Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are about as bad a drug reaction as you can get. These are basically the same condition, with TEN being on the more serious side of the spectrum compared to SJSSJS: Less than 10% of body surface area is affected. Mucous membranes virtually always involved. macules which are erythematous or purpuric morph into epidermal necrosis and sloughing.
TEN: See above, except >30% of the body is involved. Diffuse erythema is also seen in this condition.
Both: Associated with systemic symptoms like fever, malaise, anorexia. Bullae may form on the skin prior to sloughing.
What causes it? Mostly in response to medications. Classic drugs include allopurinol, sulfa medications, penicillins, anti-seizure drugs (dilantin, carbamazepine), and some NSAIDS.
How do your manage these cases? 1. early recognition, 2. discontinuation of offending agent, 3. supportive care, 4. wound care management, including eyes and mouth, 5. monitor for fluid/electrolyte disturbances, 6. debridement. The use of IVIG or steroids is controversial. Many patients require specialist care in a burn unit.
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