Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

  • Farhan Huq
  • Talib Omer
  • Solomon Behar


Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a life-threatening hypersensitivity reaction which is usually triggered by medications and carries a high mortality. It is typically characterized by a nonspecific flu-like prodrome, followed by round macular or patchy dusky erythematous lesions of the skin that coalesce and develop into bullae, resembling painful thermal burns. Additionally most patients will have mucus membrane involvement. SJS and TEN are a continuum of the same disease entity, whereas SJS is the less severe form of the spectrum with <10% body surface involvement, and TEN with more than 30% is the most severe form, carrying a mortality of 25–34%.

Early discontinuation of the offending drug is essential. Given its similarity to thermal burns, the treatment strategy is predominantly supportive in nature and ideally should occur in a specialized burn unit where the focus should be aggressive fluid resuscitation, early recognition of possible skin infections, pain control, and nutritional support.


Stevens-Johnson syndrome (SJS) Toxic epidermal necrolysis (TEN) Lyell syndrome Nikolsky sign Asboe-Hansen sign Bullae Mucocutaneous Burn Mucosal Macular exanthem SCORTEN score 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Farhan Huq
    • 1
  • Talib Omer
    • 2
  • Solomon Behar
    • 3
  1. 1.Department of DermatologyUniversity of MichiganAnn ArborUSA
  2. 2.Department of Emergency Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Pediatric Emergency MedicineLong Beach Memorial/Miller Children’s Hospital & Children’s Hospital Los AngelesLos AngelesUSA

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