dermatologic disorders
Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
Introduction
Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous hypersensitivity reactions. Drugs, especially sulfa drugs, antiseizure drugs, and antibiotics, are the most common causes. Macules rapidly spread and coalesce, leading to epidermal blistering, necrosis, and sloughing. Diagnosis is usually obvious by appearance of initial lesions and clinical syndrome. Treatment is supportive care;cyclosporine, plasmapheresis or IV immune globulin, early corticosteroid therapy, and tumor necrosis factor-alpha inhibitors have been used. Mortality can be as high as 7.5% in children and 20 to 25% in adults but tends to be lower with early treatment. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are clinically similar except for their distribution. By one commonly accepted definition, changes affect<10% of body surface area in SJS and>30% of body surface area in TEN; involvement of 10 to 30% of body surface area is considered SJS/TEN overlap. The disorders affect between 1 and 5 people/million. Incidence, severity, or both of these disorders may be higher in bone marrow transplant recipients, in Helicobacter pylori Infection –infected HIV patients, in patients with 