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Erythema multiforme,
Steven-Johnson syndrome
and toxic epidermal…
Erythema multiforme,
Steven-Johnson syndrome
and toxic epidermal necrolysis
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Aetiology
SJS
Infection: HSV, mycoplasma
Drugs: sulfonamides, AEDs, NSAIDs, penicillin
TEN
Drugs: sulphonamides, AEDs, NSAIDs, penicillins
EM
Idiopathic (common)
Infection: HSV, Orf (sheep poxvirus)
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Diagnosis
Examination
Derm exam
Erythematous, widespread target lesions (EM),
mucosal involvement (SJS), extensive exfoliation (TEN)
History
DH
Meds, allergies
Recent abx
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SH
Living arrangements,
occupation/school, smoking, alcohol
PC/HPC
Erythematous skin, mucosa (mouth, genitals, eyes),
fever, recent infection e.g. URTI
Management
Conservative
Information, advice, support
Refer derm ASAP (SJS, TEN)
Admit to HDU, ITU or burns (SJS, TEN)
Supportive care (fluids, skin protection)
Medical
Antimicrobials
Indication: EM with infection trigger
E.g. abx, antivirals
IV Ig
Indication: SJS, TEN
MOA: neutralises autoantibodies,
reducing autoimmune skin reaction
Analgesia
Indication: pain
E.g. paracetamol, NSAIDs, codeine, morphine
Steroids
Indication: EM
E.g. topical, PO (severe)
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Definition
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Toxic epidermal necrolysis (TEN)
Extensive skin and mucosal necrosis (>30% BSA)
plus systemic toxicity
DERMATOLOGICAL EMERGENCY
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