Stevens Johnsons Syndrome - Treatment Part I
 

Treatment and Management

Recognition of SJS symptoms enables early diagnosis, prompt management and the withdrawal of causative drugs in order to achieve a positive recovery and favorable outcome.  If the causative drug is withdrawn later due to lack of symptom recognition and early diagnosis morbidity and mortality increase. Causative drugs have either a short elimination half life or a long half life. When short half life drugs are withdrawn within one day of the appearance of blisters and irritation occur the death rate is lowered. With long half life drugs no difference was observed based upon the timing of cessation of the drug.

Primary care for the patient after drug cessation involves initiating intravenous fluid replacement. IV fluids used should be macromolecules or saline solutions.  

Prompt referral of the patient to an intensive care unit or burn center reduces the mortality rate by reducing the risk of infection and can have an effect on the length of time the patient is hospitalized.  

List of Burn Unit Centers
 
General Principles of Symptomatic Treatment


The main symptomatic treatments are similar as the treatments for burns. The regulated temperature, careful and aseptic handling, sterile field creation, and avoidance of adhesive materials, make burn units ideal for the treatment of TEN. The experience of burn unit physicians and nurses allows the maintenance of venous peripheral access, initiation of oral nutrition through nasogastric tubes, anticoagulation, and prevention of stress ulcers and medication for pain and anxiety which are all essential to the recovery and treatment of the symptoms of TEN.  


There are differences between TEN and burned patients. Burns often occur within a few seconds and don’t  spread; TEN-SJS progresses over several days and continues to spread even after beginning a treatment plan. The level of cutaneous necrosis is more varied and deeper in burns than instances of TEN.


The differences create important treatment/management specifics. Due to the severe injury to blood vessels in a burn subcutaneous edema is a common feature of burns, and is very uncommon in TENs patients. The fluid requirements for TEN patients are generally two thirds to three fourths of those needed for patients with burns covering the same area.

Because TENs lesions are limited to the epidermal layer and doesn’t typically affect the hair follicles, regrowth of the epidermis is fairly rapid in SJS-TEN patients. This difference allows for a differing approach to topical treatment.