Stevens-Johnson Syndrome / TEN

SJS/TEN = drug-induced epidermal necrosis: painful dusky rash, mucositis, Nikolsky-positive blistering, typically 1–4 weeks after a culprit drug (allopurinol, anticonvulsants, sulfonamides). Stopping the drug is the single life-saving act. Classify…

Severe Cutaneous Adverse Reaction Pathway

The pathway

1 · Recognise

Prodrome then painful dusky rash, target lesions
Mucositis — mouth, eyes, genitals
Nikolsky positive — skin shears

2 · STOP the drug

Identify and stop every possible culprit
Document allergy prominently
The one intervention proven to improve survival

3 · Score severity

% detachment: SJS <10 / overlap 10–30 / TEN >30
SCORTEN within 24h — predicts mortality

4 · Burns-style support

IV fluids, warmth, analgesia (opioids)
Non-adherent dressings, minimal handling
No prophylactic antibiotics

5 · Specialists day one

Dermatology urgent ± biopsy
Burns unit/ITU if significant detachment
Ophthalmology same day — eyes scar and blind

6 · Aftermath

MHRA Yellow Card
Allergy documentation + cross-reactant counselling
HLA screening learning for at-risk groups

Drugs

Drug	Dose	Route	Notes
Morphine	Titrated	IV/SC	Skin pain is severe — treat like a burn.
Balanced crystalloid	Guided by losses	IV	Less than equivalent-area burns — avoid overload.
Ocular lubricants	Hourly	TOP	Plus same-day ophthalmology — prevents cicatricial blindness.
AVOID: prophylactic antibiotics	—	—	Treat proven infection only.

When to escalate

Any suspected SJS/TEN — dermatology same hour,Detachment >10% — burns unit/ITU discussion,Ocular involvement — same-day ophthalmology,Airway/oesophageal mucositis — anaesthetics + careful swallow

Reference: BAD SJS/TEN Guidelines 2016 / UK guidelines for SCARs

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