Stevens-Johnson syndrome and toxic epidermal necrolysis

Last reviewed: 4 Jun 2022
Last updated: 13 Sep 2019



History and exam

Key diagnostic factors

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

Risk factors

  • anticonvulsant medicines
  • recent infection
  • recent antibiotic use
  • other medicines
  • systemic lupus erythematosus
  • AIDS
  • radiotherapy
  • bone marrow transplantation
  • human leukocyte antigen and genetic predisposition
  • smallpox vaccination
More risk factors

Diagnostic investigations

1st investigations to order

  • skin biopsy
  • blood cultures
  • FBC
  • glucose
  • magnesium
  • phosphate
  • urea
  • bicarbonate
  • LFTs
  • arterial blood gases and saturation of oxygen
More 1st investigations to order

Investigations to consider

  • serum electrolytes
  • serum creatinine
  • direct immunofluorescence
More investigations to consider

Treatment algorithm


all patients



Areta Kowal-Vern, MD

Adjunct Research Faculty

Arizona Burn Center

Maricopa Integrated Health Systems




AK-V performs occasional manuscript reviews on various topics for Research Square, Inc. in the US for which she receives a nominal monetary fee.

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

    • European guidelines on the use of high-dose intravenous immunoglobulin in dermatology
    • Guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis: an Indian perspective
    More Guidelines
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