From the Guidelines
The treatment of Stevens-Johnson Syndrome (SJS) requires immediate hospitalization, ideally in a burn unit or intensive care setting, with a focus on supportive care, wound management, and prevention of secondary infections, as outlined in the most recent guidelines 1. The management of SJS involves several key components, including:
- Discontinuation of any suspected causative medications, particularly antibiotics, anticonvulsants, or NSAIDs
- Supportive care, including fluid and electrolyte replacement, nutritional support, temperature regulation, and pain management with opioid analgesics
- Wound care, involving gentle cleansing with sterile saline, application of non-adherent dressings, and avoiding adhesive materials
- For ocular involvement, ophthalmology consultation is essential, with recommendations for daily ophthalmological review, two-hourly application of lubricants, and ocular hygiene to remove inflammatory debris and break down conjunctival adhesions 1
- Systemic corticosteroids, such as IV methylprednisolone (0.5-1 mg/kg), may be considered in the management of SJS, particularly in cases associated with immune checkpoint inhibitor therapy 1
- Intravenous immunoglobulin (IVIG) or cyclosporine may also be considered in severe or steroid-unresponsive cases
- Close monitoring for secondary infections is crucial, treating with appropriate antibiotics only when infection is confirmed The mortality rate for SJS is 5-10%, with most deaths resulting from sepsis or respiratory complications, highlighting the importance of comprehensive care and infection prevention 1.
From the Research
Treatment Options for Stevens-Johnson Syndrome
- The treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) involves a combination of supportive care and immunomodulatory therapies 2, 3, 4.
- Supportive care is the cornerstone of management, including wound care, fluid resuscitation, and prevention of infection 4.
- Immunomodulatory therapies such as corticosteroids, intravenous immunoglobulin (IVIG), and tumor necrosis factor-alpha (TNF-alpha) inhibitors like etanercept may be used to reduce disease severity and improve outcomes 2, 3, 5, 6.
Pharmacological Interventions
- Corticosteroids, such as methylprednisolone, may be used to reduce inflammation and prevent disease progression 2, 5.
- IVIG has been shown to be effective in reducing disease severity and improving outcomes in some studies 2, 5.
- Etanercept, a TNF-alpha inhibitor, has been suggested as a potentially beneficial agent in the treatment of SJS/TEN, with some studies showing improved mortality benefit and decreased skin healing times 5, 6.
- Cyclosporin has also been used as an immunomodulatory therapy, with some studies showing promising results 5.
Comparative Effectiveness of Treatments
- The comparative effectiveness of different treatments for SJS/TEN is not well established, with limited high-quality evidence available 5.
- A systematic review found that the certainty of the evidence for most comparisons was very low, highlighting the need for further research to determine the best treatments for SJS/TEN 5.
- Etanercept may result in mortality reduction compared to corticosteroids, but the evidence is still limited and more studies are needed to confirm this finding 5, 6.