Stevens-Johnson syndrome and toxic epidermal necrolysis

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 20 Aug 2025

最后更新： 07 Feb 2025

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe skin detachments with mucocutaneous complications associated with a history of medication use, most commonly anticonvulsants, antibiotics, and nonsteroidal anti-inflammatory drugs.

Patients with HIV or active cancer are at an increased risk of SJS/TEN.

SJS/TEN may present with mild symptoms in early disease, but the condition progresses over several days; close monitoring and regular reassessment is essential.

Once a diagnosis is established, the causative agent should be identified and withdrawn; the patient should receive skin care and supportive management.

Transfer to a burn center, a specialized wound care center, or a dermatology intensive care unit is recommended for patients diagnosed with SJS/TEN.

Patients at risk may need human leukocyte antigen screening if they are to receive medications such as carbamazepine, allopurinol, or trimethoprim/sulfamethoxazole.

定义

SJS is a severe skin detachment with mucocutaneous complications.[1] It is an immune reaction to foreign antigens. SJS is a less severe manifestation of TEN.[2]

Classification is dependent on the percentage of skin involvement: SJS has <10% total body surface area (TBSA) involvement; SJS/TEN overlap has 10% to 30% TBSA involvement; and TEN has >30% TBSA involvement.[3]

病史和体格检查

关键诊断因素

rash
mucosal involvement
Nikolsky sign
blisters

完整详情

危险因素

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

完整详情

诊断性检查

首要检查

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

完整详情

Tests to avoid

erythrocyte sedimentation rate (ESR)

完整详情

需考虑的检查

direct immunofluorescence

完整详情

治疗流程

急症处理

all patients

撰稿人

作者

Areta Kowal-Vern, MD

Adjunct Research Faculty

Arizona Burn Center

Valleywise Health Medical Center

Phoenix

利益声明

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.

同行评议者

Barbara A. Latenser, MD

Director Burn Unit

Department of Surgery

University of Iowa Hospitals

Iowa City

利益声明

BAL declares that she has no competing interests.

Tina Palmieri, MD

Assistant Chief of Burns

Shriners Hospital

UC Davis

Sacramento

利益声明

TP declares that she has no competing interests.

Venkat Gudi, MB BS

Consultant Dermatologist

Department of Dermatology

West Suffolk Hospital

Bury St. Edmunds

利益声明

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.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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. 摘要

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.全文摘要

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. 摘要

Gregory DG. New grading system and treatment guidelines for the acute ocular manifestations of Stevens-Johnson syndrome. Ophthalmology. 2016 Aug;123(8):1653-8. 摘要

参考文献

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
更多 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)
更多 Guidelines
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Stevens-Johnson syndrome and toxic epidermal necrolysis

小结

定义

病史和体格检查

关键诊断因素

危险因素

诊断性检查

首要检查

Tests to avoid

需考虑的检查

治疗流程

all patients

撰稿人

作者

Areta Kowal-Vern, MD

利益声明

同行评议者

Barbara A. Latenser, MD

利益声明

Tina Palmieri, MD

利益声明

Venkat Gudi, MB BS

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice