Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Question 1

Stevens-Johnson syndrome (SJS) pathophysiology

Answer 1

Disproportional immune response causes epidermal necrosis, resulting in blistering and shedding of the top layer of skin

Question 2

Difference between Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Answer 2

Steven Johnson syndrome affects < 10% of body

Toxic Epidermal Necrolysis affects > 10% of body

Question 3

Which medications can cause SJS or TEN

Answer 3

Anti-epileptics

Antibiotics

Allopurinol

NSAIDs

Question 4

Which infections can cause SJS or TEN

Answer 4

Herpes simplex

Mycoplasma pneumonia

Cytomegalovirus

HIV

Question 5

Presentation of SJS

Answer 5

Start with non-specific symptoms of fever, cough, sore throat, mouth, eyes and itchy skin.

Then develop a purple or red rash that spreads across the skin and starts to blister.

After the blistering starts, the skin starts to break away and shed

Pain, erythema, blistering and shedding can also happen to the lips and mucous membranes.

Eyes can become inflamed and ulcerated.

Can also affect the urinary tract, lungs and internal organs.

Question 6

Management of SJS and TEN

Answer 6

Medical emergencies - admitted to a dermatology or burns unit

Supportive care - hydration, analgesia, antiseptic, ophthalmology input

Treatment:

• steroids
• immunoglobulins
• immunosuppressants

Question 7

Complications of SJS or TENS

Answer 7

Secondary infection: Cellulitis and sepsis.

Permanent skin damage: scarring and damage to skin, hair, nails, lungs and genitals.

Visual complications: Eye involvement can range from sore eyes to severe scarring and blindness.