Stevens–Johnson syndrome is a disease of the skin. In most cases, it is caused by an allergic reaction to drugs. This accounts for about half the cases. Lymphoma, and other infections are responsible for most other cases. The disease is characterized by cell death that causes the epidermis to separate from the dermis.
Treatment for Stevens-Johnson syndrome
The management of patients must be prompt; early diagnosis with the early recognition and withdrawal of all potential causitive drugs is essential to a favorable outcome. Morbidity and mortality increase if the culprit drug is withdrawn late. We observed that death rates were lower when causative drugs with short elimination half-lives were withdrawn no later than the day when blisters or erosions first occurred. No difference was seen for drugs with long half-lives.
Second, intravenous fluid replacement must be initiated using macromolecules or saline solutions.
Third, the patient must be transferred to an intensive care unit or a burn center. Prompt referral reduces risk of infection, mortality rate and length of hospitalization.
The main types of symptomatic treatment are the same as for burns, and the experience of burn units is helpful for the treatment of TEN: environmental temperature control, careful and aseptic handling, sterile field creation, avoidance of any adhesive material, maintenance of venous peripheral access distant from affected areas (no central line when possible), initiation of oral nutrition by nasogastric tube, anticoagulation, prevention of stress ulcer, and medication administration for pain and anxiety control are all essential.
However, TEN and burned patients are not identical: burns happen in a very short time period (a few seconds) and do not spread thereafter; the TEN-SJS progress occurs during several days, including after hospital admittance. Cutaneous necrosis is more variable and often deeper in burns than in TEN.
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