04/12/2026
🔍 What it is
SJS is part of a spectrum:
SJS (milder form): 30% skin detachment
SJS–TEN overlap: in between
It involves widespread cell death in the skin, causing the epidermis to separate from the dermis.
⚠️ Causes
Most commonly due to drugs, such as:
Antibiotics (e.g., sulfonamides)
Anticonvulsants (phenytoin, carbamazepine, lamotrigine)
NSAIDs (especially oxicam type)
Allopurinol
Other causes:
Viral infections (e.g., herpes, Mycoplasma pneumoniae)
Rarely idiopathic (unknown)
🧬 Pathophysiology (simplified)
Immune-mediated hypersensitivity reaction
Cytotoxic T cells → keratinocyte apoptosis
Leads to epidermal necrosis and sloughing
🩺 Clinical features
Usually begins with flu-like symptoms:
Fever
Malaise
Sore throat
Then progresses to:
Painful red or purplish rash
Blistering and peeling skin
Positive Nikolsky sign (skin sloughs with pressure)
Mucosal involvement (key feature):
Mouth (painful ulcers)
Eyes (conjunctivitis, risk of blindness)
Ge****ls
🚨 Complications
Dehydration
Secondary infections → sepsis
Respiratory failure
Permanent eye damage
🏥 Management
This is a medical emergency → treat like a burn patient.
Immediate discontinuation of the causative drug
Supportive care:
IV fluids
Electrolyte management
Wound care (burn unit/ICU)
Pain control
Nutritional support
Sometimes:
IV immunoglobulin (IVIG)
Corticosteroids (controversial)
Cyclosporine (in some cases)
🛡️ Prognosis
Mortality ~5–10% (higher in TEN)
Assessed using SCORTEN score
