Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jan 14 2020

Stevens-Johnson Syndrome

  • Snapshot
    • A 21-year-old gentleman comes to the emergency room with a painful rash all over his body, including some lesions in his mouth. He also describes feeling feverish. On physical exam, his skin has multiple bullae that sloughs off easily with a single rub. The rash covers > 30% of his body. A careful history reveals that he was recently put on lamotrigine for his epilepsy. The lamotrigine is stopped and patient is immediately admitted to the burn unit.
  • Introduction
    • Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – two diseases on the same spectrum
      • SJS: < 10% of body surface area
      • TEN: > 30% of body surface area
      • SJS/TEN overlap: 10-30% of body surface area
    • Severe, febrile blistering disease of skin and mucous membranes
      • often caused by drugs (>>> infection)
        • e.g., penicillin, sulfonamides, phenytoin, carbamazepine, lamotrigine, NSAIDs
      • can be caused by infection
        • e.g., mycoplasma pneumonia
    • Erythema multiforme (EM) is a distinct disease from SJS/TEN according to the current consensus definition
  • Presentation
    • Symptoms
      • very painful skin (vs in EM, where pain/burning is typically very mild)
      • systemic signs
        • fever
        • dehydration
        • hypotension
    • Physical exam
      • initially dusky red macules or patches (not raised)that progress to tense bullae and eventual skin sloughing (vs in EM, where lesions are typically papular)
      • mucous membranes always involved
        • bullae and erosions in oral, genital, anal mucosa
      • + Nikolsky sign (rubbing of skin easily causes sloughing – splitting of epidermis from dermis)
  • Evaluation
    • Based on clinical history and symptoms
    • Skin biopsy: mainly to distinguish staphylococcal scalded skin syndrome and TEN
      • full-thickness epidermal necrosis
    • Labs: normal
  • Differential Diagnosis
    • Staphylococcal scalded skin syndrome
    • Graft versus host disease
    • Pemphigus vulgaris
    • Erythema multiforme
  • Treatment
    • Discontinue causative agent
    • Supportive care
      • wound care
      • fluids, electrolytes, nutrition
    • Treat underlying infection
  • Prognosis, Prevention, and Complications
    • High mortality, especially with TEN
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options