Stevens-Johnson syndrome: Difference between revisions
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==Etiology== |
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*Infection: especially common in children |
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** |
**[[Mycoplasma pneumoniae]]: moderate to severe involvement of two or more mucosal sites and sparse, or even absent, skin involvement |
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**[[Neisseria gonorrhoeae]][[CiteRef::tan2012pr]] |
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*Drugs |
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**[[Allopurinol]] |
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**Aromatic [[antiepileptic drugs]] and [[lamotrigine]] |
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**Antibacterial sulfonamides (including [[sulfamethoxazole]] and [[sulfasalazine]]) |
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**[[Nevirapine]] |
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**[[Oxicam]] nonsteroidal anti-inflammatory drugs (NSAIDs) |
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**Less strongly, other antibiotics |
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*** [[Doxycycline]] |
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***[[Doxycycline]] |
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***[[Amoxicillin]]/[[ampicillin]] |
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***[[Ciprofloxacin]] |
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***[[Levofloxacin]] |
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***[[Rifampin]] |
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== Management == |
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* Risk stratify with [[SCORTEN score]] |
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* Consider referral to burn centre or ICU if [[BSA]] 30% or greater, or if SCORTEN score is 2 or greater |
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*Stop offending drug, if applicable |
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*Supportive care, including wound care and IV fluids (2 ml per kg times BSA over first 24 hours) |
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**Room temperature 30ΒΊ to 32ΒΊC |
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**May need NG tube |
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**Pain control, as pain may be severe |
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*Ophthalmologic exam and management |
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**Saline rinses |
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**Artificial tears even if no involvement |
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**Corticosteroids with or without antibiotics for any involvement |
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*No clear benefit to steroids or IVIG |
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*Cyclosporine 3 to 5 mg per kg in one or two divided doses may slow progression |
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Latest revision as of 13:39, 10 April 2024
Etiology
- Infection: especially common in children
- Mycoplasma pneumoniae: moderate to severe involvement of two or more mucosal sites and sparse, or even absent, skin involvement
- Neisseria gonorrhoeae1
- Drugs
- Allopurinol
- Aromatic antiepileptic drugs and lamotrigine
- Antibacterial sulfonamides (including sulfamethoxazole and sulfasalazine)
- Nevirapine
- Oxicam nonsteroidal anti-inflammatory drugs (NSAIDs)
- Less strongly, other antibiotics
Management
- Risk stratify with SCORTEN score
- Consider referral to burn centre or ICU if BSA 30% or greater, or if SCORTEN score is 2 or greater
- Stop offending drug, if applicable
- Supportive care, including wound care and IV fluids (2 ml per kg times BSA over first 24 hours)
- Room temperature 30ΒΊ to 32ΒΊC
- May need NG tube
- Pain control, as pain may be severe
- Ophthalmologic exam and management
- Saline rinses
- Artificial tears even if no involvement
- Corticosteroids with or without antibiotics for any involvement
- No clear benefit to steroids or IVIG
- Cyclosporine 3 to 5 mg per kg in one or two divided doses may slow progression
References
- ^ SK Tan, YK Tay. Profile and Pattern of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a General Hospital in Singapore: Treatment Outcomes. Acta Dermato Venereologica. 2012;92(1):62-66. doi:10.2340/00015555-1169.
