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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SJS and TEN Continuum Defined
- Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) form a disease continuum involving a delayed hypersensitivity reaction.
- Classification depends on total body surface area (TBSA) affected: SJS <10%, TEN >30%, overlap in between.
Incidence and Mortality Differences
- SJS incidence is about 9 per million adults yearly, TEN much rarer, around 2 per million.
- Mortality rates differ drastically: less than 5% for SJS versus 15-50% for TEN.
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.