From the Research
Erythema marginatum is not typically associated with Stevens-Johnson Syndrome (SJS), and the two conditions have distinct causes and presentations. Stevens-Johnson Syndrome is a severe, potentially life-threatening skin reaction characterized by widespread blistering and sloughing of the skin and mucous membranes, often triggered by medications like antibiotics, anticonvulsants, or NSAIDs. Treatment for SJS requires immediate discontinuation of the suspected causative agent, hospitalization for supportive care including fluid management, wound care, pain control, and prevention of complications, as recommended by the most recent guidelines 1.
Some key points to consider in the management of SJS include:
- Immediate discontinuation of the suspected causative agent
- Hospitalization for supportive care
- Fluid management and prevention of hypothermia
- Nutritional support
- Pain and psychological distress management
- Management of acute respiratory failure
- Local skincare and ophthalmological management
Medications like cyclosporine (3-5 mg/kg/day) or IVIG (1 g/kg/day for 3 days) may be used in severe cases, although the use of corticosteroids is debatable and not clearly indicated by randomized studies 2. Erythema marginatum, on the other hand, is a distinctive rash associated with rheumatic fever, appearing as pink rings with clear centers that migrate across the skin. It's not a feature of SJS. The confusion may arise because both conditions affect the skin, but they have different etiologies, presentations, and treatments. If a patient presents with widespread blistering rash involving mucous membranes, SJS should be suspected and urgent medical attention is required, following the guidelines for supportive care in the acute phase of SJS/TEN 1.
In terms of specific management, the international, multidisciplinary Delphi-based consensus provides recommendations for supportive care in the acute phase of SJS/TEN, including multidisciplinary team composition, suspect drug management, infection prevention, and fluid resuscitation and prevention of hypothermia 1. The Society of Dermatology Hospitalists also provides supportive care guidelines for the management of SJS/TEN in adults, emphasizing the importance of a multidisciplinary approach and evidence-based practice 3.
Overall, the management of SJS requires a comprehensive and supportive approach, with a focus on preventing complications and improving outcomes, as recommended by the most recent and highest quality studies 1, 3.