Materiały źródłowe

• #1 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Treating Stevens-Johnson syndrome requires hospitalization, possibly in an intensive care unit or a burn unit. […] The first and most important step in treating Stevens-Johnson syndrome is to stop taking any medications that may be causing it. […] Supportive care you’re likely to receive while in the hospital includes: […] Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. […] Medications used in the treatment of Stevens-Johnson syndrome include: […] If the underlying cause of Stevens-Johnson syndrome can be eliminated and the skin reaction stopped, new skin may begin to grow within several days. In severe cases, full recovery may take several months.

• #2 Stevens-Johnson syndrome

  https://www.nhs.uk/conditions/stevens-johnson-syndrome/

  Stevens-Johnson syndrome is treated in hospital, often in an intensive care unit. […] Without treatment, the symptoms can become life-threatening. […] If it’s thought Stevens-Johnson syndrome is being caused by a medicine you’re taking, the medicine will be stopped. […] You’ll have treatment to relieve your symptoms, which may include: fluids into a vein to prevent dehydration, creams and dressings to moisturise and protect the skin, strong painkillers to help ease any pain, medicines to control inflammation and prevent infection.

• #3 Stevens-Johnson Syndrome (SJS): Causes, Rash & Treatments

  https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

  Hospitalized treatment includes stopping the problem medication, replacing electrolytes, applying skin dressings, and providing pain medications and antibiotics. […] Treatments for Stevens-Johnson syndrome include: stopping the medication that has caused the problem, replacing electrolytes with intravenous (IV) fluids, using non-adhesive dressings on the affected skin, using high-calorie food, possibly by tube-feeding, to promote healing, using antibiotics when needed to prevent infection, providing pain relief medications, treating you in a hospital, possibly even in an intensive care or burn unit, using specialist teams from dermatology and ophthalmology (if your eyes are affected), in some cases, treating you with IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts (for your eyes).

• #4 Management of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: Looking Beyond Guidelines!

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5903040/

  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. […] Early discontinuation of all medicines, supportive measures (hydration, electrolytes, and care of denuded skin), corticosteroids and cyclosporine has been found to be useful. […] Immediate withdrawal of all the suspected drugs is the key to the management of SJS-TEN. […] Maintenance of an ambient body temperature (31C32C), proper fluid-electrolyte balance, and maintenance of a strict aseptic environment are crucial. […] Coverage of denuded skin should be done using paraffin gauze. […] Steroids: From Indian perspective of the disease, systemic steroids have been used for decades in the management.

• #5 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Treating Stevens-Johnson syndrome requires hospitalization, possibly in an intensive care unit or a burn unit. […] The first and most important step in treating Stevens-Johnson syndrome is to stop taking any medications that may be causing it. […] Supportive care you’re likely to receive while in the hospital includes: […] Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. […] Medications used in the treatment of Stevens-Johnson syndrome include: […] If the underlying cause of Stevens-Johnson syndrome can be eliminated and the skin reaction stopped, new skin may begin to grow within several days. In severe cases, full recovery may take several months.

• #6 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Treatment is supportive care; cyclosporine, plasmapheresis or IV immune globulin, early corticosteroid therapy, and tumor necrosis factor-alpha inhibitors have been used. […] Treatment is most successful when Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are recognized early and treated in an inpatient dermatologic or intensive care unit setting; treatment in a burn unit may be needed for severe disease. […] Ophthalmology consultation and specialized eye care are mandatory for patients with ocular involvement. […] Potentially causative medications should be stopped immediately. […] Patients are isolated to minimize exposure to infection and are given fluids, electrolytes, blood products, and nutritional supplements as needed. […] Skin care includes prompt treatment of secondary bacterial infections and daily wound care as for severe burns.

• #7 Stevens-Johnson Syndrome (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/stevens-johnson-syndrome

  Multidisciplinary management of eyes, mucous membranes (gynae, mouth, gastrointestinal tract) helps to improve outcomes and reduce adverse sequelae. […] Acute phase: identify and remove causative drug or underlying cause. […] Use of the ALDEN (Algorithm for assessment of Drug-induced Epidermal Necrolysis) may be useful. […] A rapid assessment of prognosis should be made using the SCORTEN (Score for Toxic Epidermal Necrolysis) system. SCORTEN is an illness severity score which has been developed to predict the mortality rate in SJS and TEN. […] Patients with a SCORTEN score of 3 should be managed in intensive care. […] Supportive: Attention to airway and haemodynamic stability. […] Severe fluid loss may require intravenous fluid replacement and electrolyte correction. […] Pain control.

• #8 Stevens-Johnson syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/symptoms-causes/syc-20355936

  Stevens-Johnson syndrome is a medical emergency that usually requires hospitalization. Treatment focuses on removing the cause, caring for wounds, controlling pain and minimizing complications as skin regrows. It can take weeks to months to recover. […] If you’ve had Stevens-Johnson syndrome (SJS) and your health care provider told you it was caused by a medication, avoid that drug and others like it. This is key to preventing a recurrence, which is usually more severe than the first episode and can be fatal.

• #9 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Management of patients with Stevens-Johnson syndrome usually is provided in intensive care units or burn centers. No specific treatment of Stevens-Johnson syndrome is noted; therefore, most patients are treated symptomatically. In principle, the symptomatic treatment of patients with Stevens-Johnson syndrome does not differ from the treatment of patients with extensive burns. […] Patients should be treated with special attention to airway and hemodynamic stability, fluid status, wound/burn care, and pain control. Care in the ED must be directed to fluid replacement and electrolyte correction. Treatment is primarily supportive and symptomatic. Some have advocated corticosteroids, cyclophosphamide, plasmapheresis, hemodialysis, and immunoglobulin. […] Several therapeutic modalities have been advocated for the treatment of Stevens-Johnson syndrome based on the current, yet incomplete, understanding of its pathogenetic mechanisms. Plasmapheresis, immunosuppressive therapy, and intravenous immunoglobulin (IVIG) have been used with variably successful results.

• #10 Stevens-Johnson Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1197450-overview

  Most patients with Stevens-Johnson syndrome are treated symptomatically. In principle, the symptomatic treatment of patients with this disorder does not differ from the therapy applied to patients with extensive thermal or chemical burns. […] Therapy for Stevens-Johnson syndrome proceeds as follows: Withdrawal of any agent suspected of causing the condition is critically important. Oral lesions are managed with mouthwashes; topical anesthetics are useful in reducing pain and allowing the patient to take in fluids. Areas of denuded skin must be covered with compresses of saline or Burow solution (an aqueous solution of aluminium triacetate). Tetanus prophylaxis must be addressed. […] Extensive debridement of nonviable epidermis followed by immediate cover with biologic dressings is among the recommended treatments.

• #11 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Management of patients with Stevens-Johnson syndrome usually is provided in intensive care units or burn centers. No specific treatment of Stevens-Johnson syndrome is noted; therefore, most patients are treated symptomatically. In principle, the symptomatic treatment of patients with Stevens-Johnson syndrome does not differ from the treatment of patients with extensive burns. […] Patients should be treated with special attention to airway and hemodynamic stability, fluid status, wound/burn care, and pain control. Care in the ED must be directed to fluid replacement and electrolyte correction. Treatment is primarily supportive and symptomatic. Some have advocated corticosteroids, cyclophosphamide, plasmapheresis, hemodialysis, and immunoglobulin. […] Several therapeutic modalities have been advocated for the treatment of Stevens-Johnson syndrome based on the current, yet incomplete, understanding of its pathogenetic mechanisms. Plasmapheresis, immunosuppressive therapy, and intravenous immunoglobulin (IVIG) have been used with variably successful results.

• #12 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Treating Stevens-Johnson syndrome requires hospitalization, possibly in an intensive care unit or a burn unit. […] The first and most important step in treating Stevens-Johnson syndrome is to stop taking any medications that may be causing it. […] Supportive care you’re likely to receive while in the hospital includes: […] Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. […] Medications used in the treatment of Stevens-Johnson syndrome include: […] If the underlying cause of Stevens-Johnson syndrome can be eliminated and the skin reaction stopped, new skin may begin to grow within several days. In severe cases, full recovery may take several months.

• #13 Stevens-Johnson Syndrome (SJS): Causes, Rash & Treatments

  https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

  Hospitalized treatment includes stopping the problem medication, replacing electrolytes, applying skin dressings, and providing pain medications and antibiotics. […] Treatments for Stevens-Johnson syndrome include: stopping the medication that has caused the problem, replacing electrolytes with intravenous (IV) fluids, using non-adhesive dressings on the affected skin, using high-calorie food, possibly by tube-feeding, to promote healing, using antibiotics when needed to prevent infection, providing pain relief medications, treating you in a hospital, possibly even in an intensive care or burn unit, using specialist teams from dermatology and ophthalmology (if your eyes are affected), in some cases, treating you with IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts (for your eyes).

• #14 Stevens-Johnson Syndrome (SJS): Causes, Rash & Treatments

  https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

  Hospitalized treatment includes stopping the problem medication, replacing electrolytes, applying skin dressings, and providing pain medications and antibiotics. […] Treatments for Stevens-Johnson syndrome include: stopping the medication that has caused the problem, replacing electrolytes with intravenous (IV) fluids, using non-adhesive dressings on the affected skin, using high-calorie food, possibly by tube-feeding, to promote healing, using antibiotics when needed to prevent infection, providing pain relief medications, treating you in a hospital, possibly even in an intensive care or burn unit, using specialist teams from dermatology and ophthalmology (if your eyes are affected), in some cases, treating you with IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts (for your eyes).

• #15 Stevens-Johnson syndrome

  https://www.nhs.uk/conditions/stevens-johnson-syndrome/

  Stevens-Johnson syndrome is treated in hospital, often in an intensive care unit. […] Without treatment, the symptoms can become life-threatening. […] If it’s thought Stevens-Johnson syndrome is being caused by a medicine you’re taking, the medicine will be stopped. […] You’ll have treatment to relieve your symptoms, which may include: fluids into a vein to prevent dehydration, creams and dressings to moisturise and protect the skin, strong painkillers to help ease any pain, medicines to control inflammation and prevent infection.

• #16 Management of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: Looking Beyond Guidelines!

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5903040/

  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, which are mainly caused by drugs; and these are usually associated with high degree of morbidity and mortality. […] Early discontinuation of all medicines, supportive measures (hydration, electrolytes, and care of denuded skin), corticosteroids and cyclosporine has been found to be useful. […] Immediate withdrawal of all the suspected drugs is the key to the management of SJS-TEN. […] Maintenance of an ambient body temperature (31C32C), proper fluid-electrolyte balance, and maintenance of a strict aseptic environment are crucial. […] Coverage of denuded skin should be done using paraffin gauze. […] Steroids: From Indian perspective of the disease, systemic steroids have been used for decades in the management.

• #17 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  What is the treatment for SJS/TEN? […] For further details, see Stevens Johnson syndrome / toxic epidermal necrolysis: nursing management. […] Care of a patient with SJS/TEN requires: […] Cessation of suspected causative drug(s) the patient is less likely to die, and complications are less if the culprit drug is on or before the day that blisters/erosions appear […] Hospital admission preferably immediately to an intensive care and burns unit with specialist nursing care, as this improves survival, reduces infection and shortens hospital stay […] Consider fluidised air bed […] Nutritional and fluid replacement (crystalloid) by intravenous and nasogastric routes reviewed and adjusted daily […] Temperature maintenance as body temperature regulation is impaired, the patient should be in a warm room (3032C)

• #18 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #19 Stevens-Johnson syndrome

  https://www.nhs.uk/conditions/stevens-johnson-syndrome/

  Stevens-Johnson syndrome is treated in hospital, often in an intensive care unit. […] Without treatment, the symptoms can become life-threatening. […] If it’s thought Stevens-Johnson syndrome is being caused by a medicine you’re taking, the medicine will be stopped. […] You’ll have treatment to relieve your symptoms, which may include: fluids into a vein to prevent dehydration, creams and dressings to moisturise and protect the skin, strong painkillers to help ease any pain, medicines to control inflammation and prevent infection.

• #20 Stevens–Johnson syndrome and toxic epidermal necrolysis – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis

  SJS/TEN is a complex medical emergency and patients should receive urgent and regular input from a range of specialists, including dermatologists, ophthalmologists, intensivists, dietitians and pharmacists. […] There are no recommended immunomodulatory therapies, but the following may be used on a patient-by-patient basis: Ciclosporin; Corticosteroids; Intravenous immunoglobulins. […] Although the pathophysiology of SJS/TEN is driven via cytotoxic T-lymphocytes and immunocytokine pathways, the role of immunomodulation remains unclear. […] Pain is a characteristic feature of SJS/TEN and patients should be assessed at least once per day using a patient-appropriate pain score. […] Patients should receive adequate background simple analgesia, such as paracetamol, and a weak opioid, such as codeine or tramadol, if required to control pain at rest. […] All patients should receive prophylactic anticoagulation with low-molecular-weight heparin, unless contraindicated.

• #21 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Consider heparin to prevent thromboembolism (blood clots). […] The role of systemic corticosteroids (cortisone) remains controversial. Some clinicians prescribe high doses of corticosteroids for a short time at the start of the reaction, usually prednisone 12 mg/kg/day for 35 days. However concerns have been raised that they may increase the risk of infection, impair wound healing and other complications, and they have not been proven to have any benefit. They are not effective later in the course of the illness. […] Case reports and small patient series have reported benefit from active adjuvant treatments delivered during the first 2448 hours of illness. As SJS/TEN is a rare condition, controlled trials of therapies in large numbers of patients are difficult. […] Ciclosporin 35 mg/kg/day is reported to reduce mortality by 60% compared to patients with similar SCORTEN score on admission that were not treated with ciclosporin. There are contraindications to treatment such as renal impairment.

• #22 Stevens-Johnson Syndrome (SJS): Causes and Treatments

  https://www.webmd.com/skin-problems-and-treatments/stevens-johnson-syndrome

  You’ll be treated for SJS in the hospital by a special team of doctors and nurses. Some people are treated in a burn center or intensive care unit. […] The first thing doctors will do is to stop the medication or treat the infection that made you sick. They’ll also try to relieve your symptoms, prevent infections, and support your healing. […] Your body needs to stay hydrated, and your skin needs protein to rebuild. You’ll probably get fluids from an IV at first, then be fed through a tube that goes into your stomach through your nose. […] Hospital staff will keep your skin clean. They’ll gently remove dead skin and cover bare patches with a special dressing. […] Your care team will clean your eyes and use special drops and creams to keep them from drying out. […] You could be in the hospital from 2 to 4 weeks. It takes time to recover from SJS, and most people do.

• #23 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #24 Stevens-Johnson Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30294

  Patients should undergo interprofessional assessment in a specialized hospital environment. […] Care of a patient with Stevens-Johnson syndrome/toxic epidermal necrolysis requires supportive care, including: cessation of the suspected causative drug(s), hospital admission: preferably to an intensive care and/or burn unit, fluid replacement (crystalloid), nutritional assessment: may require nasogastric tube feeding, temperature control: warm environment, emergency blanket, pain relief, supplemental oxygen and, in some cases, intubation with mechanical ventilation, sterile/aseptic handling. […] Skincare requires daily examination of skin and mucosal surfaces for infection, non-adherent dressings, and avoidance of trauma to the skin. […] Antibiotics may be required for secondary infection but are best avoided prophylactically.

• #25 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #26 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #27 Stevens-Johnson Syndrome – Causes, Symptoms, Diagnosis, Treatment, Prevention & Prognosis

  https://www.medindia.net/health/conditions/stevens-johnson-syndrome.htm

  Stevens-Johnson syndrome is a medical emergency and requires immediate hospitalization. […] Firstly, the medicines suspected of causing SJS are stopped. […] Treatment of skin and mucous membrane lesions: The dead skin is gently removed and the sore areas of the skin are covered with a non-stick dressing to protect them against infection while they heal. Dressings with biosynthetic skin substitutes, or non-adherent nanocrystalline containing silver gauze may be used. […] Antibiotics and local antiseptics are used to treat infection. Tetanus immunization may be given to prevent tetanus infection. […] Intravenous immunoglobulins (IVIG) is given to stop the disease process. It is not clear whether corticosteroids, drugs used to control inflammation reduce mortality or hospital stay in toxic epidermal necrolysis and Stevens-Johnson syndrome since they could increase the chances of infection.

• #28 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #29 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #30 Stevens-Johnson syndrome | Burn and Reconstructive Centers of America

  https://burncenters.com/wounds/wound-services/stevens-johnson-syndrome/

  These skin disorders not only ravage the epithelial tissues of the body but leave the patient susceptible to infection, multi-organ system failure, and other severe complications. For this reason, individuals affected by SJS or TEN must receive treatment at a multi-disciplinary burn center that has experience in healing these disorders. […] Additionally, this can result in requiring skin graft surgeries. Patients may even require intubation on a ventilator to protect the airway.

• #31 Stevens-Johnson Syndrome – What You Need to Know

  https://www.drugs.com/cg/stevens-johnson-syndrome.html

  The goal of treating SJS is to stop symptoms from getting worse. You are put in the hospital to treat SJS. Your healthcare provider will stop the medicine you were taking that caused SJS. You may need any of the following: […] The following list of medications are related to or used in the treatment of this condition. […] What treatments may be used for SJS? Wound care is done to protect skin sores and help them heal. Hydrotherapy is done in a whirlpool to help clean your wounds, and to remove dead tissue from your skin. Physical therapy may be needed to help your arm and leg movement if you have to stay in bed. Surgery may be needed if your skin does not heal properly. You may need debridement to clean the wounds and to remove dirt or dead tissues. A skin graft may be done to cover and help heal the areas where you lost skin. TPN is liquid nutrition that provides your body with protein, sugar, vitamins, minerals, and sometimes fat (lipids). TPN is used when you have problems with eating or digesting food.

• #32 Stevens-Johnson Syndrome (SJS): Causes, Rash & Treatments

  https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

  Hospitalized treatment includes stopping the problem medication, replacing electrolytes, applying skin dressings, and providing pain medications and antibiotics. […] Treatments for Stevens-Johnson syndrome include: stopping the medication that has caused the problem, replacing electrolytes with intravenous (IV) fluids, using non-adhesive dressings on the affected skin, using high-calorie food, possibly by tube-feeding, to promote healing, using antibiotics when needed to prevent infection, providing pain relief medications, treating you in a hospital, possibly even in an intensive care or burn unit, using specialist teams from dermatology and ophthalmology (if your eyes are affected), in some cases, treating you with IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts (for your eyes).

• #33 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #34 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Treatment is supportive care; cyclosporine, plasmapheresis or IV immune globulin, early corticosteroid therapy, and tumor necrosis factor-alpha inhibitors have been used. […] Treatment is most successful when Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are recognized early and treated in an inpatient dermatologic or intensive care unit setting; treatment in a burn unit may be needed for severe disease. […] Ophthalmology consultation and specialized eye care are mandatory for patients with ocular involvement. […] Potentially causative medications should be stopped immediately. […] Patients are isolated to minimize exposure to infection and are given fluids, electrolytes, blood products, and nutritional supplements as needed. […] Skin care includes prompt treatment of secondary bacterial infections and daily wound care as for severe burns.

• #35 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Stevens-Johnson syndrome (SJS) is a type IV hypersensitivity that presents as an acute inflammatory vesiculobullous reaction involving the skin and mucous membranes. […] Ophthalmologists play a critical role in managing the acute stage to help lessen chronic sequelae. […] Management ideally is done in a burn unit with collaboration between intensivist/hospitalist, dermatology, and ophthalmology for management of dehydration and infection. […] Despite controversy in the efficacy of significantly reducing late ocular complications, systemic therapy such as immunosuppressive medications, intravenous corticosteroids, and intravenous immunoglobulin may be utilized. […] From an ophthalmic standpoint, the main goal from at this stage includes lubrication of the ocular surface, which can be achieved with frequent preservative-free artificial tears or ointment.

• #36 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #37 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #38 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Stevens-Johnson syndrome (SJS) is a type IV hypersensitivity that presents as an acute inflammatory vesiculobullous reaction involving the skin and mucous membranes. […] Ophthalmologists play a critical role in managing the acute stage to help lessen chronic sequelae. […] Management ideally is done in a burn unit with collaboration between intensivist/hospitalist, dermatology, and ophthalmology for management of dehydration and infection. […] Despite controversy in the efficacy of significantly reducing late ocular complications, systemic therapy such as immunosuppressive medications, intravenous corticosteroids, and intravenous immunoglobulin may be utilized. […] From an ophthalmic standpoint, the main goal from at this stage includes lubrication of the ocular surface, which can be achieved with frequent preservative-free artificial tears or ointment.

• #39 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #40 Stevens-Johnson Syndrome: What a Pharmacist Should Know

  https://www.uspharmacist.com/article/stevens-johnson-syndrome-what-a-pharmacist-should-know-41888

  Prompt initiation of appropriate treatment can potentially reduce the morbidity and mortality associated with SJS. Supportive care, similar to that provided to burn victims, is a vital component in the acute management of patients with SJS. Patients will commonly have fluid and electrolyte abnormalities that require careful monitoring; a recommended equation for fluid replacement is 0.7 mL/kg per percentage of body surface area (BSA) affected. […] Mouth care with disinfecting mouthwashes (chlorhexidine) and mild ointments (white petroleum) is essential in managing the mucosal lesions of the oral cavity and lips. […] Every patient, whether acute ocular involvement is apparent or not, should have his or her eyes evaluated, preferably by an ophthalmologist. […] Recent evidence suggests that the use of ophthalmic topical steroids (fluorometholone ointment 0.1% every 1-2 hours for about 1-2 weeks) and amniotic membranes may help to preserve visual acuity and protect against scarring.

• #41 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Additional supportive therapy includes saline rinses to remove inflammatory debris, removal of membranes, mechanical lysis of adhesions, bandage contact lens placement, and use of topical antibiotics in the presence of epithelial defects. […] The most significant therapeutic intervention shown to have long-term benefit at this stage is the application of early amniotic membrane covering the entire ocular surface (cornea, bulbar conjunctiva, palpebral conjunctiva) and eyelid margins within the first week of symptom onset or as early in the clinical course as possible. […] Following the acute course of SJS, patients should be reevaluated as an outpatient within 1 month of hospital discharge, every 2 to 4 months for the first year, and then every 6 months afterward based on clinical course.

• #42 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Additional supportive therapy includes saline rinses to remove inflammatory debris, removal of membranes, mechanical lysis of adhesions, bandage contact lens placement, and use of topical antibiotics in the presence of epithelial defects. […] The most significant therapeutic intervention shown to have long-term benefit at this stage is the application of early amniotic membrane covering the entire ocular surface (cornea, bulbar conjunctiva, palpebral conjunctiva) and eyelid margins within the first week of symptom onset or as early in the clinical course as possible. […] Following the acute course of SJS, patients should be reevaluated as an outpatient within 1 month of hospital discharge, every 2 to 4 months for the first year, and then every 6 months afterward based on clinical course.

• #43 Stevens-Johnson Syndrome: What a Pharmacist Should Know

  https://www.uspharmacist.com/article/stevens-johnson-syndrome-what-a-pharmacist-should-know-41888

  Prompt initiation of appropriate treatment can potentially reduce the morbidity and mortality associated with SJS. Supportive care, similar to that provided to burn victims, is a vital component in the acute management of patients with SJS. Patients will commonly have fluid and electrolyte abnormalities that require careful monitoring; a recommended equation for fluid replacement is 0.7 mL/kg per percentage of body surface area (BSA) affected. […] Mouth care with disinfecting mouthwashes (chlorhexidine) and mild ointments (white petroleum) is essential in managing the mucosal lesions of the oral cavity and lips. […] Every patient, whether acute ocular involvement is apparent or not, should have his or her eyes evaluated, preferably by an ophthalmologist. […] Recent evidence suggests that the use of ophthalmic topical steroids (fluorometholone ointment 0.1% every 1-2 hours for about 1-2 weeks) and amniotic membranes may help to preserve visual acuity and protect against scarring.

• #44 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Maintenance of ocular integrity can be achieved through the use of amniotic membrane grafting, adhesive glues, lamellar grafts, and penetrating keratoplasty, either in the acute phase or in subsequent follow-up care. […] Long-term management frequently involves the treatment of trichitic lashes and/or eyelid margin repair for distichiasis or entropion. If the ocular surface repeatedly fails to heal after multiple surgical interventions, keratoprosthesis may be considered as a last resort.

• #45 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  In the chronic stage, management is tailored to severity, but lubrication again remains vital. […] Long-term treatment and visual rehabilitation may require eyelid surgery (eg, mucous membrane graft), keratoplasty, ocular surface stem cell transplantation, keratoprosthesis, and globe-salvaging procedures. […] Preventing irreversible sequelae with appropriate early management can be easier than trying to address them later.

• #46 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  Maintenance of ocular integrity can be achieved through the use of amniotic membrane grafting, adhesive glues, lamellar grafts, and penetrating keratoplasty, either in the acute phase or in subsequent follow-up care. […] Long-term management frequently involves the treatment of trichitic lashes and/or eyelid margin repair for distichiasis or entropion. If the ocular surface repeatedly fails to heal after multiple surgical interventions, keratoprosthesis may be considered as a last resort.

• #47 BostonSight | PROSE | Medical Treatment for Stevens-Johnson Syndrome

  https://www.bostonsight.org/patients/eye-conditions/sjs/

  Currently, there is no cure for damage to the eyes caused by SJS. However, PROSE treatment can provide relief and improved vision. […] PROSE treatment uses specially designed prosthetic scleral lenses that vault over the corneal surface, creating a reservoir between the cornea and the lens. The reservoir is filled with preservative-free saline to bathe and hydrate the eye all day, providing immediate relief and comfort and promoting healing. PROSE prosthetic lenses can also provide improved vision. […] 100% of patients with ocular complications from SJS / TENS reported that their eye health, vision, and quality of life improved with PROSE treatment by BostonSight.

• #48 Stevens–Johnson syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Stevens%E2%80%93Johnson_syndrome

  An ophthalmologist should be consulted immediately, as SJS frequently causes the formation of scar tissue inside the eyelids, leading to corneal vascularization, impaired vision, and a host of other ocular problems. Those with chronic ocular surface disease caused by SJS may find some improvement with PROSE treatment (prosthetic replacement of the ocular surface ecosystem treatment).

• #49 Stevens-Johnson Syndrome: What a Pharmacist Should Know

  https://www.uspharmacist.com/article/stevens-johnson-syndrome-what-a-pharmacist-should-know-41888

  Prompt initiation of appropriate treatment can potentially reduce the morbidity and mortality associated with SJS. Supportive care, similar to that provided to burn victims, is a vital component in the acute management of patients with SJS. Patients will commonly have fluid and electrolyte abnormalities that require careful monitoring; a recommended equation for fluid replacement is 0.7 mL/kg per percentage of body surface area (BSA) affected. […] Mouth care with disinfecting mouthwashes (chlorhexidine) and mild ointments (white petroleum) is essential in managing the mucosal lesions of the oral cavity and lips. […] Every patient, whether acute ocular involvement is apparent or not, should have his or her eyes evaluated, preferably by an ophthalmologist. […] Recent evidence suggests that the use of ophthalmic topical steroids (fluorometholone ointment 0.1% every 1-2 hours for about 1-2 weeks) and amniotic membranes may help to preserve visual acuity and protect against scarring.

• #50 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #51 Stevens-Johnson Syndrome: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1197450-overview

  Most patients with Stevens-Johnson syndrome are treated symptomatically. In principle, the symptomatic treatment of patients with this disorder does not differ from the therapy applied to patients with extensive thermal or chemical burns. […] Therapy for Stevens-Johnson syndrome proceeds as follows: Withdrawal of any agent suspected of causing the condition is critically important. Oral lesions are managed with mouthwashes; topical anesthetics are useful in reducing pain and allowing the patient to take in fluids. Areas of denuded skin must be covered with compresses of saline or Burow solution (an aqueous solution of aluminium triacetate). Tetanus prophylaxis must be addressed. […] Extensive debridement of nonviable epidermis followed by immediate cover with biologic dressings is among the recommended treatments.

• #52 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Topical oral anaesthetic […] Genital care […] If ulcerated, prevent vaginal adhesions using intravaginal steroid ointment, soft vaginal dilators. […] Lung care […] Consider aerosols, bronchial aspiration, physiotherapy […] May require intubation and mechanical ventilation if trachea and bronchi are involved […] Urinary care […] Catheter because of genital involvement and immobility […] Culture urine for bacterial infection […] General […] Psychiatric support for extreme anxiety and emotional lability […] Physiotherapy to maintain joint movement and reduce the risk of pneumonia […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis

• #53 Stevens-Johnson Syndrome: What a Pharmacist Should Know

  https://www.uspharmacist.com/article/stevens-johnson-syndrome-what-a-pharmacist-should-know-41888

  Prompt initiation of appropriate treatment can potentially reduce the morbidity and mortality associated with SJS. Supportive care, similar to that provided to burn victims, is a vital component in the acute management of patients with SJS. Patients will commonly have fluid and electrolyte abnormalities that require careful monitoring; a recommended equation for fluid replacement is 0.7 mL/kg per percentage of body surface area (BSA) affected. […] Mouth care with disinfecting mouthwashes (chlorhexidine) and mild ointments (white petroleum) is essential in managing the mucosal lesions of the oral cavity and lips. […] Every patient, whether acute ocular involvement is apparent or not, should have his or her eyes evaluated, preferably by an ophthalmologist. […] Recent evidence suggests that the use of ophthalmic topical steroids (fluorometholone ointment 0.1% every 1-2 hours for about 1-2 weeks) and amniotic membranes may help to preserve visual acuity and protect against scarring.

• #54 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Topical oral anaesthetic […] Genital care […] If ulcerated, prevent vaginal adhesions using intravaginal steroid ointment, soft vaginal dilators. […] Lung care […] Consider aerosols, bronchial aspiration, physiotherapy […] May require intubation and mechanical ventilation if trachea and bronchi are involved […] Urinary care […] Catheter because of genital involvement and immobility […] Culture urine for bacterial infection […] General […] Psychiatric support for extreme anxiety and emotional lability […] Physiotherapy to maintain joint movement and reduce the risk of pneumonia […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis

• #55 Stevens-Johnson Syndrome – Causes, Symptoms, Diagnosis, Treatment, Prevention & Prognosis

  https://www.medindia.net/health/conditions/stevens-johnson-syndrome.htm

  Mouthwash and topical oral anesthetics are prescribed to alleviate pain in the mouth and throat and enable oral nutritional intake. […] The eyes are treated with lubricant or artificial tears to stop the surface drying out. Topical steroids, antiseptics and antibiotics may be used to prevent inflammation and infection. Surgical treatment e.g. PROSE treatment (prosthetic replacement of ocular surface ecosystem) may be needed for chronic ocular surface disease. […] Intravaginal steroid ointments are used in women to prevent scar tissue formation in the vagina. […] Other treatments used for SJS patients include: Nutritional and fluid replacement through a nasogastric tube or intravenously to prevent and treat dehydration and support nutrition. […] Temperature maintenance of 30-32C as body temperature regulation is impaired. […] Analgesics/ painkillers for pain relief. […] Intubation and mechanical ventilation, which may be required if the trachea (windpipe) and bronchi are affected, and the patient has respiratory problems. […] Psychiatric support for extreme anxiety and emotional lability, if present.

• #56 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Topical oral anaesthetic […] Genital care […] If ulcerated, prevent vaginal adhesions using intravaginal steroid ointment, soft vaginal dilators. […] Lung care […] Consider aerosols, bronchial aspiration, physiotherapy […] May require intubation and mechanical ventilation if trachea and bronchi are involved […] Urinary care […] Catheter because of genital involvement and immobility […] Culture urine for bacterial infection […] General […] Psychiatric support for extreme anxiety and emotional lability […] Physiotherapy to maintain joint movement and reduce the risk of pneumonia […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis

• #57 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9495335/

  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are uncommon but life-threatening diseases mostly caused by drugs. Although various systemic immunomodulating agents have been used, their therapeutic efficacy has been inconsistent. […] The use of systemic corticosteroids and IVIg is still controversial. An increasing number of studies have suggested the effectiveness of cyclosporine and biologic anti-TNF- in recent years. […] The pathophysiology of SJS/TEN is now believed to involve immune-mediated reactions from both innate and adaptive immune systems. Therefore, use of various systemic immunomodulating agents including steroids, intravenous immunoglobulin (IVIg), cyclosporine, and anti-TNF- has been investigated for stopping the progression of epidermal necrosis. However, many of the reports pertaining to these therapies were uncontrolled studies and there is no consistent evidence of the therapeutic effectiveness.

• #58 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  The management essentials include early recognition of the condition, cessation of suspected drug(s) if any, prompt institution of supportive therapy, referral if required, initiation of specific therapy, management of complications and prevention of future episodes. […] Disease-modifying therapy in SJS/TEN is aimed at halting the immunological processes leading to keratinocyte apoptosis. Various immunomodulating agents such as systemic corticosteroids, cyclosporine, intravenous immunoglobulin, plasmapheresis, tumor necrosis factor- inhibitors, granulocyte colony-stimulating factor and N-acetylcysteine have been used with variable results across the globe. […] Traditionally, systemic corticosteroids have remained the mainstay of therapy of Stevens-Johnson syndrome and toxic epidermal necrolysis in most centers.

• #59 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Pharmacotherapy of SJS/TEN is controversial. Cyclosporine (3 to 5 mg/kg orally once/day) inhibits CD8 cells and has been shown to decrease the duration of active disease (eg, by 2 to 3 days in some instances) and possibly decrease mortality. […] The use of systemic corticosteroids remains controversial. […] However, some reports show improved outcomes with early corticosteroid therapy. […] Plasmapheresis can remove reactive drug metabolites or antibodies and can be considered. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #60 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9495335/

  According to the UK guidelines for the management of SJS/TEN, withdrawal of the culprit drug and multidisciplinary supportive care should be prioritized over systemic treatment because of the paucity of evidence of the treatment efficacy. However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] Several meta-analyses suggest a beneficial effect of CsA. […] The increased TNF- levels in SJS/TEN patients has led to the suggestions of using TNF- inhibitors. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice.

• #61 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  The use of systemic steroids remains controversial. Some authors believe that they are contraindicated, especially because there may be some question about the diagnosis. […] The currently advocated approach for corticosteroid use suggests the early use of short-term (4-7 days), high-dose intravenous corticosteroids. […] The rationale for the use of IVIG is the most appealing. Based on in vitro and clinical data, IVIG can block the Fas receptors on the surface of the keratinocytes, thus interfering with the Fas-Fas ligand mediated apoptosis. […] The role of other immunosuppressive therapy, that is, cyclosporine, azathioprine, or cyclophosphamide, in the acute phase is less popular, particularly since such medication typically takes weeks to begin to influence immunologic reactions. […] Treatment of acute ocular manifestations usually begins with aggressive lubrication of the ocular surface.

• #62 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor- inhibitors. […] The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. […] This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids.

• #63 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor- inhibitors. […] The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. […] This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids.

• #64 Glucocorticoids for the treatment of SJS/TEN syndrome | CCID

  https://www.dovepress.com/effectiveness-and-safety-of-early-short-course-moderate–to-high-dose–peer-reviewed-fulltext-article-CCID

  Early systemic application of medium- to high-dose glucocorticoids is effective in the treatment of SJS/TEN, and it is beneficial in reducing mortality. […] The short-term application of medium- to high-dose hormone therapy for SJS/TEN has little effect on underlying diseases. […] The related complications are mostly mild, and the treatment is safe. […] All 56 patients were treated with systemic glucocorticoids. […] The initial dose was equivalent to 33.75 mg/d-150 mg/d prednisone. […] Thirty-two patients (57.1%) received combined intravenous human immunoglobulin. […] The actual mortality rate was 1.8%, which was significantly lower than the overall expected mortality rate of 15.0%. […] The remaining 55 patients had improved/recovered skin and mucous membranes, infections and visceral complications. […] The rash recovery rate was 98.2%. […] The early systemic application of high-dose hormones is prone to suspected hormone-related adverse reactions, but most are mild. […] With the reduction in steroid doses and related symptomatic treatment, these patients can rapidly improve/recover.

• #65 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://www.mdpi.com/2227-9059/10/9/2105

  However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] However, meta-analyses by Zimmermann et al. (2017) and Houschyar et al. (2021) suggested that steroids may improve survival. […] Japanese treatment guidelines recommend pulse corticosteroid therapy as one of the first-line treatments for SJS/TEN under appropriate infection control. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] However, a large retrospective study of 281 patients in 2008 found no significant difference in mortality on comparing patients treated with IVIg and those who received supportive care.

• #66 SciELO Brazil – Stevens-Johnson syndrome and toxic epidermal necrolysis: a review Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

  https://www.scielo.br/j/ramb/a/D75h5BfLmz5Tw5JnMTXtPjF/

  Prophylactic antibiotic therapy is not recommended as it can induce resistance and because these drugs can per se be causative agents of SJS or TEN. Therefore, they are given only in proven cases of infection, or when there is sudden decrease/rise in temperature, poor general condition, or positive skin cultures. […] Specific therapies for SJS and TEN have not yet reached evidence-based acceptance standards. The low prevalence of the disease and its lethal potential make it difficult to perform randomized clinical trials. […] Some reviews concluded that steroids do not shorten the duration of disease and may also increase the risk of infections and worsen healing. Many authors do not recommend the routine use of systemic steroids in the treatment of SJS/TEN but some centers advocate an early pulse (first 48 hours).

• #67 Clinical characteristics and treatment outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis

  https://www.spandidos-publications.com/10.3892/etm.2015.2549

  The use of systemic corticosteroid treatment in patients with SJS/TEN is controversial, with concerns regarding an increased rate of infections, the masking of septicemia, and delay of epithelialization. By contrast, the benefits of immunosuppressants (including corticosteroids) have been reported as preventing ocular complications. In the present study, 65% of patients received systemic steroid treatment (range, 1-10 days). Notably, there was no mortality in patients treated with systemic steroids. […] The results of the present study suggest the beneficial effect of systemic corticosteroid use in selected groups of SJS and/or TEN patients.

• #68 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Most authors agree that corticosteroids are useful when given at an early stage. […] In recent years, cyclosporine has gained popularity in the treatment of SJS/TEN. […] A perception that use of corticosteroids leads to enhanced mortality in SJS/TEN led to the search for alternative immunomodulatory agent(s). […] The various aspects of the management of SJS/TEN with their evidence levels and grade of recommendation are summarized in

• #69 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9495335/

  According to the UK guidelines for the management of SJS/TEN, withdrawal of the culprit drug and multidisciplinary supportive care should be prioritized over systemic treatment because of the paucity of evidence of the treatment efficacy. However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] Several meta-analyses suggest a beneficial effect of CsA. […] The increased TNF- levels in SJS/TEN patients has led to the suggestions of using TNF- inhibitors. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice.

• #70 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Pharmacotherapy of SJS/TEN is controversial. Cyclosporine (3 to 5 mg/kg orally once/day) inhibits CD8 cells and has been shown to decrease the duration of active disease (eg, by 2 to 3 days in some instances) and possibly decrease mortality. […] The use of systemic corticosteroids remains controversial. […] However, some reports show improved outcomes with early corticosteroid therapy. […] Plasmapheresis can remove reactive drug metabolites or antibodies and can be considered. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #71 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor- inhibitors. […] The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. […] This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids.

• #72 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor- inhibitors. […] The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. […] This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids.

• #73 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Pharmacotherapy of SJS/TEN is controversial. Cyclosporine (3 to 5 mg/kg orally once/day) inhibits CD8 cells and has been shown to decrease the duration of active disease (eg, by 2 to 3 days in some instances) and possibly decrease mortality. […] The use of systemic corticosteroids remains controversial. […] However, some reports show improved outcomes with early corticosteroid therapy. […] Plasmapheresis can remove reactive drug metabolites or antibodies and can be considered. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #74 Stevens-Johnson syndrome

  https://www.myamericannurse.com/stevens-johnson-syndrome/

  Immediate medication discontinuation aids treatment success. […] Treatment for minor rashes includes stopping the triggering agent and administering diphenhydramine. Severe rashes require hospitalization and treatment with prednisone. […] For more severe rashes, treatment includes prednisone 10 mg twice a day. […] Patients experiencing severe symptoms require hospital admission and laboratory studies to monitor for developing anemia, neutropenia, thrombocytopenia, elevated erythrocyte sedimentation rate, and elevated blood urea nitrogen. […] If the rash is minor, treatment includes stopping the agent and administering diphenhydramine 25 to 50 mg twice a day. […] The hospitalist also orders cyclosporine (5 mg/kg in two divided doses per day), which has recently emerged as a promising treatment for SJS because of its effective anti-apoptotic activity.

• #75 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Pharmacotherapy of SJS/TEN is controversial. Cyclosporine (3 to 5 mg/kg orally once/day) inhibits CD8 cells and has been shown to decrease the duration of active disease (eg, by 2 to 3 days in some instances) and possibly decrease mortality. […] The use of systemic corticosteroids remains controversial. […] However, some reports show improved outcomes with early corticosteroid therapy. […] Plasmapheresis can remove reactive drug metabolites or antibodies and can be considered. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #76 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Consider heparin to prevent thromboembolism (blood clots). […] The role of systemic corticosteroids (cortisone) remains controversial. Some clinicians prescribe high doses of corticosteroids for a short time at the start of the reaction, usually prednisone 12 mg/kg/day for 35 days. However concerns have been raised that they may increase the risk of infection, impair wound healing and other complications, and they have not been proven to have any benefit. They are not effective later in the course of the illness. […] Case reports and small patient series have reported benefit from active adjuvant treatments delivered during the first 2448 hours of illness. As SJS/TEN is a rare condition, controlled trials of therapies in large numbers of patients are difficult. […] Ciclosporin 35 mg/kg/day is reported to reduce mortality by 60% compared to patients with similar SCORTEN score on admission that were not treated with ciclosporin. There are contraindications to treatment such as renal impairment.

• #77 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor- inhibitors. […] The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. […] This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids.

• #78

  https://link.springer.com/article/10.1007/s40257-024-00889-6

  Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, T cell-mediated, severe cutaneous adverse reaction (SCAR) to medication. […] Supportive care remains the mainstay of all SJS/TEN treatment and a high-level evidence base is lacking for any single therapeutic intervention. TNF inhibitors (etanercept), cyclosporine, and combinations of different agents show some promise in unblinded randomized controlled trials and small observational studies. […] Treatment for SJS/TEN is complex, and there are no standardized guidelines for treatment currently. Our inability to accurately measure severity and appropriate outcomes is a major hindrance to determining standard of care. Withdrawal of the offending drug and all nonessential medications is critical, followed by hospitalization and supportive care.

• #79 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Consider heparin to prevent thromboembolism (blood clots). […] The role of systemic corticosteroids (cortisone) remains controversial. Some clinicians prescribe high doses of corticosteroids for a short time at the start of the reaction, usually prednisone 12 mg/kg/day for 35 days. However concerns have been raised that they may increase the risk of infection, impair wound healing and other complications, and they have not been proven to have any benefit. They are not effective later in the course of the illness. […] Case reports and small patient series have reported benefit from active adjuvant treatments delivered during the first 2448 hours of illness. As SJS/TEN is a rare condition, controlled trials of therapies in large numbers of patients are difficult. […] Ciclosporin 35 mg/kg/day is reported to reduce mortality by 60% compared to patients with similar SCORTEN score on admission that were not treated with ciclosporin. There are contraindications to treatment such as renal impairment.

• #80 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9495335/

  According to the UK guidelines for the management of SJS/TEN, withdrawal of the culprit drug and multidisciplinary supportive care should be prioritized over systemic treatment because of the paucity of evidence of the treatment efficacy. However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] Several meta-analyses suggest a beneficial effect of CsA. […] The increased TNF- levels in SJS/TEN patients has led to the suggestions of using TNF- inhibitors. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice.

• #81 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://www.mdpi.com/2227-9059/10/9/2105

  However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] However, meta-analyses by Zimmermann et al. (2017) and Houschyar et al. (2021) suggested that steroids may improve survival. […] Japanese treatment guidelines recommend pulse corticosteroid therapy as one of the first-line treatments for SJS/TEN under appropriate infection control. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] However, a large retrospective study of 281 patients in 2008 found no significant difference in mortality on comparing patients treated with IVIg and those who received supportive care.

• #82 Stevens-Johnson Syndrome Treatment & Management: Approach Considerations, Supportive Systemic Therapy, Infection Control

  https://emedicine.medscape.com/article/1197450-treatment

  The use of systemic steroids remains controversial. Some authors believe that they are contraindicated, especially because there may be some question about the diagnosis. […] The currently advocated approach for corticosteroid use suggests the early use of short-term (4-7 days), high-dose intravenous corticosteroids. […] The rationale for the use of IVIG is the most appealing. Based on in vitro and clinical data, IVIG can block the Fas receptors on the surface of the keratinocytes, thus interfering with the Fas-Fas ligand mediated apoptosis. […] The role of other immunosuppressive therapy, that is, cyclosporine, azathioprine, or cyclophosphamide, in the acute phase is less popular, particularly since such medication typically takes weeks to begin to influence immunologic reactions. […] Treatment of acute ocular manifestations usually begins with aggressive lubrication of the ocular surface.

• #83 Use of intravenous immunoglobulin for Stevens–Johnson syndrome and toxic epidermal necrolysis in children: Report of two cases secondary to anticonvulsants | Allergologia et Immunopathologia

  https://www.elsevier.es/en-revista-allergologia-et-immunopathologia-105-articulo-use-intravenous-immunoglobulin-for-stevensjohnson-S0301054614001219

  Use of intravenous immunoglobulin for Stevens-Johnson syndrome and toxic epidermal necrolysis in children: Report of two cases secondary to anticonvulsants. […] There is no specific treatment for SJS and TEN. The first step is to suspend the use of the drug suspected to be the cause. Concurrently, supportive care should be administered, and any complications should be treated. The state of hydration and nourishment of the patient is essential for the disease management. […] Considering the immunological basis of SJS and TEN, the use of intravenous immunoglobulin (IVIG) as a treatment in paediatric patients has been proposed, with certain studies reporting successful results. […] IVIG acts at the level of the Fas receptor, thereby blocking its binding to FasL and preventing apoptosis of keratinocytes in SJS and TEN. In addition, IVIG also has effects that support its use in these conditions because IVIG decreases the infectious complications, reduces fluid loss through the denuded skin, and has immunomodulatory effects.

• #84 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Other options include: […] Anti-TNF monoclonal antibodies (eg, infliximab, etanercept) […] Cyclophosphamide […] Intravenous immunoglobulin (IVIG) 23 g/kg given over 23 days […] Plasmapheresis […] Granulocyte-colony stimulating factor (GCS-F). […] Thalidomide, trialled because of its anti-TNF effect, increased mortality, and should not be used.

• #85 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Pharmacotherapy of SJS/TEN is controversial. Cyclosporine (3 to 5 mg/kg orally once/day) inhibits CD8 cells and has been shown to decrease the duration of active disease (eg, by 2 to 3 days in some instances) and possibly decrease mortality. […] The use of systemic corticosteroids remains controversial. […] However, some reports show improved outcomes with early corticosteroid therapy. […] Plasmapheresis can remove reactive drug metabolites or antibodies and can be considered. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #86 RF – Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Treatment Update | Actas Dermo-Sifiliográficas

  http://www.actasdermo.org/en-rf-stevens-johnson-syndrome-toxic-articulo-S1578219016000160

  Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially serious diseases, usually caused by a drug reaction, with a mortality rate of approximately 25%. Optimum treatment is not well established. The only randomized clinical trial, which took several years to complete, showed that thalidomide was not only ineffective but was associated with higher mortality. […] In 1998, IVIG was reported as an effective therapy in patients with SJS/TEN for the first time. Since then, the studies published show conflicting results, and it has not been possible to demonstrate a significant improvement in survival among patients treated with IVIG compared to those who receive only supportive care. However, a study has shown decreased mortality when IVIG is used at high doses (2g/kg).

• #87 SciELO Brazil – Stevens-Johnson syndrome and toxic epidermal necrolysis: a review Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

  https://www.scielo.br/j/ramb/a/D75h5BfLmz5Tw5JnMTXtPjF/

  Studies have suggested benefit of plasmapheresis for the treatment of SJS/TEN; however, there are reports showing that its use did not significantly affect mortality and length of hospital stay in some cases. […] Cyclosporin is an immunosuppressive medication with anti-apoptotic activity and has been considered as a potentially useful drug for treatment; however, its usefulness is not well defined. […] Viard et al., in 1998, reported that commercial preparations of intravenous immunoglobulin contained natural anti-Fas (anti-CD95) antibodies that blocked Fas to FasL binding, thus intervening in disease pathogenesis. The studies show mixed results. Successful treatment depends on the dose and its early use.

• #88 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://www.mdpi.com/2227-9059/10/9/2105

  However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] However, meta-analyses by Zimmermann et al. (2017) and Houschyar et al. (2021) suggested that steroids may improve survival. […] Japanese treatment guidelines recommend pulse corticosteroid therapy as one of the first-line treatments for SJS/TEN under appropriate infection control. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] However, a large retrospective study of 281 patients in 2008 found no significant difference in mortality on comparing patients treated with IVIg and those who received supportive care.

• #89 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9495335/

  According to the UK guidelines for the management of SJS/TEN, withdrawal of the culprit drug and multidisciplinary supportive care should be prioritized over systemic treatment because of the paucity of evidence of the treatment efficacy. However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] Several meta-analyses suggest a beneficial effect of CsA. […] The increased TNF- levels in SJS/TEN patients has led to the suggestions of using TNF- inhibitors. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice.

• #90

  https://link.springer.com/article/10.1007/s40257-024-00889-6

  Cyclosporine, used on the basis of its T cell-specific mechanism, shows promise as an immunomodulatory medication that in small observational studies has had positive impact on hospital stay and progression of skin detachments in SJS/TEN patients. […] Oral and intravenous corticosteroids are often used. Studies have suggested that prompt initiation of high dose corticosteroids within 12 days of symptoms onset leads to improved outcomes. […] Intravenous immunoglobulin (IVIG), which likely works via inhibition of the Fas receptor, has been used both alone and in combination with corticosteroids. […] Biologic TNF- inhibitors, such as etanercept, have been shown to be an effective treatment with minimal side effects. […] A randomized, controlled open-labelled trial comparing intravenous corticosteroids to etanercept showed a significant decrease in time to re-epithelialization. […] The combination of etanercept and corticosteroids showed improved mortality rates compared with the combination of corticosteroids/IVIG and corticosteroids alone.

• #91 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Other options include: […] Anti-TNF monoclonal antibodies (eg, infliximab, etanercept) […] Cyclophosphamide […] Intravenous immunoglobulin (IVIG) 23 g/kg given over 23 days […] Plasmapheresis […] Granulocyte-colony stimulating factor (GCS-F). […] Thalidomide, trialled because of its anti-TNF effect, increased mortality, and should not be used.

• #92 SJS/TEN Induced by Tumor-targeted therapy | JIR

  https://www.dovepress.com/emerging-insights-into-stevens-johnson-syndrome-and-toxic-epidermal-ne-peer-reviewed-fulltext-article-JIR

  Anticancer drugs have revolutionized tumor therapy, with cutaneous toxicities such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) being common immune-related adverse events. […] The debate over the efficacy of systemic corticosteroids in treating these conditions persists, while tumor necrosis factor (TNF)-alpha inhibitors show promise. This study aims to evaluate the effectiveness and safety of combination therapy involving the TNF- inhibitor adalimumab for SJS/TEN induced by anticancer drugs. […] Combination therapy with adalimumab significantly reduced mucocutaneous reepithelization time and healing duration compared to corticosteroid monotherapy. […] The findings suggest that adalimumab in combination with corticosteroids provides significant clinical benefits and is safer than corticosteroids alone for treating SJS/TEN induced by targeted anticancer therapies and immunotherapies.

• #93 Systemic interventions for treatment of Stevens‐Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome – Jacobsen, A – 2022 | Cochrane Library

  https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013130.pub2/full

  Etanercept (25 mg (50 mg if weight 65 kg) twice weekly „until skin lesions healed”) may reduce disease-specific mortality compared to corticosteroids (intravenous prednisolone 1 to 1.5 mg/kg/day „until skin lesions healed”) (RR 0.51, 95% CI 0.16 to 1.63; 1 study; 91 participants; low-certainty evidence); however, the CIs were consistent with possible benefit and possible harm. […] It is uncertain if there is any difference between cyclosporin (3 mg/kg/day or intravenous 1 mg/kg/day until complete reepithelialisation, then tapered off (10 mg/day reduction every 48 hours)) and IVIG (continuous infusion 0.75 g/kg/day for 4 days (total dose 3 g/kg) in participants with normal renal function) in risk of disease-specific mortality (RR 0.13, 95% CI 0.02 to 0.98, 1 study; 22 participants; very low-certainty evidence). […] The treatment of SJS/TEN varies widely across institutions, and mortality remains high. Etanercept, a tumour necrosis factor-alpha inhibitor, has emerged as a potential treatment option for people with SJS/TEN. However, the availability and cost may limit its use in resource-poor settings.

• #94 Efficacy of Etanercept in the Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis | MDedge Dermatology

  https://www.mdedge9-ma1.mdedge.com/content/efficacy-etanercept-treatment-stevens-johnson-syndrome-and-toxic-epidermal-necrolysis

  It has been suggested that the use of etanercept for treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) might provide improved mortality benefit and decreased skin healing times. […] Results of this study support the use of single-dose subcutaneous etanercept 50 mg as a potentially lifesaving therapy for patients with SJS/TEN. […] Our data suggest that etanercept is a lifesaving and disease-modifying therapy.

• #95 Combination Therapy Effective for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis – Dermatology Advisor

  https://www.dermatologyadvisor.com/news/combo-therapy-effective-for-sj-syndrome-toxic-epidermal-necrolysis/

  The efficacy of TNF- inhibition plus steroid for treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) was evaluated. […] The addition of tumor necrosis factor (TNF) -a inhibition to steroid treatment was found to be effective when treating Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), according to findings from a study published in the Journal of American Academy of Dermatology. […] All 25 patients achieved significant clinical improvement without any sequela. Treatment with the combination therapy led to significantly shorter courses of initial steroid use, acute stage of the disease, and hospitalization stay, the researchers noted. […] The combination therapy also decreased skin healing time (median, 12 days) compared with steroid monotherapy (median, 16 days).

• #96 SJS/TEN Induced by Tumor-targeted therapy | JIR

  https://www.dovepress.com/emerging-insights-into-stevens-johnson-syndrome-and-toxic-epidermal-ne-peer-reviewed-fulltext-article-JIR

  The exploration of combination therapy, which involves the additional use of TNF- inhibitors and other biologic agents, presents itself as a potential strategy. […] In our recent randomized controlled study, which compared adalimumab and systemic steroids, we obtained findings indicating that TNF- inhibitors may confer potential benefits in the management of SJS and TEN. […] The adoption of combination therapy involving anti-TNF- biologics and systemic corticosteroids has the potential to amplify the anti-inflammatory impact and, in turn, mitigate the adverse effects associated with systemic corticosteroid treatment. […] Our study has contributed fresh insights into the utilization of a combined therapeutic approach involving anti-TNF- biologics and systemic corticosteroids for the management of SJS/TEN patients induced by targeted anticancer therapies and immunotherapies. Notably, this combination therapy demonstrated superior effectiveness in expediting cutaneous healing and reducing mortality rates among SJS/TEN patients.

• #97 Combination Therapy Effective for Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis – Dermatology Advisor

  https://www.dermatologyadvisor.com/news/combo-therapy-effective-for-sj-syndrome-toxic-epidermal-necrolysis/

  Data from this study led researchers to conclude that their study confirmed the effectiveness of etanercept in combination with systemic steroids in SJS/TEN. Particularly, the additional etanercept could significantly shorten the clinical courses measured by acute duration and skin healing time. They wrote that this strategy provides a practical approach to reduce hospital stays and remedy the defects of systemic steroid monotherapy.

• #98 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://www.mdpi.com/2227-9059/10/9/2105

  In a multi-center retrospective study of 48 patients with TEN, the survival rate of patients treated with high-dose IVIg was 88%. […] Although meta-analysis by Barron et al. found no beneficial effect of IVIg in decreasing the mortality of SJS/TEN, increasing dose of IVIg was inversely correlated with mortality. […] In a retrospective study conducted in China, 20 patients receiving a combination of IVIg and systemic steroid showed no significant reduction in mortality. […] Cyclosporine A, a calcineurin inhibitor, has drawn attention in recent years. […] Several meta-analyses suggest a beneficial effect of CsA. […] TNF-α inhibitors monotherapy improved outcomes and may be safer compared to combination therapy. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice. […] Plasmapheresis is a safe treatment and can be performed daily or every other day with few adverse side effects.

• #99 Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-ten

  Pharmacotherapy of SJS/TEN is controversial. Cyclosporine (3 to 5 mg/kg orally once/day) inhibits CD8 cells and has been shown to decrease the duration of active disease (eg, by 2 to 3 days in some instances) and possibly decrease mortality. […] The use of systemic corticosteroids remains controversial. […] However, some reports show improved outcomes with early corticosteroid therapy. […] Plasmapheresis can remove reactive drug metabolites or antibodies and can be considered. […] Early high-dose IVIG 2.7 g/kg over 3 days blocks antibodies and Fas ligand. […] The TNF-alpha inhibitors infliximab and etanercept can help reduce inflammation. […] Consider cyclosporine and possibly plasmapheresis for severe cases.

• #100 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9495335/

  According to the UK guidelines for the management of SJS/TEN, withdrawal of the culprit drug and multidisciplinary supportive care should be prioritized over systemic treatment because of the paucity of evidence of the treatment efficacy. However, Japanese guidelines for SJS/TEN recommend early systemic corticosteroids, either alone or in combination with cyclosporin as the first-line treatment. […] Systemic corticosteroids were one of the first recognized treatments for SJS/TEN. The effectiveness of systemic corticosteroids in the treatment of SJS/TEN has long been debated. […] Intravenous immunoglobulin (IVIg), derived from the pooled plasma of healthy donors, is the treatment of choice for both SJS and TEN. […] Several meta-analyses suggest a beneficial effect of CsA. […] The increased TNF- levels in SJS/TEN patients has led to the suggestions of using TNF- inhibitors. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice.

• #101 A Review of the Systemic Treatment of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

  https://www.mdpi.com/2227-9059/10/9/2105

  In a multi-center retrospective study of 48 patients with TEN, the survival rate of patients treated with high-dose IVIg was 88%. […] Although meta-analysis by Barron et al. found no beneficial effect of IVIg in decreasing the mortality of SJS/TEN, increasing dose of IVIg was inversely correlated with mortality. […] In a retrospective study conducted in China, 20 patients receiving a combination of IVIg and systemic steroid showed no significant reduction in mortality. […] Cyclosporine A, a calcineurin inhibitor, has drawn attention in recent years. […] Several meta-analyses suggest a beneficial effect of CsA. […] TNF-α inhibitors monotherapy improved outcomes and may be safer compared to combination therapy. […] The Japanese guidelines recommend systematic steroids, IVIg, and plasmapheresis as the three first-line treatments of choice. […] Plasmapheresis is a safe treatment and can be performed daily or every other day with few adverse side effects.

• #102 Effectiveness of early treatment with plasma exchange in patients with Stevens–Johnson syndrome and toxic epidermal necrolysis | Scientific Reports

  https://www.nature.com/articles/s41598-024-53653-5

  The rationale for PE in SJS/TEN is to filter causative drugs and their metabolites, and remove immunological factors involved in the disease. However, conflicting results have been reported, and its effectiveness remains unknown. […] The effectiveness of initiating PE immediately on hospital admission in patients with severe SJS/TEN was evaluated using a nationwide database and adjusted using a doubly robust estimation method to minimise confounding. The results showed no benefit of PE for reducing in-hospital mortality or the length of hospital stay. […] This study, with appropriate adjustments for concurrent treatment, provided no evidence that PE reduced mortality or shortened the length of hospital stay. Additionally, the study revealed that patients who received PE did not have an increased risk of sepsis. […] In contrast to previous studies, this study did not find any evidence of a benefit of early PE in patients with severe SJS/TEN.

• #103 Management of Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis: Looking Beyond Guidelines!

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5903040/

  Cyclosporine: As per the survey, cyclosporine is the second most commonly used immunomodulator in the treatment of SJS-TEN. […] IVIgs: According to a recent survey, this is the most common immunomodulator worldwide, used in the treatment of SJS-TEN. […] Plasmapheresis: It is a promising alternative modality. […] Intravenous N-acetylcysteine (NAC): When this compound is used at a dose of 300 mg/kg/day, it was found to reduce the time for re-epithelialization. […] Biologics: Cytokines such as IL-6 and TNF-alpha are found in higher quantities in the skin of patients of TEN. […] Literature for management of SJS-TEN in children is lacking.

• #104 Stevens-Johnson Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30294

  It is unknown whether systemic corticosteroids are beneficial, but they are often prescribed in high doses for the first three to five days of admission. Granulocyte colony-stimulating factor (G-CSF) may be of benefit in patients with severe neutropenia. […] Other drugs reported effective include systemic corticosteroids, ciclosporin, TNF-alpha inhibitors, N-acetylcysteine, and intravenous immunoglobulins. Their role remains controversial.

• #105 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Other options include: […] Anti-TNF monoclonal antibodies (eg, infliximab, etanercept) […] Cyclophosphamide […] Intravenous immunoglobulin (IVIG) 23 g/kg given over 23 days […] Plasmapheresis […] Granulocyte-colony stimulating factor (GCS-F). […] Thalidomide, trialled because of its anti-TNF effect, increased mortality, and should not be used.

• #106 Stevens-Johnson Syndrome (SJS): Causes, Rash & Treatments

  https://my.clevelandclinic.org/health/diseases/17656-stevens-johnson-syndrome

  Hospitalized treatment includes stopping the problem medication, replacing electrolytes, applying skin dressings, and providing pain medications and antibiotics. […] Treatments for Stevens-Johnson syndrome include: stopping the medication that has caused the problem, replacing electrolytes with intravenous (IV) fluids, using non-adhesive dressings on the affected skin, using high-calorie food, possibly by tube-feeding, to promote healing, using antibiotics when needed to prevent infection, providing pain relief medications, treating you in a hospital, possibly even in an intensive care or burn unit, using specialist teams from dermatology and ophthalmology (if your eyes are affected), in some cases, treating you with IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts (for your eyes).

• #107 Stevens-Johnson Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/30294

  Patients should undergo interprofessional assessment in a specialized hospital environment. […] Care of a patient with Stevens-Johnson syndrome/toxic epidermal necrolysis requires supportive care, including: cessation of the suspected causative drug(s), hospital admission: preferably to an intensive care and/or burn unit, fluid replacement (crystalloid), nutritional assessment: may require nasogastric tube feeding, temperature control: warm environment, emergency blanket, pain relief, supplemental oxygen and, in some cases, intubation with mechanical ventilation, sterile/aseptic handling. […] Skincare requires daily examination of skin and mucosal surfaces for infection, non-adherent dressings, and avoidance of trauma to the skin. […] Antibiotics may be required for secondary infection but are best avoided prophylactically.

• #108 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Topical oral anaesthetic […] Genital care […] If ulcerated, prevent vaginal adhesions using intravaginal steroid ointment, soft vaginal dilators. […] Lung care […] Consider aerosols, bronchial aspiration, physiotherapy […] May require intubation and mechanical ventilation if trachea and bronchi are involved […] Urinary care […] Catheter because of genital involvement and immobility […] Culture urine for bacterial infection […] General […] Psychiatric support for extreme anxiety and emotional lability […] Physiotherapy to maintain joint movement and reduce the risk of pneumonia […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis

• #109 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #110 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Topical oral anaesthetic […] Genital care […] If ulcerated, prevent vaginal adhesions using intravaginal steroid ointment, soft vaginal dilators. […] Lung care […] Consider aerosols, bronchial aspiration, physiotherapy […] May require intubation and mechanical ventilation if trachea and bronchi are involved […] Urinary care […] Catheter because of genital involvement and immobility […] Culture urine for bacterial infection […] General […] Psychiatric support for extreme anxiety and emotional lability […] Physiotherapy to maintain joint movement and reduce the risk of pneumonia […] Regular assessment for staphylococcal or gram negative infection […] The appropriate antibiotic should be given if an infection develops; prophylactic antibiotics are not recommended and may even increase the risk of sepsis

• #111 SciELO Brazil – Stevens-Johnson syndrome and toxic epidermal necrolysis: a review Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

  https://www.scielo.br/j/ramb/a/D75h5BfLmz5Tw5JnMTXtPjF/

  Prophylactic antibiotic therapy is not recommended as it can induce resistance and because these drugs can per se be causative agents of SJS or TEN. Therefore, they are given only in proven cases of infection, or when there is sudden decrease/rise in temperature, poor general condition, or positive skin cultures. […] Specific therapies for SJS and TEN have not yet reached evidence-based acceptance standards. The low prevalence of the disease and its lethal potential make it difficult to perform randomized clinical trials. […] Some reviews concluded that steroids do not shorten the duration of disease and may also increase the risk of infections and worsen healing. Many authors do not recommend the routine use of systemic steroids in the treatment of SJS/TEN but some centers advocate an early pulse (first 48 hours).

• #112 SciELO Brazil – Stevens-Johnson syndrome and toxic epidermal necrolysis: a review Stevens-Johnson syndrome and toxic epidermal necrolysis: a review

  https://www.scielo.br/j/ramb/a/D75h5BfLmz5Tw5JnMTXtPjF/

  Prophylactic antibiotic therapy is not recommended as it can induce resistance and because these drugs can per se be causative agents of SJS or TEN. Therefore, they are given only in proven cases of infection, or when there is sudden decrease/rise in temperature, poor general condition, or positive skin cultures. […] Specific therapies for SJS and TEN have not yet reached evidence-based acceptance standards. The low prevalence of the disease and its lethal potential make it difficult to perform randomized clinical trials. […] Some reviews concluded that steroids do not shorten the duration of disease and may also increase the risk of infections and worsen healing. Many authors do not recommend the routine use of systemic steroids in the treatment of SJS/TEN but some centers advocate an early pulse (first 48 hours).

• #113 Stevens Johnson Syndrome / Toxic Epidermal Necrolysis. SJS/TEN

  https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis

  Pain relief as pain can be extreme […] Sterile handling and reverse isolation procedures. […] Skin care […] Examine daily for the extent of detachment and infection (take swabs for bacterial culture). […] Topical antiseptics can be used (eg, silver nitrate, chlorhexidine [but not silver sulfadiazine as it is a sulfa drug]) […] Dressings such as gauze with petrolatum, non-adherent nanocrystalline-containing silver gauze or biosynthetic skin substitutes such as Biobrane can reduce pain. […] Avoid using adhesive tapes and unnecessary removal of dead skin; leave the blister roof as a biological dressing. […] Eye care […] Daily assessment by an ophthalmologist […] Frequent eye drops/ointments (antiseptics, antibiotic, corticosteroid) […] Mouth care […] Mouthwashes

• #114 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Additional supportive therapy includes saline rinses to remove inflammatory debris, removal of membranes, mechanical lysis of adhesions, bandage contact lens placement, and use of topical antibiotics in the presence of epithelial defects. […] The most significant therapeutic intervention shown to have long-term benefit at this stage is the application of early amniotic membrane covering the entire ocular surface (cornea, bulbar conjunctiva, palpebral conjunctiva) and eyelid margins within the first week of symptom onset or as early in the clinical course as possible. […] Following the acute course of SJS, patients should be reevaluated as an outpatient within 1 month of hospital discharge, every 2 to 4 months for the first year, and then every 6 months afterward based on clinical course.

• #115 Stevens-Johnson syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/symptoms-causes/syc-20355936

  Stevens-Johnson syndrome is a medical emergency that usually requires hospitalization. Treatment focuses on removing the cause, caring for wounds, controlling pain and minimizing complications as skin regrows. It can take weeks to months to recover. […] If you’ve had Stevens-Johnson syndrome (SJS) and your health care provider told you it was caused by a medication, avoid that drug and others like it. This is key to preventing a recurrence, which is usually more severe than the first episode and can be fatal.

• #116 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  Additional supportive therapy includes saline rinses to remove inflammatory debris, removal of membranes, mechanical lysis of adhesions, bandage contact lens placement, and use of topical antibiotics in the presence of epithelial defects. […] The most significant therapeutic intervention shown to have long-term benefit at this stage is the application of early amniotic membrane covering the entire ocular surface (cornea, bulbar conjunctiva, palpebral conjunctiva) and eyelid margins within the first week of symptom onset or as early in the clinical course as possible. […] Following the acute course of SJS, patients should be reevaluated as an outpatient within 1 month of hospital discharge, every 2 to 4 months for the first year, and then every 6 months afterward based on clinical course.

• #117 Stevens-Johnson syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/symptoms-causes/syc-20355936

  Stevens-Johnson syndrome is a medical emergency that usually requires hospitalization. Treatment focuses on removing the cause, caring for wounds, controlling pain and minimizing complications as skin regrows. It can take weeks to months to recover. […] If you’ve had Stevens-Johnson syndrome (SJS) and your health care provider told you it was caused by a medication, avoid that drug and others like it. This is key to preventing a recurrence, which is usually more severe than the first episode and can be fatal.

• #118 Stevens-Johnson Syndrome (SJS): Symptoms and Treatments

  https://www.allaboutvision.com/conditions/related/stevens-johnson-syndrome/

  Finally, if you develop Stevens-Johnson syndrome due to an adverse reaction to a drug, it’s critical to avoid the medication and any related ones in the future to prevent reexposure. Family members may also need to avoid the medication as a precaution. Your health care provider can help you determine which medications you need to avoid.

• #119 Treatment of severe drug reactions: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis and Hypersensitivity syndrome

  https://escholarship.org/uc/item/97d8t291

  In conclusion, we believe that no specific treatment has been proven to be beneficial for TEN/SJS, which is a self-limited disease. For us, to date, the best management is supportive care alone. […] Sun exposure must be avoided for several months because UV can worsen hyperpigmentation sequelae. […] Survivors of TEN/SJS should not be re-exposed to the suspected offending agent(s) or to related compounds.

• #120 Treatment of severe drug reactions: Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis and Hypersensitivity syndrome

  https://escholarship.org/uc/item/97d8t291

  In conclusion, we believe that no specific treatment has been proven to be beneficial for TEN/SJS, which is a self-limited disease. For us, to date, the best management is supportive care alone. […] Sun exposure must be avoided for several months because UV can worsen hyperpigmentation sequelae. […] Survivors of TEN/SJS should not be re-exposed to the suspected offending agent(s) or to related compounds.

• #121 MillennialEYE | Stevens-Johnson Syndrome: Critical Aspects of Care

  https://millennialeye.com/articles/2021-may-june/stevens-johnson-syndrome-critical-aspects-of-care/

  In the chronic stage, management is tailored to severity, but lubrication again remains vital. […] Long-term treatment and visual rehabilitation may require eyelid surgery (eg, mucous membrane graft), keratoplasty, ocular surface stem cell transplantation, keratoprosthesis, and globe-salvaging procedures. […] Preventing irreversible sequelae with appropriate early management can be easier than trying to address them later.

• #122 Stevens-Johnson Syndrome (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/stevens-johnson-syndrome

  Multidisciplinary management of eyes, mucous membranes (gynae, mouth, gastrointestinal tract) helps to improve outcomes and reduce adverse sequelae. […] Acute phase: identify and remove causative drug or underlying cause. […] Use of the ALDEN (Algorithm for assessment of Drug-induced Epidermal Necrolysis) may be useful. […] A rapid assessment of prognosis should be made using the SCORTEN (Score for Toxic Epidermal Necrolysis) system. SCORTEN is an illness severity score which has been developed to predict the mortality rate in SJS and TEN. […] Patients with a SCORTEN score of 3 should be managed in intensive care. […] Supportive: Attention to airway and haemodynamic stability. […] Severe fluid loss may require intravenous fluid replacement and electrolyte correction. […] Pain control.

• #123 Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Mimics – Differential Diagnosis and Initial Management – emDocs

  https://www.emdocs.net/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis-mimics-differential-diagnosis-and-initial-management/

  Stevens-Johnson syndrome (SJS) is a life-threatening skin condition that exists on a spectrum of severity. […] The mainstay of SJS/TEN treatment is supportive care. First, stop the offending agent. Local wound care, pain control, and IV fluids should be continued through the course of the illness, much like you would treat a burn patient. […] Studies have shown that there unfortunately was no survival benefit to those treated with systemic corticosteroids when compared to those treated with usual care. […] A useful decision tool in determining the clinical setting best suited for management of your patient is the SCORTEN scale which can assess severity of disease; those with a score greater than equal to 2 are recommended for ICU or Burn center admission. […] Treatment Breakdown: SJS/TEN: supportive care, treat like any other burn.

• #124 Stevens-Johnson Syndrome (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/stevens-johnson-syndrome

  Multidisciplinary management of eyes, mucous membranes (gynae, mouth, gastrointestinal tract) helps to improve outcomes and reduce adverse sequelae. […] Acute phase: identify and remove causative drug or underlying cause. […] Use of the ALDEN (Algorithm for assessment of Drug-induced Epidermal Necrolysis) may be useful. […] A rapid assessment of prognosis should be made using the SCORTEN (Score for Toxic Epidermal Necrolysis) system. SCORTEN is an illness severity score which has been developed to predict the mortality rate in SJS and TEN. […] Patients with a SCORTEN score of 3 should be managed in intensive care. […] Supportive: Attention to airway and haemodynamic stability. […] Severe fluid loss may require intravenous fluid replacement and electrolyte correction. […] Pain control.

• #125 Stevens-Johnson syndrome – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/stevens-johnson-syndrome/

  Management involves a multidisciplinary team of specialists (e.g., dermatology, ophthalmology, gynecology). […] Discontinue the offending drug. […] Supportive management is similar to that of extensive burns, including: Goal-directed IV fluid therapy: See Strategies for IV fluid therapy. […] Pain management: See Oral analgesics and Parenteral analgesics for dosages. […] Wound care […] Mucosal care (e.g., oral care) […] Specialized nutrition support […] Adequate glycemic control […] ICU admission is typically required; consider transfer to a burn center. […] Monitor for acute complications, including: Infection, septic shock […] Hypovolemic shock […] Treat complications, e.g., with: Respiratory support […] Electrolyte repletion […] Rewarming techniques […] Antibiotics for sepsis. […] Only administer antibiotics if there are signs of infection, e.g., fever, worsening skin pain.

• #126 Stevens-Johnson syndrome

  https://www.myamericannurse.com/stevens-johnson-syndrome/

  Immediate medication discontinuation aids treatment success. […] Treatment for minor rashes includes stopping the triggering agent and administering diphenhydramine. Severe rashes require hospitalization and treatment with prednisone. […] For more severe rashes, treatment includes prednisone 10 mg twice a day. […] Patients experiencing severe symptoms require hospital admission and laboratory studies to monitor for developing anemia, neutropenia, thrombocytopenia, elevated erythrocyte sedimentation rate, and elevated blood urea nitrogen. […] If the rash is minor, treatment includes stopping the agent and administering diphenhydramine 25 to 50 mg twice a day. […] The hospitalist also orders cyclosporine (5 mg/kg in two divided doses per day), which has recently emerged as a promising treatment for SJS because of its effective anti-apoptotic activity.

• #127 Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/guidelines-for-the-management-of-stevens-johnson-syndrome-toxic-epidermal-necrolysis-an-indian-perspective/

  Stevens-Johnson syndrome and toxic epidermal necrolysis are severe, life-threatening mucocutaneous adverse drug reactions with a high morbidity and mortality that require immediate medical care. The various immunomodulatory treatments include systemic corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, plasmapheresis and tumor necrosis factor- inhibitors. […] The ideal therapy of Stevens-Johnson syndrome/toxic epidermal necrolysis still remains a matter of debate as there are only a limited number of studies of good quality comparing the usefulness of different specific treatments. […] This expert group recommends prompt withdrawal of the culprit drug, meticulous supportive care, and judicious and early (preferably within 72 h) initiation of moderate to high doses of oral or parenteral corticosteroids (prednisolone 1-2 mg/kg/day or equivalent), tapered rapidly within 7-10 days. Cyclosporine (3-5 mg/kg/day) for 10-14 days may also be used either alone, or in combination with corticosteroids.

• #128

  https://link.springer.com/article/10.1007/s40257-024-00889-6

  Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, T cell-mediated, severe cutaneous adverse reaction (SCAR) to medication. […] Supportive care remains the mainstay of all SJS/TEN treatment and a high-level evidence base is lacking for any single therapeutic intervention. TNF inhibitors (etanercept), cyclosporine, and combinations of different agents show some promise in unblinded randomized controlled trials and small observational studies. […] Treatment for SJS/TEN is complex, and there are no standardized guidelines for treatment currently. Our inability to accurately measure severity and appropriate outcomes is a major hindrance to determining standard of care. Withdrawal of the offending drug and all nonessential medications is critical, followed by hospitalization and supportive care.

• #129 Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management

  https://www.mdpi.com/1648-9144/57/9/895

  Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare diseases that are characterized by widespread epidermal necrosis and sloughing of skin. […] Regarding treatment, cyclosporine is the most effective therapy for the treatment of SJS, and a combination of intravenous immunoglobulin (IVIg) and corticosteroids is most effective for SJS/TEN overlap and TEN. […] Removal of the offending agent and supportive care are the mainstays in treatment of SJS/TEN. […] Adjunctive therapies, such as corticosteroids and intravenous immunoglobulin (IVIg), are often utilized, although there is still no consensus on the most effective adjunctive therapy. […] The role of corticosteroids as monotherapy is still debated. […] The role of IVIg has also been controversial, and there appears to be no mortality benefit associated with monotherapy.

• #130 Stevens–Johnson syndrome and toxic epidermal necrolysis – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis

  SJS/TEN is a complex medical emergency and patients should receive urgent and regular input from a range of specialists, including dermatologists, ophthalmologists, intensivists, dietitians and pharmacists. […] There are no recommended immunomodulatory therapies, but the following may be used on a patient-by-patient basis: Ciclosporin; Corticosteroids; Intravenous immunoglobulins. […] Although the pathophysiology of SJS/TEN is driven via cytotoxic T-lymphocytes and immunocytokine pathways, the role of immunomodulation remains unclear. […] Pain is a characteristic feature of SJS/TEN and patients should be assessed at least once per day using a patient-appropriate pain score. […] Patients should receive adequate background simple analgesia, such as paracetamol, and a weak opioid, such as codeine or tramadol, if required to control pain at rest. […] All patients should receive prophylactic anticoagulation with low-molecular-weight heparin, unless contraindicated.

• #131 Stevens-Johnson Syndrome (Causes, Symptoms, and Treatment)

  https://patient.info/doctor/stevens-johnson-syndrome

  Multidisciplinary management of eyes, mucous membranes (gynae, mouth, gastrointestinal tract) helps to improve outcomes and reduce adverse sequelae. […] Acute phase: identify and remove causative drug or underlying cause. […] Use of the ALDEN (Algorithm for assessment of Drug-induced Epidermal Necrolysis) may be useful. […] A rapid assessment of prognosis should be made using the SCORTEN (Score for Toxic Epidermal Necrolysis) system. SCORTEN is an illness severity score which has been developed to predict the mortality rate in SJS and TEN. […] Patients with a SCORTEN score of 3 should be managed in intensive care. […] Supportive: Attention to airway and haemodynamic stability. […] Severe fluid loss may require intravenous fluid replacement and electrolyte correction. […] Pain control.

• #132 Stevens-Johnson syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/diagnosis-treatment/drc-20355942

  Treating Stevens-Johnson syndrome requires hospitalization, possibly in an intensive care unit or a burn unit. […] The first and most important step in treating Stevens-Johnson syndrome is to stop taking any medications that may be causing it. […] Supportive care you’re likely to receive while in the hospital includes: […] Because skin loss can result in significant loss of fluid from your body, replacing fluids is an important part of treatment. […] Medications used in the treatment of Stevens-Johnson syndrome include: […] If the underlying cause of Stevens-Johnson syndrome can be eliminated and the skin reaction stopped, new skin may begin to grow within several days. In severe cases, full recovery may take several months.

• #133 Stevens-Johnson Syndrome (SJS): Causes and Treatments

  https://www.webmd.com/skin-problems-and-treatments/stevens-johnson-syndrome

  You’ll be treated for SJS in the hospital by a special team of doctors and nurses. Some people are treated in a burn center or intensive care unit. […] The first thing doctors will do is to stop the medication or treat the infection that made you sick. They’ll also try to relieve your symptoms, prevent infections, and support your healing. […] Your body needs to stay hydrated, and your skin needs protein to rebuild. You’ll probably get fluids from an IV at first, then be fed through a tube that goes into your stomach through your nose. […] Hospital staff will keep your skin clean. They’ll gently remove dead skin and cover bare patches with a special dressing. […] Your care team will clean your eyes and use special drops and creams to keep them from drying out. […] You could be in the hospital from 2 to 4 weeks. It takes time to recover from SJS, and most people do.

• #134 Stevens-Johnson syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/symptoms-causes/syc-20355936

  Stevens-Johnson syndrome is a medical emergency that usually requires hospitalization. Treatment focuses on removing the cause, caring for wounds, controlling pain and minimizing complications as skin regrows. It can take weeks to months to recover. […] If you’ve had Stevens-Johnson syndrome (SJS) and your health care provider told you it was caused by a medication, avoid that drug and others like it. This is key to preventing a recurrence, which is usually more severe than the first episode and can be fatal.

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