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Understanding

SJS and TEN


Presented by
Jacynta F Pepin (RN)

Stevens-Johnson Syndrome (SJS) and


Toxic Epidermal Necrolysis (TEN)

Life-threatening mucocutaneous
diseases
Within the spectrum of SCAR
Resemble erythema multiforme majus
(EMM)
Mucosal involvement
Epidermal necrosis

SJS and TEN


SJS usually less severe
Etiology, genetic susceptibility and
pathomechanism are same
Mainly cause by drugs, infection or
unknown
Presents as medical emergency

Signs and Symptoms


Early sign:
Fever
Sore throat
Cough
Burning eyes

Signs and Symptoms

Facial swelling
Tongue swelling
Hives
Skin pain
A red or purple skin rash that spreads
within hours to days
Blisters on skin and mucous membranes
Shedding (sloughing) of skin

Clinical Presentation
Typical Targets with three
concentric zones

Clinical Presentation
Confluent
purpuric
macules and
limited areas of
skin detachment
Nikolsky sign is
positive in
SJS/TEN

Nikolsky Sign
skin can be
pushed slightly
aside by
pressure of
fingers
refer to the base
of the blister,
and thus to the
level of
epidermal

Clinical Presentation
Detachment of large epidermal
sheets in SJS/TEN overlap

Drug Causes

Infectious causes
Herpes (herpes simplex or herpes
zoster)
Influenza
HIV
Diphtheria
Typhoid
Hepatitis

Risk Factor
Almost equal in ratio men:female
Mortality rate:
SJS 10%
SJS / TEN ovelap 30%
TEN 50%

Therapeutic Consideration
Treatment focuses on eliminating the
underlying cause, controlling
symptoms and minimizing
complications.
Recovery can take weeks to months,
depending on the severity of
condition.

Topical Treatment
Blister should be left in place
Erosion: Chlorhexidine, octenisept,
polyhexanide
High room temp
Debride skin under GA and apply
allograft

Supportive Treatment
ICU / Burn Unit
Fluid replacement 0.7ml/kg/%BSA
affected
Albumin 1ml/kg/%skin detachment
Nutritional

Medications

Analgesic
Antihistamines
Antibiotics, when needed
Steroids (topical/oral)
Intravenous corticosteroids
Immunoglobulin intravenous
(IVIG)

Complication
Transdermal fluid loss- hypovolumia
Electrolyte imbalance- katabolic
metabolism
Septicemia usually induced from
CVL
Multiorgan failure

Summary
SJS and TEN are considered as one
disease entity of different severity.
SJS/TEN is mainly caused by drugs,
but also by infections and probably
other risk factors not yet identified.

Summary
The cytolytic protein granulysin
was identified a marker for the
severity of the disease based on skin
detachment.
No treatment has been identified to
be capable of halting the progression
of skin detachment yet.

Summary
supportive management is crucial to
improve the patients state.
Despite all therapeutic efforts,
mortality is high and increases with
disease severity, patients age and
underlying medical conditions.

Thank You

I
SURVIVED