Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: a Review and Update

Abstract

Purpose of Review This review highlights current concepts in the management of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Recent Findings A new scoring system, the ABCD-10, was recently developed to better estimate mortality among SJS/TEN patients. Supportive care remains the mainstay of treatment, and includes wound care, fluid and electrolyte management, management of medical co-morbidities, and infection control. The value of adjuvant therapy remains unclear, but new recent retrospective studies suggest that the combination therapies may be efficacious. Recent prospective studies investigating cyclosporine and etanercept have shown promise in the treatment of SJS/TEN. Summary SJS and TEN are severe mucocutaneous drug reactions associated with high morbidity and mortality. Supportive care is the most universally accepted therapy, although specific strategies may vary among institutions. Adjuvant therapies include corticosteroids, IVIG, cyclosporine, TNF alpha inhibitors, and plasmapheresis but prospective data is still lacking. Clinical trials that may better elucidate their efficacy are currently under way.

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

“…Supportive care is the mainstay of treatment for patients with SJS/TEN and includes cessation of the causative drug, fluid and electrolyte management, infection control, and wound care. Of these components, identification and cessation of the causative drug is most important [46,49,72], but optimization of each measure is necessary to achieve the best outcomes.…”

“…Prognostication is also an important step in the management of SJS/TEN, as it can guide management and placement in an intensive care or burn unit [ 49 ]. The severity-of-illness score for Toxic Epidermal Necrolysis (SCORTEN) scale is the most widely used tool for determining prognosis in patients with SJS/TEN.…”

“…Fluid, electrolyte, and nutrition management is important in SJS/TEN patients and mirrors the requirements of burn patients due to insensible losses through wounds, although fluid requirements are about 30% less in SJS/TEN patients than in burn patients with similar degrees of cutaneous involvement [ 73 , 74 ]. The environment should be kept warm (30–32 °C) [ 49 ] due to loss of thermoregulatory function of skin, and fluid replacement should be driven by urine output, with a goal of 0.5–1 mL/kg/h [ 73 ]. Enteral feeding should be initiated as early as possible and through nasogastric tube feeds if necessary [ 49 ].…”

“…The environment should be kept warm (30–32 °C) [ 49 ] due to loss of thermoregulatory function of skin, and fluid replacement should be driven by urine output, with a goal of 0.5–1 mL/kg/h [ 73 ]. Enteral feeding should be initiated as early as possible and through nasogastric tube feeds if necessary [ 49 ].…”

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Guide for Nurses

“…Despite the risk of infection, prophylactic antibiotic use is not recommended. 6,10,15,23 Wound management can be done with very conservative daily wound care, surgically, or a combination of both. Research does not show evidence of one management method being superior to the other, but many burn centers use a conservative approach initially.…”