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Stevens-Johnson syndrome

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of Stevens-Johnson syndrome are prepared by our editorial team based on guidelines from the Society of Dermatology Hospitalists (SDH 2020) and the British Association of Dermatologists (BAD 2019,2016). ...
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Classification and risk stratification

Risk assessment: as per BAD 2016 guidelines, calculate the SCORTEN score within the first 24 hours of admission.
B
Severity of Illness Score for Toxic Epidermal Necrolysis (SCORTEN score)
Age > 40 years
Malignancy
Tachycardia > 120/min
> 10% initial epidermal detachment
Serum urea > 10 mmol/L
Serum glucose > 14 mmol/L
Serum bicarbonate < 20 mmol/L
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Diagnostic investigations

Initial assessment: as per BAD 2016 guidelines, elicit a detailed history in patients and/or relatives of patients with SJS.
E
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  • Drug hypersensitivity testing

  • Airway examination

Medical management

Setting of care: as per BAD 2016 guidelines, ensure a multidisciplinary team coordinated by a specialist in skin failure, usually dermatology and/or plastic surgery, and including clinicians from intensive care, ophthalmology and skincare nursing.
E
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  • Withdrawal of causative drug

  • Fluid management

  • Oral care

  • Ocular care (conservative management)

  • Urogenital care

  • Thromboprophylaxis

  • Antibiotics

  • Management of pain

  • Management of neutropenia

Nonpharmacologic interventions

Enteral nutrition: as per BAD 2016 guidelines, insert a nasogastric tube and institute nasogastric feeding if the patient cannot maintain adequate nutrition PO.
E
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Surgical interventions

Wound care: as per BAD 2016 guidelines, institute a conservative approach of wound care in all patients with SJS/TEN.
E
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Specific circumstances

Pediatric patients, differential diagnosis: as per BAD 2019 guidelines, exclude staphylococcal scalded skin syndrome by clinical assessment of mucosae (not involved in staphylococcal scalded skin syndrome) and skin biopsy if any diagnostic uncertainty.
A
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  • Pediatric patients (risk assessment)

  • Pediatric patients (history and physical examination)

  • Pediatric patients (laboratory tests)

  • Pediatric patients (setting of care)

  • Pediatric patients (withdrawal of causative drug)

  • Pediatric patients (initial stabilization)

  • Pediatric patients (fluid management)

  • Pediatric patients (nutritional support)

  • Pediatric patients (management of pain)

  • Pediatric patients (immunomodulatory therapy)

  • Pediatric patients (skin care)

  • Pediatric patients (mouth care)

  • Pediatric patients (eye care)

  • Pediatric patients (urogenital care)

  • Pediatric patients (discharge and follow-up)

Patient education

Counseling before discharge
As per BAD 2016 guidelines:
Provide patients with a written information about drugs to avoid.
E
Encourage patients to wear a MedicAlert bracelet.
E

Follow-up and surveillance

Infection surveillance: as per BAD 2016 guidelines, employ strict barrier nursing to reduce nosocomial infections.
E

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  • Follow-up

Quality improvement

Reporting
As per BAD 2016 guidelines:
Document drug allergy in the patient's notes and inform all doctors involved in the patient's care.
E
Report the episode to the national pharmacovigilance authorities.
E