Managing the ADR of Stevens-Johnson syndrome/toxic epidermal necrolysis

ABSTRACT

Introduction

Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening adverse drug reactions that are collectively known as epidermal necrolysis. The abrupt detachment of the skin and mucositis results in systemic complications such as fluid and electrolyte disturbances, hypothermia, sepsis, organ failure, and death. Management is multidisciplinary and complex.

Areas covered

This present article reviews the principles and best practices in the care of patients with epidermal necrolysis. These include having prompt admissions to optimal care facilities, coordinated specialized care during the acute phase, as well as long-term follow-up to manage chronic sequelae.

Expert Opinion

Patients with epidermal necrolysis should be managed in specialized/reference centers that are experienced with the management of the disease. Multi-disciplinary supportive care remains the cornerstone. Current evidence precludes definitive recommendation on any immunomodulatory agent as treatment. Long-term follow-up is required in order to diagnose and treat any chronic sequelae.

KEYWORDS:

• Stevens-Johnson syndrome
• toxic epidermal necrolysis
• supportive care
• drug hypersensitivity

Article highlights

• SJS/TEN are life-threatening severe cutaneous adverse reactions largely due to medications.

• A small proportion of cases are idiopathic and are presumably infectious-related.

• The ideal immunomodulatory treatment remains elusive

• Supportive care remains the cornerstone of care

• Survivors should be followed up longitudinally to evaluate and treat for long term sequelae

This box summarizes key points contained in the article.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.