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Review
. 2020 Jul;9(7):426-439.
doi: 10.1089/wound.2019.0977. Epub 2020 Jan 9.

Toxic Epidermal Necrolysis and Steven-Johnson Syndrome: A Comprehensive Review

Olivia A Charlton  1   2 , Victoria Harris  3 , Kevin Phan  4 , Erin Mewton  1 , Chris Jackson  2   5 , Alan Cooper  1   2
Affiliations
Review

Toxic Epidermal Necrolysis and Steven-Johnson Syndrome: A Comprehensive Review

Olivia A Charlton et al. Adv Wound Care (New Rochelle). 2020 Jul.

Abstract

Significance: Toxic epidermal necrolysis (TEN) and Steven-Johnson syndrome (SJS) are potentially fatal acute mucocutaneous vesiculobullous disorders. Evidence to date suggests that outcomes for patients with both TEN and SJS are largely dependent on stopping the causative agent, followed by supportive care and appropriate wound management in a specialized burns unit. These are life-threatening conditions characterized by widespread full-thickness cutaneous and mucosal necrosis. This article outlines the approach to holistic management of such patients, in a specialized unit, highlighting various practical aspects of wound care to prevent complications such as infection, mucosal and adhesions, and ocular scaring. Recent Advances: There is improved understanding of pain and morbidity with regard to the type and frequency of dressing changes. More modern dressings, such as nanocrystalline, are currently favored as they may be kept in situ for longer periods. The most recent evidence on systemic agents, such as corticosteroids and cyclosporine, and novel treatments, are also discussed. Critical Issues: Following cessation of the culprit trigger, management in a specialized burns unit is the most important management step. It is now understood that a multidisciplinary team is essential in the care of these patients. Following admission of such patients, dermatology, ear, nose, and throat surgery, ophthalmology, urology, colorectal surgery, and gynecology should all be consulted to prevent disease sequelae. Future Directions: Looking forward, research is aimed at achieving prospective data on the efficacy of systemic immunomodulating agents and dressing types. Tertiary centers with burns units should develop policies for such patients to ensure that the relevant teams are consulted promptly to avoid mucocutaneous complications.

Keywords: Steve–Johnson syndrome; drug reaction; toxic epidermal necrolysis.

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Conflict of interest statement

C.J. and A.C. have shares in a company with an interest in a variant of activated protein C to treat diabetic wounds. No other competing financial interests exist.

None of the other authors has any disclosures. The content of this article was expressly written by the authors listed. No ghostwriters were used to write this article.

Figures

None
Olivia A. Charlton, BAS, MBBS, MPH
Figure 1.
Figure 1.
Widespread epidermal detachment with exposed dermis, affecting >30% of the total body surface area, consistent with a diagnosis of TEN. (a) Upper limb. (b) Torso. TEN, toxic epidermal necrolysis.
Figure 2.
Figure 2.
TEN affecting mucosal sites. (a) Penis, (b) mouth, and (c) eyes.
Figure 3.
Figure 3.
(a) Wound care for the torso in TEN/SJS. (b) Area-specific wound care in TEN/SJS. SJS, Steven–Johnson syndrome.
Figure 3.
Figure 3.
(a) Wound care for the torso in TEN/SJS. (b) Area-specific wound care in TEN/SJS. SJS, Steven–Johnson syndrome.
Figure 4.
Figure 4.
TEN affecting the face, eyes, lips, oral mucosa, and respiratory tract, necessitating intubation.
See this image and copyright information in PMC

References

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