steven Jonson syndrome and toxic epidermal necrolysis

Question 1

most common causes of SJS and TEN

Answer 1

sulfa drugs
anticonvulsants
allopurinol
NSAIDs
antibiotics

Question 2

Steven Jonson syndrome and toxic epidermal necrolysis

Answer 2

full-thickness epidermal necrosis
blister and mucosal

Definition:
Steven Johnson syndrome SJS
total BSA of blistering and detachment < 10%
mortality 10%

SJS and toxic epidermal necrolysis (TEN) overlap
- total BSA or blistering and detachment 10-30%

TEN toxic epidermal neurolysis
total BSA of blistering and detachment > 30%
mortality 30%

Question 3

SJS and TEN signs and symptoms

Answer 3

fever > 102
sore throat’
conjunctivitis
acute onset of lesions
- painful dusky, atypical

intensinal and upper respiratiory involvement
poor progniosis

Question 4

SJS and TEN diagnosis

Answer 4

frozen section skin bx
aides in DX
characterize reaction
does not indicate causality

laboratory
CBC LFT, CMP
eosinophilia
transaminitis
identify altrnative

Question 5

SJS and TEN treatment plan

Answer 5

no consensus on most effective treatment
best outcome:
early diagnosis
immediate discontinuation of drug
supportive care

management and supportive care
IVF
atraumatic wound care
infection prevention
ophthalmologic and respiratory support
systemic glucocorticoid
- predisone
- avoid long-term use

Other:
IVIG met with questionable data
cyclosporin and etanercept