STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS: A MULTIDISCIPLINARY DERMATOLOGIC, OPHTHALMOLOGIC, AND ANESTHETIC APPROACH

Abstract

DOI: https://doi.org/10.46296/yc.v9i17.0733

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, immune-mediated mucocutaneous reactions, usually triggered by medications. They represent a spectrum of the same disease, defined by the extent of skin detachment: SJS involves <10% body surface area (BSA), TEN >30%, with overlap forms between 10–30%. Their combined incidence is low (0.4–1.9 cases per million per year), but they carry high morbidity and mortality, especially in TEN (25–30% in different series) (1, 6). Clinically, SJS/TEN are characterized by a flu-like prodrome followed by a diffuse rash with purpuric macules, atypical target lesions, blisters, and epidermal detachment (positive Nikolsky’s sign), accompanied by mucosal involvement of the eyes, mouth, and genitals in most patients (2, 6). The most common triggers are medications, notably anticonvulsants (e.g., lamotrigine, carbamazepine), antibiotics (especially sulfonamides and beta-lactams), non-steroidal anti-inflammatory drugs, and allopurinol (6). Management is based on immediate withdrawal of the offending drug and intensive supportive care, similar to burn patient management, with strict fluid-electrolyte control, early nutritional support, pain control, infection prevention, and early multidisciplinary support (2, 6). Given the multisystem nature of SJS/TEN, an approach involving dermatology, ophthalmology, anesthesiology/critical care, and other specialties is critical to reduce sequelae and mortality. This review analyzes current therapeutic strategies, evidence for major immunomodulatory treatments (corticosteroids, intravenous immunoglobulin, cyclosporine, anti-TNF biologics, among others), and the specific interventions of each specialty in the acute comprehensive management of SJS/TEN. The importance of coordinated multidisciplinary care is emphasized for managing acute cutaneous and systemic complications, as well as preventing chronic sequelae – particularly ophthalmic – that affect survivors’ quality of life.

Keywords: Stevens Johnson syndrome, patient care team, ophthalmology, dermatology, anesthesiology.