Stevens-Johnson Syndrome Basics

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, acute, life-threatening reactions involving the skin and mucous membranes. They form one disease spectrum called epidermal necrolysis. Most adult cases are medication related, although infection or another cause may be considered when no culprit medication is found. The immune reaction kills keratinocytes, leading to full-thickness epidermal necrosis and separation of the epidermis. Loss of the skin barrier then disrupts fluid and electrolyte balance, temperature control, and protection from infection. Think of SJS/TEN when an ill patient has painful, rapidly evolving red or dusky macules, atypical flat target lesions, blisters, skin detachment, or erosions of the mouth, eyes, or genital area. This pattern is an emergency, not an uncomplicated medication rash. In hospital, activate the rapid response or local emergency process and notify the physician or nurse practitioner immediately. In the community, call 911 for emergency transport to an emergency department. Follow agency policy to withhold the next dose of a suspected medication while the prescriber urgently reviews and discontinues potential culprit drugs; do not wait for biopsy or laboratory results...