Synopsis
Recognise painful mucocutaneous epidermal necrolysis early, stop culprit medicines, quantify detachment, and coordinate intensive supportive and specialist care.
- Painful skin, fever and mucosal erosion often precede obvious detachment; do not wait for large blisters to suspect SJS or TEN.
- SJS involves under ten percent detached or detachable body surface, overlap ten to thirty percent, and TEN more than thirty percent.
- Stop likely culprit and non-essential medicines immediately, using a dated timeline because latency and drug half-life influence causality.
- Transfer to an experienced intensive, burns or specialist dermatology environment according to local pathways before avoidable deterioration.
- Support temperature, fluid, nutrition, pain, wounds and thrombosis prevention; avoid routine prophylactic systemic antibiotics without infection evidence.
- Obtain ophthalmology review within the acute phase even when eye symptoms initially appear mild, and assess oral, genital and urinary mucosa.
- Stevens-Johnson syndrome and toxic epidermal necrolysis must be assessed by lesion duration, onset, distribution, symptoms, mucosal findings, systemic physiology and the full medicine timeline rather than by colour alone.
- For Stevens-Johnson syndrome and toxic epidermal necrolysis, document the working diagnosis, excluded emergencies, uncertain culprit or trigger, treatment response and the exact safety-net given.
Key red flags
Eye pain, photophobia, oral or genital erosions, skin tenderness, rapidly spreading dusky macules, blisters, positive epidermal shearing, fever, hypotension or oliguria requires emergency admission.
Marked skin tenderness or burning out of proportion to visible change is an early warning for evolving epidermal necrosis.
Hypothermia, tachycardia, hypotension, oliguria and rising oxygen requirement indicate critical barrier and organ dysfunction.
Investigation priorities
Stop high-risk exposures and estimate causality from start dates, withdrawal and half-life.
Management branches
Skin pain, dusky targetoid lesions, mucosal erosions or detachment appears after a plausible medicine.
- Withdraw plausible culprit and non-essential medicines, document exact exposure dates and obtain emergency dermatology plus critical-care assessment.
- Biopsy a fresh representative edge when safe, measure detached and detachable surface and initiate physiological monitoring without awaiting pathology.
- Transfer early to the locally designated experienced setting because transport becomes harder after extensive skin failure develops.