DermatologyEmergency Medicine
Stevens-Johnson Syndrome / TEN
Severe drug reaction — stop offending drug, ITU/burns unit, supportive care, SCORTEN prognosis, IVIG / ciclosporin in selected.
Source: BAD 2016; UK Dermatology
Step 1 of ~4
info
Recognise + Classify
Mucocutaneous hypersensitivity reaction — typically drug-induced (allopurinol, anticonvulsants — carbamazepine, lamotrigine, phenytoin; sulphonamides; NSAIDs; antibiotics) within 1–4 weeks of exposure.
Classification by % TBSA detached:
• SJS: <10% TBSA + mucocutaneous involvement.
• Overlap: 10–30%.
• TEN: >30%.
Features: prodrome (fever, malaise) → painful red macules + targetoid lesions → blistering → epidermal detachment + Nikolsky sign positive. Mucous membranes (mouth, eyes, genitals) involved in nearly all.
Mortality: SJS 1–5%, overlap 10–30%, TEN 25–50%.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- Meropenem (Burns — Severe Sepsis/MDR) · Antibiotic — Carbapenem
- Phenylephrine · Alpha-1 Adrenergic Agonist (Pure Vasoconstrictor)
- Ciclosporin · Systemic Immunosuppressant — Eczema / Psoriasis
- Carbimazole · Antithyroid Drug
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Tezepelumab (CRSwNP / Severe Asthma) · Anti-TSLP (Thymic Stromal Lymphopoietin) Monoclonal Antibody
Pathways
- Suspicious Pigmented Lesion — Melanoma Pathway · NICE NG14 2015 / BAD
- Cellulitis and Erysipelas · NICE NG141 2019 / CREST
- Psoriasis — Severity Assessment and Step-Up Therapy · NICE NG153 2019 / BAD
- Atopic Eczema — Assessment and Step-Up Therapy · NICE NG95 2023
- Urticaria and Angioedema · BSACI / EAACI Guidelines 2022
- Acne Vulgaris — Grading and Treatment · NICE NG198 2021 / BAD
Decision support only. Always apply local guidelines and clinical judgement.