy (cancer) 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.)
