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Review
. 2025 Jul;64(7):1164-1172.
doi: 10.1111/ijd.17768. Epub 2025 Apr 15.

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Current Management and Innovative Therapies

Jose Dario Martinez Villarreal  1 , Jesus Alberto Cardenas-de la Garza  2 , Marius-Anton Ionescu  3 , Alin Laurentiu Tatu  4   5   6 , Camelia Busila  4 , Mourad Mokni  7 , Luis Manuel Saenz Medina  8 , Sergio Maximo Delgado Jasso  9 , Eduardo David Poletti  10 , Kenneth J Tomecki  11
Affiliations
Review

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Current Management and Innovative Therapies

Jose Dario Martinez Villarreal et al. Int J Dermatol. 2025 Jul.

Abstract

There is no consensus regarding the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Supportive care remains the preferred approach internationally, while the efficacy of topical/systemic therapies is subject to controversy. We reviewed published guidelines and recommendations on SJS/TEN management and assessed supportive care involving topical and systemic therapies in a series of SJS patients. We included several specialty departments from different countries to determine the consensus in the management of SJS/TEN. We also included SJS patients and provided supportive care including silver nitrate at 0.5% sprayed on denuded areas, in conjunction with a single dose of subcutaneous etanercept. Based on our literature review and experience, we propose a management algorithm for SJS/TEN. Our review confirmed the importance of supportive care, including specific topical and systemic treatments, for SJS/TEN. Systemic corticotherapy, cyclosporine A, intravenous immunoglobulin, tumor necrosis factor-alpha (TNF-α) blockers, or combinations are subject to controversies. In our pilot series of seven adult patients with SJS, we obtained good clinical results within 1 week, with mucosal and skin clearance at Week 2, along with a good safety profile. This was achieved by spraying topical silver nitrate at a concentration of 0.5% on denuded areas, following a single dose of etanercept. This consensus led to the recommendation of a combination of supportive care along with several possible topical and systemic therapies for SJS/TEN. Corticosteroids, immunoglobulins, cyclosporine A, and TNF-alpha blockers were used in our centers alone or in combination, with good results associated with 0.5% topical silver nitrate. In our series of SJS patients, silver nitrate at 0.5% associated with etanercept showed a good response.

Keywords: Stevens‐Johnson syndrome; etanercept; silver nitrate; supportive care; toxic epidermal necrolysis.

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References

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