dermatologic disorders
Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)
Diagnosis of SJS and TEN
Clinical evaluation Often skin biopsy Diagnosis is often obvious from appearance of lesions and rapid progression of symptoms. Histologic examination of sloughed skin shows necrotic epithelium, a distinguishing feature. Differential diagnosis in Stevens-Johnson syndrome (SJS) and early toxic epidermal necrolysis (TEN) includes Erythema Multiforme , viral exanthems, and other drug rashes; SJS/TEN can usually be differentiated clinically as the disorder evolves and is characterized by significant pain and skin sloughing. In later stages of TEN, differential diagnosis includes the following: Toxic Shock Syndrome (TSS) (usually has more prominent multiple organ involvement and different cutaneous manifestations, such as macular rash on palms and soles that evolves to desquamation over about 2 weeks) Erythroderma (usually spares mucous membranes and is not as painful) Pemphigus Vulgaris (sometimes with different mucocutaneous findings or in patients with evidence of cancer) In children, TEN is less common and must be distinguished from Staphylococcal Scalded Skin Syndrome . Characteristics of staphylococcal scalded skin syndrome usually include sparing of mucous membranes, absence of risk factors for TEN (eg, drug history), and clinical suspicion of staphylococcal infection. 