Stevens-Johnson syndrome and toxic epidermal necrolysis
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.
Revisores
Barbara A. Latenser, MD
Director Burn Unit
Department of Surgery
University of Iowa Hospitals
Iowa City
IA
Declarações
BAL declares that she has no competing interests.
Tina Palmieri, MD
Assistant Chief of Burns
Shriners Hospital
UC Davis
Sacramento
CA
Declarações
TP declares that she has no competing interests.
Venkat Gudi, MB BS
Consultant Dermatologist
Department of Dermatology
West Suffolk Hospital
Bury St. Edmunds
UK
Declarações
VG declares that he has no competing interests.
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Declarações
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Referências
Principais artigos
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. Resumo
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.Texto completo Resumo
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. Resumo
Gregory DG. New grading system and treatment guidelines for the acute ocular manifestations of Stevens-Johnson syndrome. Ophthalmology. 2016 Aug;123(8):1653-8. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Drug rash with eosinophilia and systemic symptoms (DRESS)
- Staphylococcal scalded skin syndrome
- Toxic shock syndrome
Mais Diagnósticos diferenciaisDiretrizes
- 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)
Mais Diretrizes
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