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.
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.
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.