This handout is for stevens-johnson syndrome / toxic epidermal necrolysis (sjs/ten). Your care team identified this based on: painful dusky macules / atypical targets → flaccid bullae + ≥2 mucosal sites (bastuji-garin classification, arch dermatol 1993; pmid 8420497).
Other reasons your team may use this plan: new high-risk drug (allopurinol, aromatic anticonvulsant, sulfonamide, nevirapine, oxicam nsaid) started 4–28 d prior (sassolas alden, clin pharmacol ther 2010; pmid 20375998; mockenhaupt euroscar, pmid 17805350); prodromal fever / odynophagia / photophobia 1–3 d before rash + oral/ocular/genital erosions (creamer uk guideline, br j dermatol 2016; pmid 27317286); positive nikolsky sign + sheet-like epidermal detachment (bastuji-garin classification; pmid 8420497).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| discontinue probable culprit + all non-essential drugs | — | n/a | — | Garcia-Doval Arch Dermatol 2000 (PMID 10724193) — early withdrawal lowers mortality; delayed withdrawal of long-half-life culprits raises death OR ~1.9/day; ALDEN-highest culprit (Sassolas; PMID 20375998) |
| isotonic crystalloid resuscitation (titrate to urine output; ~⅔ of equivalent-burn formula) | — | IV | — | Creamer UK guideline (PMID 27317286) — TEN insensible loss is lower than thermal burn; titrate to UOP 0.5–1 mL/kg/h, avoid over-resuscitation |
| non-adherent wound care + temperature/airway/ocular protection + analgesia + nutrition (NO prophylactic systemic antibiotics) | — | topical/supportive | — | Creamer UK guideline (PMID 27317286) — supportive care is the only universally agreed intervention; infection surveillance not prophylaxis; early ophthalmology |
Plan: SJS/TEN management — culprit withdrawal + supportive cornerstone ± contested immunomodulation
Call 911 or go to the nearest emergency room right away if you have:
Ocular (symblepharon, dry eye, vision loss), cutaneous (dyspigmentation, scarring), oral, genital (synechiae), pulmonary (bronchiolitis obliterans) sequelae screen; psychological support; HLA pharmacogenomic counseling + lifelong culprit-class + cross-reactor avoidance card (Creamer UK guideline; PMID 27317286; CPIC HLA-B guideline, Clin Pharmacol Ther 2018; PMID 29392710)
Guideline: Creamer UK BAD/BBA SJS/TEN management guideline (Br J Dermatol 2016) + Bastuji-Garin consensus classification (Arch Dermatol 1993) + SCORTEN / day-3 SCORTEN / ABCD-10 prognostication + Sassolas ALDEN drug causality + Mockenhaupt EuroSCAR culprit registry + Garcia-Doval early-withdrawal mortality + Zimmermann/González-Herrada/Wang/Barron contested-immunomodulation comparative-mortality literature + CPIC HLA-B pharmacogenomics