Stevens-Johnson syndrome/toxic epidermal necrolysis

Disease Overview

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a very severe reaction, most commonly triggered by medications, that causes skin tissue to die (necrosis) and detach. The mucous membranes of the eyes, mouth, and/or genitals are also commonly affected.[14967] SJS and TEN previously were thought to be separate conditions, but they are now considered part of a disease spectrum. SJS is at the less severe end of the spectrum, and TEN is at the more severe end.[12150] It is considered SJS when skin detachment involves less than 10% of the body surface, and TEN when skin detachment involves more than 30% of the body surface. People with skin detachment involving 10-30% of the body surface are said to have “SJS/TEN overlap.”[14967] All forms of SJS/TEN are a medical emergency that can be life-threatening.[12150][2146]

The first symptoms of SJS/TEN often include fever and flu-like symptoms (such as general ill feeling, body aches, and cough).[14967][2146] Within about 1 to 3 days, a red or purplish rash forms, and then the skin begins to blister and peel, leading to “raw” areas of skin that are painful.[14967][12150] This often starts on the face and then spreads to other parts of the body.[14967][12150] The mucous membranes may also become involved during this time, which can lead to symptoms such as severe conjunctivitis (when the eyes are affected), trouble swallowing and breathing (when the mouth and airway are affected), and difficulty urinating and genital pain (when the genitals are affected).[14967][12150]

SJS/TEN often is triggered by certain medications including  allopurinol, anti-epileptics, pain relievers, cancer therapies, or antibiotics (sometimes up to 2 weeks after stopping the medication). SJS/TEN can also be triggered by infections such as pneumonia, herpes virus, and hepatitis A. In many cases the cause cannot be identified.[12150][2146] People that may be at increased risk to develop SJS/TEN include those with HIV, a weakened immune system, a personal or family history of the condition, and certain variations of a gene called
HLA-B.[12150][2146] There are no universal diagnostic criteria for SJS/TEN. Currently the diagnosis is based on the person’s medical history and symptoms.[14967] People suspected of having SJS/TEN should be admitted to the hospital to confirm the diagnosis and assess severity.[14418] As mentioned earlier, whether a person is diagnosed specifically with SJS, TEN, or SJS/TEN overlap depends on the percentage of body surface area affected.[14967]

Treatment needs should be assessed in the hospital to determine severity and where treatment should be provided (e.g. intensive care unit, burn unit, or dermatology unit). Treatment may involve stopping a triggering medication (for those suspected of having medication-induced SJS/TEN), standard therapies used for major burns, various eye treatments (for those with eye involvement), pain control, and preventing and treating infections.[14418] The overall mortality rate is about 25%, ranging from about 10% for SJS to over 30% for TEN. The most common causes of death include sepsis, acute respiratory distress syndrome, and multiple organ failure. Those that survive may experience recurrence (particularly if re-exposed to a trigger) and/or long-term complications involving the skin and affected mucous membranes.[14418]

Synonyms

• SJS/TEN
• Drug-induced Stevens Johnson syndrome
• Stevens-Johnson syndrome toxic epidermal necrolysis spectrum
• Susceptibility to severe cutaneous adverse reaction ITY TO
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis