SJS / TEN
1. Clinical Identification
Definition: A severe immune-mediated mucocutaneous reaction, most commonly triggered by medications (Allopurinol, NSAIDs, Anticonvulsants, Sulfa drugs).
The Diagnostic Triad:
- Skin Pain: Exquisite tenderness (the skin hurts to touch). This is the earliest and most reliable warning sign.
- Mucosal Involvement: Painful erosions/crusting of at least 2 sites (Mouth, Eyes, Genitalia).
- Skin Detachment: Erythematous/dusky macules that progress to blisters and sheet-like sloughing.
2. Severity Classification (BSA)
| Diagnosis | Body Surface Area (BSA) |
|---|---|
| SJS | < 10% detachment |
| SJS/TEN Overlap | 10% – 30% detachment |
| TEN | > 30% detachment |
3. Bedside Critical Signs
Nikolsky Sign (Positive):
Apply firm lateral pressure with a finger on normal-appearing skin. If the epidermis slides off or a blister forms, the sign is positive, indicating active epidermal necrolysis.
Atypical Target Lesions:
Unlike Erythema Multiforme (3 rings), SJS/TEN features atypical targets (2 rings or dusky centers) that are often flat and poorly defined.
4. Management
Immediate Primary Care Action:
- Withdraw Trigger: Identify and STOP all suspected medications immediately.
- Fluid Resuscitation: Start IV fluids (Normal Saline/Hartmann's) as for burn patients.
- Wound Care: Do not debride blisters. Apply non-adherent dressings (e.g., paraffin gauze).
- Urgent Referral.
Multi-Disciplinary Care:
- Ophthalmology (Mandatory to prevent blindness/symblepharon).
- Urology/Gynaecology (To prevent mucosal adhesions).
⚠️ Clinical Pearl: SCORTEN is the validated severity-of-illness scale used to predict mortality. If you suspect SJS, check the patient's age, heart rate, and glucose/urea levels for the score.
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