SJS/TEN is a spectrum of epidermal detachment with systemic illness, where SJS involves < 10 percent of the body surface area and TEN involves >30 percent [1, 2]. Causes include medications (commonly antibiotics and anticonvulsants), infection (herpes simplex virus, human immunodeficiency virus), cancer, immunologic disease, and idiopathic etiologies.
Management should include: airway evaluation, as mucosal involvement can include sloughing of the respiratory epithelium; resuscitation with correction of electrolytes; temperature control; monitoring for signs of infection; dermatology and ophthalmology consults; and admission to a burn intensive care unit (ICU) if available. Ophthalmology should be consulted early as these patients are at risk for complications from corneal inflammation.
Diagnosis is supported by clinical findings and skin biopsy, and the likelihood of drug relation can be supported by the algorithm of drug causality for epidermal necrolysis (ALDEN) . Illness severity scoring systems like Score of Toxic Epidermal Necrosis (SCORTEN) & ABCD-10 (asymmetry, border, color, diameter) can be used to better predict mortality in adults .
Take Home Points
- In patients with SJS/TEN, immediately resuscitate to correct hypovolemia and electrolyte abnormalities.
- Consult dermatology, ophthalmology, and burn teams early, with admission to a burn ICU if available.
- The ALDEN algorithm can help support the likelihood of drug reaction, while SCORTEN and ABCD-10 scores are used to predict mortality in adults.