Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Updates on Management

Abstract

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are dermatologic emergencies characterized by extensive epidermal necrolysis and sloughing. The incidence rates vary depending on location, with the UK experiencing an annual incidence of 5.76 cases per million individuals from 1995 to 2013. Females are more frequently afflicted than males, with mortality rates ranging from 4.8-9% to 14.8-48%. Nonpharmacologic treatment for SJS/TEN patients includes supportive care, fluid and electrolyte management, infection control, and wound care. The most critical component is the identification and cessation of the causative substance. Management of fluid, electrolytes, and nutrition is crucial for SJS/TEN patients, as they have lower fluid requirements than burn patients. Prophylactic antibiotics do not enhance outcomes, but infection prevention requires appropriate wound care and antiseptic handling. The role of surgical debridement has been a topic of controversy, and the decision to pursue this treatment option depends on the location of care. Anti-shear therapy, which involves aspiration of blister fluid and preservation of denuded epidermis, has been shown to be effective in reducing mortality rates. Pharmacologic treatment for SJS/TEN has been the subject of few prospective studies due to the disease's rarity. Various treatment regimens involving corticosteroids, IVIg, cyclosporine, and TNF-alpha inhibitors have been reported, but it is challenging to determine whether the disease's remission was due to a specific treatment or the natural course of the disease.