Severe drug-induced mucocutaneous necrosis; SJS <10% BSA, TEN >30% BSA detachment.
Clinical features
- • Prodromal fever and malaise
- • Painful erythematous macules progressing to blisters
- • Positive Nikolsky sign
- • Mucosal ulceration of eyes, mouth and genitals
Investigations
- • SCORTEN prognostic score
- • Skin biopsy (full-thickness epidermal necrosis)
- • Bloods, cultures, fluid balance
Management
- • Stop the culprit drug immediately
- • Transfer to burns/ICU for fluid, temperature and wound care
- • Ophthalmology, urology and ENT review for mucosal involvement
- • Consider ciclosporin or IVIG (evidence limited)
- • Analgesia and nutritional support
Clinical pearls
- • Common culprits: allopurinol, lamotrigine, carbamazepine, sulfonamides, NSAIDs
- • Do not use prophylactic antibiotics
Educational — verify locally.
