Management

Stevens-Johnson syndrome has an attributable mortality of 5% and TEN an overall mortality of 30%.  Comorbid infections such as bacterial systemic infections or tuberculosis are associated with a higher risk of mortality.^[177] Discontinuation of the offending drug is essential. Drugs initiated in the last 1 to 3 weeks before illness should be considered as potential causes including all drugs the patient is receiving, including over-the-counter and non-prescription as well as herbal and traditional medicine. There is no reliable laboratory test to determine the offending drug; diagnosis is based on the patient’s history and the temporal relationship of suspected drugs. Provocation tests are not indicated since re-exposure is likely to elicit a new episode of increased severity.^[178]  Stevens-Johnson syndrome and TEN should be managed by an experienced physician. Supportive measures include identification and removal of the offending medication, admission to a burn unit if necessary,  intravenous fluid administration, maintenance of electrolyte and temperature homeostasis, and ophthalmological assessment in case of ocular involvement. Skin care consists of proper wound dressings, oral hygiene (i.e. chlorhexidine rinses), antihistamine and topical corticosteroid therapy for pruritus, and antimicrobial therapy in cases of superinfection due to skin-barrier breakdown. Some Units use high doses of immunoglobulin intravenously as mainstay therapy for TEN; however, more evidence of its effectiveness is needed. ¹⁰⁶ The use of systemic corticosteroids, or prophylactic antibiotics for sepsis prevention, is not recommended.