From the Guidelines
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are distinct conditions characterized by the extent of skin detachment, with SJS involving less than 10% of body surface area and TEN affecting more than 30%. The primary difference between the two conditions lies in the severity of skin involvement, with TEN being more severe and having higher mortality rates 1. According to the U.K. guidelines for the management of SJS/TEN in adults 1, the term SJS/TEN encompasses the full spectrum of the disease, including SJS, TEN, and SJS-TEN overlap.
Key Differences
- SJS: less than 10% of body surface area involved
- TEN: more than 30% of body surface area involved
- SJS-TEN overlap: 10-30% of body surface area involved Both conditions typically begin with flu-like symptoms followed by painful rash and blistering 1. The causes of SJS and TEN are similar, with medications such as allopurinol, aromatic anticonvulsants, sulfonamide antibiotics, and certain NSAIDs being common triggers 1.
Treatment and Management
Treatment for both SJS and TEN includes:
- Immediate discontinuation of the suspected medication
- Supportive care in specialized burn units or ICUs
- Fluid and electrolyte management
- Wound care
- Sometimes IVIG, cyclosporine, or corticosteroids Early recognition and intervention are crucial for improving outcomes in both conditions 1. The pathophysiology of SJS and TEN involves T-cell mediated cytotoxic reactions and extensive keratinocyte apoptosis, leading to separation at the dermo-epidermal junction 1.
From the Research
Difference between Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
- Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are two severe dermatologic conditions that are considered to be part of the same spectrum of disease, with the main difference being the degree of skin detachment 2.
- SJS is characterized by mucocutaneous discomfort, hemorrhagic erosions, erythema, and occasional severe epidermal separation, while TEN is marked by more widespread full-thickness cutaneous and mucosal necrosis 3.
- The distinction between SJS and TEN is based on the extent of skin involvement, with SJS typically involving less than 10% of the body surface area and TEN involving more than 30% 4, 5.
Causes and Risk Factors
- Both SJS and TEN are often caused by medications, such as carbamazepine, trimethoprim-sulfamethoxazole, and phenytoin, as well as infections like herpes simplex virus and Mycoplasma pneumoniae 2, 6.
- There is also a strong genetic link between the occurrence of SJS and TEN in certain populations, such as the Han Chinese population, particularly with the use of certain medications like carbamazepine 2.
Diagnosis and Management
- Diagnosis of SJS and TEN is based on clinical symptoms and histopathological examination of skin biopsies, with differential diagnoses including other blistering diseases like pemphigus vulgaris and bullous pemphigoid 2, 3.
- Management of SJS and TEN involves supportive care, including wound management and prevention of infection, as well as withdrawal of the causative agent and consideration of immunomodulating treatments like corticosteroids and cyclosporine 4, 5, 3.