Summary
Definition
History and exam
Key diagnostic factors
- rash
- mucosal involvement
- Nikolsky sign
- blisters
Risk factors
- patients with active cancer
- anticonvulsant medications
- recent infection
- recent antibiotic use
- other medications
- systemic lupus erythematosus
- HIV-positive
- radiation therapy
- human leukocyte antigen and genetic predisposition
- smallpox vaccination
- bone marrow transplantation
Diagnostic tests
1st tests to order
- skin biopsy
- blood cultures
- complete blood count
- glucose
- magnesium
- phosphate
- blood urea nitrogen
- bicarbonate
- serum electrolytes
- serum creatinine
- liver function tests
- C-reactive protein (CRP)
- arterial blood gases and saturation of oxygen
- chest x-ray
- coagulation studies
- skin swab from lesional skin
- Mycoplasma serology
Tests to avoid
- erythrocyte sedimentation rate (ESR)
Tests to consider
- direct immunofluorescence
Treatment algorithm
all patients
Contributors
Authors
Areta Kowal-Vern, MD
Adjunct Research Faculty
Arizona Burn Center
Valleywise Health Medical Center
Phoenix
AZ
Disclosures
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
IA
Disclosures
BAL declares that she has no competing interests.
Tina Palmieri, MD
Assistant Chief of Burns
Shriners Hospital
UC Davis
Sacramento
CA
Disclosures
TP declares that she has no competing interests.
Venkat Gudi, MB BS
Consultant Dermatologist
Department of Dermatology
West Suffolk Hospital
Bury St. Edmunds
UK
Disclosures
VG declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Bastuji-Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993 Jan;129(1):92-6. Abstract
Creamer D, Walsh SA, Dziewulski P, et al. UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. Br J Dermatol. 2016 Jun;174(6):1194-227.Full text Abstract
Seminario-Vidal L, Kroshinsky D, Malachowski SJ, et al. Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults. J Am Acad Dermatol. 2020 Jun;82(6):1553-67. Abstract
Gregory DG. New grading system and treatment guidelines for the acute ocular manifestations of Stevens-Johnson syndrome. Ophthalmology. 2016 Aug;123(8):1653-8. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Drug rash with eosinophilia and systemic symptoms (DRESS)
- Staphylococcal scalded skin syndrome
- Toxic shock syndrome
More DifferentialsGuidelines
- 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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