CARE / TREATMENT STEVENS JOHNSON SYNDROME

Care of Stevens Johnson Syndrome / Toxic Epidermal Necrolysis

Supportive care
Supportive care you're likely to receive while hospitalized includes:

• Fluid replacement. Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. You may receive fluids and nutrients through a tube placed through your nose and into your stomach (nasogastric tube).

• Skin nursing. Cool, wet compresses will help soothe blisters while they heal. Your health care team may gently remove any dead skin, and then place a dressing with a topical anesthetic over the affected areas, if needed.

Stevens-Johnson syndrome
Stevens-Johnson syndrome — Comprehensive overview covers signs, symptoms, diagnosis, treatment of this severe skin disorder. ... Stevens-Johnson syndrome, ...

 

Drugs cause over 80% of all cases of SJS / TEN. However, 90-95% of TEN cases are caused only by medications. While there have been very rare reports of infections causing SJS and TEN, most of those case reports were published long before scalded skin syndrome and TEN were distinguished by biopsy, making these cases more likely to have been caused by a drug.

The rarity of these reports cast doubt on the reliability of information taken regarding drug intake, and doesn't change the fact that almost all cases of TEN are always caused by a single drug. NSAIDs have recently been recognized by the scientific community to be one of the leading causes of SJS and TEN.

1: Knowles S, Shear NH. Clinical risk management of Stevens-Johnson
syndrome/toxic epidermal necrolysis spectrum. Dermatol Ther. 2009
Sep-Oct;22(5):441-51. Review. PubMed PMID: 19845721.

2: Tougeron-Brousseau B, Delcampe A, Gueudry J, Vera L, Doan S, Hoang-Xuan T,
Muraine M. Vision-related function after scleral lens fitting in ocular
complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Am J
Ophthalmol. 2009 Dec;148(6):852-9.e2. Epub 2009 Oct 17. PubMed PMID: 19837383.

3: Sobol UA, Sherman KL, Smith J, Nagda SN, Micetich K, Nickoloff BJ, Shoup MC.
Sweet's syndrome with neurologic manifestations in a patient with esophageal
adenocarcinoma: case report and review of the literature. Int J Dermatol. 2009
Oct;48(10):1062-5. Review. PubMed PMID: 19785087.

4: Chiang C, Brouha B, Romero L. Erythematous plaques involving calves--quiz
case. Arch Dermatol. 2009 Sep;145(9):1053-8. PubMed PMID: 19770452.

5: Evans J. Topical treatment protocol for Stevens-Johnson syndrome and toxic
epidermal necrolysis: a brief report. J Wound Ostomy Continence Nurs. 2009
Sep-Oct;36(5):509-11. Review. PubMed PMID: 19752660.

6: Timmer-DE Mik L, Broekhuijsen-VAN Henten DM, Oldhoff JM, DE Geer DB,
Sigurdsson V, Pasmans SG. Acquired cutis laxa in childhood Sweet's syndrome.
Pediatr Dermatol. 2009 May-Jun;26(3):358-60. Review. PubMed PMID: 19706111.

7: Luo DQ, Liu JH, Huang YB, He DY, Zhang HY. Cutaneous pili migrans: a case
report and review of the literature. Int J Dermatol. 2009 Sep;48(9):947-50.
Review. PubMed PMID: 19702977.

8: Shay E, Kheirkhah A, Liang L, Sheha H, Gregory DG, Tseng SC. Amniotic membrane
transplantation as a new therapy for the acute ocular manifestations of
Stevens-Johnson syndrome and toxic epidermal necrolysis. Surv Ophthalmol. 2009
Nov-Dec;54(6):686-96. Epub 2009 Aug 21. Review. PubMed PMID: 19699503.

9: Halpern J, Salim A. Pediatric sweet syndrome: case report and literature
review. Pediatr Dermatol. 2009 Jul-Aug;26(4):452-7. Review. PubMed PMID:
19689524.

10: Geria AN, Holcomb KZ, Scheinfeld NS. Necrolytic acral erythema: a review of
the literature. Cutis. 2009 Jun;83(6):309-14. Review. PubMed PMID: 19681342.

11: Kaur I, Dogra S, Narang T, De D. Comparative efficacy of thalidomide and
prednisolone in the treatment of moderate to severe erythema nodosum leprosum: a
randomized study. Australas J Dermatol. 2009 Aug;50(3):181-5. PubMed PMID:
19659979.

12: Cohen PR. Neutrophilic dermatoses: a review of current treatment options. Am
J Clin Dermatol. 2009;10(5):301-12. doi: 10.2165/11310730-000000000-00000.
Review. PubMed PMID: 19658442.

13: Casetti F, Jung W, Wölfle U, Reuter J, Neumann K, Gilb B, Wähling A, Wagner
S, Merfort I, Schempp CM. Topical application of solubilized Reseda luteola
extract reduces ultraviolet B-induced inflammation in vivo. J Photochem Photobiol
B. 2009 Sep 4;96(3):260-5. Epub 2009 Jul 17. PubMed PMID: 19656689.

14: Li YH, Wu Y, Wei HC, Xu YY, Jia LL, Chen J, Yang XS, Dong GH, Gao XH, Chen
HD. Protective effects of green tea extracts on photoaging and
photommunosuppression. Skin Res Technol. 2009 Aug;15(3):338-45. PubMed PMID:
19624431.

15: Monaghan TM, Thomas JD, Goddard W. A painful rash. BMJ. 2009 Jul
15;339:b2293. doi: 10.1136/bmj.b2293. PubMed PMID: 19605450.

16: Van Veen NH, Lockwood DN, van Brakel WH, Ramirez J Jr, Richardus JH.
Interventions for erythema nodosum leprosum. Cochrane Database Syst Rev. 2009 Jul
8;(3):CD006949. Review. PubMed PMID: 19588412.

17: Lim J, Suri A, Chua TP. Steroid-responsive sterile inflammation after
transradial cardiac catheterisation using a sheath with hydrophilic coating.
Heart. 2009 Jul;95(14):1202. PubMed PMID: 19564433.

18: Patel NN, Patel DN. Erythema multiforme syndrome. Am J Med. 2009
Jul;122(7):623-5. PubMed PMID: 19559161.

19: Hazin R, Abuzetun JY, Khatri KA. Derm diagnoses you can't afford to miss. J
Fam Pract. 2009 Jun;58(6):298-306. Review. PubMed PMID: 19508842.

20: Freedman BM. Topical polyphenolic antioxidants reduce the adverse effects of
intense pulsed light therapy. J Cosmet Laser Ther. 2009 Sep;11(3):142-5. PubMed
PMID: 19479604.

21: Koh MJ, Tay YK. An update on Stevens-Johnson syndrome and toxic epidermal
necrolysis in children. Curr Opin Pediatr. 2009 Aug;21(4):505-10. Review. PubMed
PMID: 19474732.

22: Lemyze M, Salomon S, Brown D, Detouche P, Collet F. What is the target? BMJ.
2009 May 27;338:b1604. doi: 10.1136/bmj.b1604. PubMed PMID: 19474026.

23: Edwards K, Stokes H, Suttle K, Potts C, Coles K. Topical treatment protocol
for Stevens-Johnson syndrome and toxic epidermal necrolysis. J Wound Ostomy
Continence Nurs. 2009 May-Jun;36(3):330-4. PubMed PMID: 19448516.

24: Muller FM, Dawe RS, Murdoch RD, McHugh SM, Marshall RP, Sousa A, Sanderson B,
Ferguson J. Delayed ultraviolet erythema not suppressed by oral prednisolone: a
randomized crossover study. Photodermatol Photoimmunol Photomed. 2009
Jun;25(3):143-5. PubMed PMID: 19438993.

25: Alster TS, Wanitphakdeedecha R. Improvement of postfractional laser erythema
with light-emitting diode photomodulation. Dermatol Surg. 2009 May;35(5):813-5.
Epub 2009 Apr 6. PubMed PMID: 19397672.

26: Kieffer C, Cribier B, Lipsker D. Neutrophilic urticarial dermatosis: a
variant of neutrophilic urticaria strongly associated with systemic disease.
Report of 9 new cases and review of the literature. Medicine (Baltimore). 2009
Jan;88(1):23-31. Review. PubMed PMID: 19352297.

27: Shrivastav A, Mitra B, Pal J. Images in clinical tropical medicine: Reactive
arthritis (Poncet's disease) and erythema nodosum accompanying tuberculosis. Am J
Trop Med Hyg. 2009 Apr;80(4):501-2. PubMed PMID: 19346365.

28: Kang W, Hao C, Nie Q. Clinical challenges and images in GI. Sweet syndrome in
association with ulcerative colitis. Gastroenterology. 2009 May;136(5):1507,
1846. Epub 2009 Mar 29. Erratum in: Gastroenterology. 2009 Jul;137(1):393. PubMed
PMID: 19336217.

29: Modi GM, Shen A, Mazloom A, Mawad J, Perez A, Sonabend ML, Hsu S. Lupus
erythematosus masquerading as erythema multiforme: does Rowell syndrome really
exist? Dermatol Online J. 2009 Feb 15;15(2):5. Review. PubMed PMID: 19336022.

30: van der Hulst AE, Sukhai RN. A red ear. J Pediatr. 2009 Apr;154(4):624.
PubMed PMID: 19324228.

31: Koller S, Gerger A, Ahlgrimm-Siess V, Weger W, Smolle J, Hofmann-Wellenhof R.
In vivo reflectance confocal microscopy of erythematosquamous skin diseases. Exp
Dermatol. 2009 Jun;18(6):536-40. Epub 2009 Mar 6. PubMed PMID: 19320740.

32: Lio PA. The many faces of cellulitis. Arch Dis Child Educ Pract Ed. 2009
Apr;94(2):50-4. Review. PubMed PMID: 19304901.

33: Shannon RJ, Chakravarthy D. Effect of a water-based no-sting, protective
barrier formulation and a solvent-containing similar formulation on skin
protection from medical adhesive trauma. Int Wound J. 2009 Feb;6(1):82-8. PubMed
PMID: 19291121.

34: Araki Y, Sotozono C, Inatomi T, Ueta M, Yokoi N, Ueda E, Kishimoto S,
Kinoshita S. Successful treatment of Stevens-Johnson syndrome with steroid pulse
therapy at disease onset. Am J Ophthalmol. 2009 Jun;147(6):1004-11, 1011.e1. Epub
2009 Mar 14. PubMed PMID: 19285657.

35: Morgan AJ, Steen CJ, Schwartz RA, Janniger CK. Erythema toxicum neonatorum
revisited. Cutis. 2009 Jan;83(1):13-6. Review. PubMed PMID: 19271565.

36: McDougal KE, Fallin MD, Moller DR, Song Z, Cutler DJ, Steiner LL, Cutting GR;
ACCESS Research Group. Variation in the lymphotoxin-alpha/tumor necrosis factor
locus modifies risk of erythema nodosum in sarcoidosis. J Invest Dermatol. 2009
Aug;129(8):1921-6. Epub 2009 Feb 19. PubMed PMID: 19225544.

37: Teo L, Tay YK, Liu TT, Kwok C. Stevens-Johnson syndrome and toxic epidermal
necrolysis: efficacy of intravenous immunoglobulin and a review of treatment
options. Singapore Med J. 2009 Jan;50(1):29-33. Review. PubMed PMID: 19224081.

38: V'lckova-Laskoska MT, Caca-Biljanovska NG, Laskoski DS, Kamberova SJ.
Palmoplantar pustulosis treated with itraconazole: a single, active-arm pilot
study. Dermatol Ther. 2009 Jan-Feb;22(1):85-9. PubMed PMID: 19222520.

39: Gueudry J, Roujeau JC, Binaghi M, Soubrane G, Muraine M. Risk factors for the
development of ocular complications of Stevens-Johnson syndrome and toxic
epidermal necrolysis. Arch Dermatol. 2009 Feb;145(2):157-62. PubMed PMID:
19221260.

40: Cassuto D, Mollia JF, Scrimali L, Sirago P. Right-left comparison study of
hydrogel pad versus transparent fluid gel in patients with dermo-cosmetic lesions
undergoing non-ablative laser therapy. J Cosmet Laser Ther. 2009 Mar;11(1):45-51.
PubMed PMID: 19204845.

41: Dadban A, Hirschi S, Sanchez M, Lagrange B. Association of Sweet's syndrome
and acute sarcoidosis: report of a case and review of the literature. Clin Exp
Dermatol. 2009 Mar;34(2):189-91. Review. PubMed PMID: 19187300.

42: Fretzayas A, Douros K, Moustaki M, Nicolaidou P. Papular-purpuric gloves and
socks syndrome in children and adolescents. Pediatr Infect Dis J. 2009
Mar;28(3):250-2. Review. PubMed PMID: 19165131.

43: Levi N, Bastuji-Garin S, Mockenhaupt M, Roujeau JC, Flahault A, Kelly JP,
Martin E, Kaufman DW, Maison P. Medications as risk factors of Stevens-Johnson
syndrome and toxic epidermal necrolysis in children: a pooled analysis.
Pediatrics. 2009 Feb;123(2):e297-304. Epub 2009 Jan 19. PubMed PMID: 19153164.

44: Morita A, Shintani Y, Nishida E, Kato H, Yoshida H, Minamoto M, Yamaguchi Y,
Maeda A. Feasibility and accuracy of a newly developed hand-held device with a
flat-type fluorescent lamp for measuring the minimal erythema dose for
narrow-band UVB therapy. Photodermatol Photoimmunol Photomed. 2009
Feb;25(1):41-4. PubMed PMID: 19152515.

45: Moseley H, Naasan H, Dawe RS, Woods J, Ferguson J. Population reference
intervals for minimal erythemal doses in monochromator phototesting.
Photodermatol Photoimmunol Photomed. 2009 Feb;25(1):8-11. PubMed PMID: 19152510.

46: Oresajo C, Stephens T, Hino PD, Law RM, Yatskayer M, Foltis P, Pillai S,
Pinnell SR. Protective effects of a topical antioxidant mixture containing
vitamin C, ferulic acid, and phloretin against ultraviolet-induced photodamage in
human skin. J Cosmet Dermatol. 2008 Dec;7(4):290-7. PubMed PMID: 19146606.