Diagnosing and Managing Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Adults: Review of Evidence 2017-2023

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening reactions associated with long-term disabling sequelae. In the acute phase, the best supportive care in expert centers is the cornerstone of treatment. The follow-up is prolonged and multidisciplinary, according to the patient's needs. In this paper, we review the evidence from 2017 to 2023 for the diagnosis and management of SJS/TEN in adults. On the basis of this review and our own experience, we present recommendations for the diagnosis of SJS/TEN in adults, management in the acute phase (best supportive care; prevention of infections; skin, ocular, and other mucosa management; intensive care measures; and etiological treatment), and follow-up. The most frequent sequelae are cutaneous, ocular, and psychological. High-quality studies assessing the efficacy of immunomodulating agents (eg, cyclosporine, corticosteroids, intravenous Igs, and anti-TNF agents) in accelerating healing and reducing mortality are still lacking. In addition, we propose avenues for future studies.

Keywords: Epidermal necrolysis; Guidelines; Stevens-Johnson syndrome; Toxic epidermal necrolysis; Treatment.