title: Clinical considerations for epidermal necrolysis.
abstract: BACKGROUND
  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered a spectrum of acute life-threatening mucocutaneous reactions that differ only in severity. Both diseases are characterized by mucous membrane and skin involvement, are often caused by medications, and are collectively known as epidermal necrolysis (EN).
  
  
  METHODS
  A severity of illness score has been devised to predict prognosis in patients with EN. The scoring system addresses 7 prognostic factors.
  
  
  RESULTS
  Patients with EN require supportive care. Those with extensive skin involvement should be admitted to an intensive care unit or burn unit if possible. Suspected, as well as unnecessary, medications should be discontinued. Baseline laboratory tests, imaging, cultures, and biopsies should be obtained. Intravenous access should be established and hydration and nutritional support begun. Daily oral care, wound care, pain control, and early physician consultation are also important aspects of treatment.
  
  
  CONCLUSIONS
  EN requires early diagnosis, appropriate workup, and appropriate treatment to minimize potential morbidity and mortality. In many clinicians' experience, EN is rare; therefore, education and improved understanding of the potential causes and appropriate treatment regimens are vital when confronted with such a patient.
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Ellender
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Cacey W
authors.initials: CW
authors.lastname: Peters
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Albritton
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA ; School of Pharmacy, University of Arizona, Tucson, AZ.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Garcia
authors.affiliation: Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA ; Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Alan David
authors.initials: AD
authors.lastname: Kaye
keywords: Drug eruptions; Stevens-Johnson syndrome; drug hypersensitivity