Stevens-Johnson syndrome and toxic epidermal necrolysis

Last reviewed: 26 Feb 2023
Last updated: 01 Dec 2022



History and exam

Key diagnostic factors

  • presence of risk factors
  • rash
  • mucosal involvement
  • Nikolsky's sign
  • blisters
More key diagnostic factors

Risk factors

  • patients with active cancer
  • anticonvulsant medicines
  • recent infection
  • recent antibiotic use
  • other medicines
  • systemic lupus erythematosus
  • HIV-positive
  • radiotherapy
  • human leukocyte antigen and genetic predisposition
  • smallpox vaccination
  • bone marrow transplantation
More risk factors

Diagnostic investigations

1st investigations to order

  • skin biopsy
  • blood cultures
  • full blood count
  • glucose
  • magnesium
  • phosphate
  • urea
  • bicarbonate
  • serum electrolytes
  • serum creatinine
  • liver function tests
  • erythrocyte sedimentation rate
  • C-reactive protein
  • arterial blood gases and saturation of oxygen
  • chest x-ray
  • coagulation studies
  • skin swab from lesional skin
  • Mycoplasma serology
More 1st investigations to order

Investigations to consider

  • direct immunofluorescence
More investigations to consider

Treatment algorithm


all patients



Areta Kowal-Vern, MD

Adjunct Research Faculty

Arizona Burn Center

Valleywise Health Medical Center




AK-V performs occasional manuscript reviews on various topics for Research Square, Inc. and the Journal of Burn Care and Research in the US for which she receives a nominal monetary fee. AK-V is an author of a reference cited in this topic.

Peer reviewers

Barbara A. Latenser, MD

Director Burn Unit

Department of Surgery

University of Iowa Hospitals

Iowa City



BAL declares that she has no competing interests.

Tina Palmieri, MD

Assistant Chief of Burns

Shriners Hospital

UC Davis




TP declares that she has no competing interests.

Venkat Gudi, MB BS

Consultant Dermatologist

Department of Dermatology

West Suffolk Hospital

Bury St. Edmunds



VG declares that he has no competing interests.

  • Stevens-Johnson syndrome and toxic epidermal necrolysis images
  • Differentials

    • Drug rash with eosinophilia and systemic symptoms (DRESS)
    • Staphylococcal scalded skin syndrome
    • Toxic shock syndrome
    More Differentials
  • Guidelines

    • Supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults
    • Management of Stevens-Johnson syndrome/toxic epidermal necrolysis in children and young people (0 to 17 years)
    More Guidelines
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