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Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: An Update

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Abstract

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.

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Acknowledgments

We would like to thank Dr. Michael Shier (Colposcopy Unit, Gynaecology Services, Sunnybrook Health Sciences Centre, Toronto, ON, Canada) for his valuable advice regarding the optimal treatment of the gynecological complications of females with SJS/TEN.

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Correspondence to Neil H. Shear.

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No funding was received for the preparation of this review.

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Roni P. Dodiuk-Gad, Wen-Hung Chung, Laurence Valeyrie-Allanore, and Neil H. Shear have no conflicts of interest—including financial interests, relationships, and affiliations—that are relevant to the subject of this submission.

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Dodiuk-Gad, R.P., Chung, WH., Valeyrie-Allanore, L. et al. Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: An Update. Am J Clin Dermatol 16, 475–493 (2015). https://doi.org/10.1007/s40257-015-0158-0

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