Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Update.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening mucocutaneous reactions, predominantly drug induced. The mortality rates for SJS and TEN are as high as 30 %, and short- and long-term morbidities are very common. SJS/TEN is one of the few dermatological diseases that constitute a true medical emergency. Early recognition and prompt and appropriate management can be lifesaving. In recent years, our understanding of the pathogenesis, clinical presentation, and management of SJS/TEN has improved. Nevertheless, in 2015, there are still no internationally accepted management guidelines. This review summarizes up-to-date insights on SJS/TEN and describes a protocol for assessment and treatment. We hope these suggested guidelines serve as a practical clinical tool in the management of SJS/TEN. The classic manifestation of SJS/TEN consists of initial "flu-like" symptoms (malaise, fever, anorexia) in the prodromal phase, followed by cutaneous and mucous membrane (ocular, oral, and genital) inflammation and pain, and other systemic involvement. Symptoms usually begin 4-28 days after the onset of drug intake. Treatment is multidisciplinary and includes identification and withdrawal of the culprit drug, transfer to a specialist unit, supportive care, medical treatment, communication, and provision of appropriate information and emotional support.
Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-737, Toronto, ON, M4N 3M5, Canada.|Department of Dermatology, Ha'emek Medical Center, Afula, Israel.
Roni P
RP
Dodiuk-Gad
Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospitals, Linkou, Taipei, Keelung, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Wen-Hung
WH
Chung
Department of Dermatology, French Reference Center for Toxic and Autoimmune Blistering Diseases, Henri Mondor Hospital, Créteil, France.|Université Paris-Est Créteil Val de Marne, Créteil, France.
Laurence
L
Valeyrie-Allanore
Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-737, Toronto, ON, M4N 3M5, Canada. neil.shear@sunnybrook.ca.|Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. neil.shear@sunnybrook.ca.
Neil H
NH
Shear
D000208:Acute Disease; D001707:Biopsy, Needle; D002423:Cause of Death; D002908:Chronic Disease; D042241:Early Diagnosis; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D004364:Pharmaceutical Preparations; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D013262:Stevens-Johnson Syndrome / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D016019:Survival Analysis
D004364:Pharmaceutical Preparations