emDOCs.net Emergency Medicine (EM) Podcast Episode 120: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
May 19, 2025
Delve into the critical world of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. The discussion covers their mechanisms, symptoms, and the nuances of treatment protocols. Discover key risk factors and the importance of specialized care for these serious conditions. Learn about their interconnected nature as delayed hypersensitivity reactions and the essential clinical criteria for effective prognosis and management. Expert insights on identifying causes and enhancing patient care make this an enlightening listen!
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Assess Drug and Infectious Triggers
- Identify medication exposures linked to SJS/TEN like allopurinol, anticonvulsants, antimicrobials, phenobarbital, and NSAIDs.
- Use the Alden tool to assess causative drug likelihood and consider infections and autoimmune triggers as possible causes.
Phases and Onset of SJS/TEN
- SJS/TEN typically begin 3-4 weeks after exposure but can range from 4 days to 8 weeks.
- The disease progresses from a viral prodrome to a painful rash with mucosal involvement followed by desquamation and potential systemic organ injury.
Clinical Diagnosis and Pseudonikolsky Sign
- Diagnose SJS/TEN clinically by a painful mucocutaneous eruption with mucous membrane involvement.
- Check for pseudonikolsky sign by gentle lateral shearing on erythematous skin to identify epidermal separation.