From the Guidelines
The treatment for Stevens-Johnson syndrome is primarily supportive care, which includes care of skin, mucous membranes, resuscitation, fluid balance, nutritional support, analgesia, and preventing life-threatening complications and long-term morbidity 1.
Treatment Overview
- Supportive care is the most important aspect of treatment, and it should be tailored to the individual patient's needs, taking into account their age and specific requirements 1.
- Systemic corticosteroids may be considered in the treatment of Stevens-Johnson syndrome, although the evidence for their effectiveness is limited and conflicting 1.
- Intravenous immunoglobulin (IVIg) has been studied as a potential treatment, but the current evidence does not support its use as a standard treatment for Stevens-Johnson syndrome 1.
Specific Treatment Considerations
- Topical treatments, such as corticosteroids and calcineurin inhibitors, may be used to manage skin and mucous membrane involvement 1.
- Systemic treatments, including corticosteroids, IVIg, and ciclosporin, may be considered in certain cases, but their use should be individualized and based on the specific clinical scenario 1.
- Age-appropriate strategies, such as play specialists, distraction, and involvement of parents, should be utilized to support children and young adults with Stevens-Johnson syndrome 1.
Key Takeaways
- Supportive care is the cornerstone of treatment for Stevens-Johnson syndrome.
- Systemic corticosteroids and IVIg may be considered in certain cases, but their use should be individualized and based on the specific clinical scenario.
- Standardized treatment and reporting are needed to compare morbidity and mortality outcomes between different approaches 1.
From the Research
Treatment Options for Stevens-Johnson Syndrome
The treatment for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) is primarily focused on supportive care, with various adjuvant therapies being used in severe cases. The following are some of the treatment options:
- Supportive care: This is the most universally accepted intervention for SJS/TEN, and it differs from the care required for patients with thermal burns 2.
- Systemic corticosteroids: The use of systemic corticosteroids as sole therapy is not supported, and the data on their effectiveness in combination with other treatments is conflicting 2, 3.
- Intravenous immunoglobulin (IVIG): IVIG is currently the standard of care for most referral centers, but the data on its effectiveness is conflicting 2, 3.
- Cyclosporine: Cyclosporine has shown promising results in recent studies, and it may be an effective treatment option for SJS/TEN 3, 4.
- Biologic anti-TNF-α: Biologic anti-TNF-α, such as etanercept, has shown promising results in recent studies, and it may be an effective treatment option for SJS/TEN 3, 5, 6.
- Combination treatments: Combination treatments, such as IVIG and corticosteroids, or cyclosporine and biologic anti-TNF-α, may be effective in treating SJS/TEN, but further studies are needed to confirm their efficacy 3, 4.
Adjuvant Therapies
Adjuvant therapies, such as plasmapheresis, have been used in some cases of SJS/TEN, but the data on their effectiveness is limited and conflicting 2.
- Plasmapheresis: The data on plasmapheresis is equivocal, and its use is not widely recommended 2.
- Thalidomide: Thalidomide has been shown to increase mortality in patients with SJS/TEN, and its use is not recommended 2.
Future Directions
Further studies are needed to determine the most effective treatment options for SJS/TEN, and to develop standardized management approaches for this condition 2, 3, 4.