Steven-Johnson Syndrome and Toxic Epidermal Necrolysis

Steven-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are both severe cutaneous adverse reactions, characterised by target lesions, blistering and mucosal involvement. 

The difference between SJS and TEN is the extent of body surface involvement
  • SJS <10% of body surface involved 
  • TEN >30% 
  • Between 10% and 30% is SJS/TEN overlap

Patients are systemically unwell
Nikolsky’s sign is positive (mechanical pressure on skin causes epidermal detachment) 

Causes of SJS/TENS: 
  • Medications
    • Antibiotics 
      • Sulfonamides 
      • Trimethoprim 
      • Penicillin 
      • Cephalosporins 
      • Quinolones 
    • Antiepileptics 
      • Carbamazepine 
      • Lamotrigine 
      • Phenytoin 
    • Other 
      • NSAIDs 
      • Allopurinol 
  • Infections 
    • Mycoplasma pneumonia 
    • Herpes simplex 

Median time from starting drug to symptoms is under 4 weeks 

  • Stop any causative drug 
  • Supportive treatment 
  • IV IG 

Approximately 10% mortality for SJS, 30% for overlap and 50% for TEN 

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