Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis Quiz
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There are blisters
Have a fever
Redness of the skin
Genital ulcers (private parts)
Have a headache
Skin is thick and scaly
Spots in mouth
Not seeing your symptoms? No worries!
What is Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis?
This serious condition affects the skin and mucous membranes, causing rashes, blisters, and peeling. It can be life threatening. The cause may be a reaction to medication, an infection, or environmental and genetic factors. Those with compromised immune systems are at higher risk.
Typical Symptoms of Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
- A lump or bump in the mouth
- Fever
- Bloodshot eyes
- Headache
- Redness of the whites of the eyes
- Ulcers in the genital area
- Blisters on the skin
- Areas of irritated or peeling skin
Diagnostic Questions for Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
Your doctor may ask these questions to check for this disease:
- Have you noticed a lump or bump in your mouth?
- Do you have a fever?
- Do you have bloodshot (red) eyes?
- Do you have a headache?
- Are the whites of your eyes red?
Treatment of Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
Prompt medical attention is critical and requires hospitalization. Treatment can be extensive, with recovery time varying based on symptom severity. Treatment includes stopping any triggering medication, providing supportive care with fluids, rehydration, wound care, and various medications.
Reviewed By:
Sarita Nori, MD (Dermatology)
Dr. Sarita Nori was drawn to dermatology because of the intersection of science and medicine that is at the heart of dermatology. She feels this is what really allows her to help her patients. “There is a lot of problem-solving in dermatology and I like that,” she explains. “It’s also a profession where you can help people quickly and really make a difference in their lives.” | Some of the typical skin problems that Dr. Nori treats include skin cancers, psoriasis, acne, eczema, rashes, and contact dermatitis. Dr Nori believes in using all possible avenues of treatment, such as biologics, especially in patients with chronic diseases such as eczema and psoriasis. “These medications can work superbly, and they are really life-changing for many patients.” | Dr. Nori feels it’s important for patients to have a good understanding of the disease or condition that is affecting them. “I like to educate my patients on their problem and have them really understand it so they can take the best course of action. Patients always do better when they understand their skin condition, and how to treat it.”
Yukiko Ueda, MD (Dermatology)
Dr. Ueda graduated from the Niigata University School of Medicine and trained at the University of Tokyo Medical School. She is currently a clinical assistant professor at the Department of Dermatology, Jichi Medical University, and holds several posts in the dermatology departments at Kyoto Prefectural University of Medicine, Komagome Hospital, University of Tokyo, and the Medical Center of Japan Red Cross Society.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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See full list
Symptoms Related to Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
Diseases Related to Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
FAQs
Q.
Severe Rash? Stevens-Johnson Syndrome & Medically Approved Next Steps
A.
A rapidly spreading, painful rash with blisters or skin peeling, especially with mouth or eye sores and fever, can be Stevens-Johnson syndrome, a rare medical emergency often triggered by a new medication. Go to the emergency room now, do not take another dose of any suspected drug, and bring a list of all medicines started in the last month. There are several factors to consider. See below for early warning signs, high-risk meds and infections, how this differs from a typical rash, what doctors do in the hospital, and step by step next actions that could affect your care.
References:
* Maverakis E, Leventhal JS, Smith GP, Sethi M, Patel F, Kuperman S, Presti B, Cheng B, Konia TH, Koru-Sengul D, Ma W, O'Malley M, Sontag S, Tan D, Torres-Ruiz J, Vang KA, Wegienka W, Wu B, Liang MG. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multidisciplinary Clinical Practice Guideline. J Am Acad Dermatol. 2024 Jan;90(1):153-171. doi: 10.1016/j.jaad.2023.08.053. Epub 2023 Sep 8. PMID: 37690466.
* Ramli N, Aw YS, Sebaratnam P. Update on Current Management of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Medicina (Kaunas). 2023 Oct 19;59(10):1825. doi: 10.3390/medicina59101825. PMID: 37893116.
* Foti C, Nettis E, Di Leo E, Bavaro DF, Custurone G, Stingeni L, Patrì A, Romita P. Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review of the literature. J Dermatol. 2023 Dec;50(12):1478-1487. doi: 10.1111/1346-8138.16979. Epub 2023 Sep 20. PMID: 37731278.
* Mittal P, Al-Niami F, Kalia S, Shah V, Al-Ani B, Grewal V, Shah J. Stevens-Johnson syndrome and toxic epidermal necrolysis: Management of adult patients in the intensive care unit-A European perspective. J Burn Care Res. 2023 Nov 2;44(6):1460-1469. doi: 10.1093/jbcr/irad040. PMID: 36980757.
* Chahal H, Palleschi GM, Shaker M, Nagele E, Shah S, Chahal K, Kumar J. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Update on Pathophysiology and Clinical Management. Adv Ther. 2022 Nov;39(11):5019-5030. doi: 10.1007/s12325-022-02302-6. Epub 2022 Sep 13. PMID: 36098939.
Q.
Is your skin peeling? Why Stevens-Johnson Syndrome happens and your next steps.
A.
Peeling skin with fever, painful rash or blisters, or sores on the mouth, eyes, or genitals especially within 1 to 3 weeks of starting a new medication can signal Stevens-Johnson syndrome, a rare emergency most often caused by a drug reaction that requires immediate ER care. There are several factors to consider. See below for key details on causes, early warning signs, exactly when to seek emergency help, what treatment involves, prevention, recovery, and the safest next steps for your situation.
References:
* Schwartz RA, Littman JR, Littman NB, Janniger CK. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Update on Etiology, Pathogenesis, and Management. Semin Cutan Med Surg. 2021 Mar;40(1):12-22. doi: 10.1016/j.sder.2021.01.002. PMID: 33712176.
* Patel S, Murrell DF, Ramchandran V. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Comprehensive Review. Int J Dermatol. 2021 Dec;60(12):1478-1489. doi: 10.1111/ijd.15930. Epub 2021 Oct 22. PMID: 34676571.
* Chang YS, Huang YC, Chen KS, Ho CL, Chen YH. Recent Advances in the Diagnosis and Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. J Immunol Res. 2022 Mar 26;2022:5884488. doi: 10.1155/2022/5884488. PMID: 35359703.
* Lerch M, Chassidim M, Jemielita T, et al. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Review of Pathogenesis and Management. Clin Rev Allergy Immunol. 2022 Feb;62(1):34-45. doi: 10.1007/s12016-021-08889-x. Epub 2021 Dec 22. PMID: 34936087.
* Yang SC, Hu S, Zhang SZ, et al. Stevens-Johnson syndrome and toxic epidermal necrolysis: A comprehensive review of pathogenesis, clinical features, and management. J Dermatol. 2023 Mar;50(3):284-302. doi: 10.1111/1346-8138.16645. Epub 2023 Jan 2. PMID: 36594248.
Q.
Is It TSS? Why Your Body Is Reacting to Toxic Shock Syndrome & Medical Next Steps
A.
Toxic shock syndrome is a rare but life threatening reaction to staph or strep toxins that trigger an overwhelming immune response, causing sudden high fever, a sunburn-like rash that may peel, vomiting or diarrhea, dizziness or fainting, and low blood pressure, sometimes after tampon use, a wound, surgery, or nasal packing. This is an emergency, remove any tampon or packing and seek urgent care now since early hospital treatment with IV antibiotics and fluids improves outcomes; there are several factors and look-alike conditions to consider, so see below for critical symptoms, risks, and next steps.
References:
* Poyet M, et al. Toxic Shock Syndrome. Curr Opin Infect Dis. 2022 Dec 1;35(6):531-537. doi: 10.1097/QCO.0000000000000854. PMID: 36322046.
* Al-Anzi S, et al. Toxic shock syndrome: A review of current management and emerging therapies. J Intensive Care Soc. 2023 Feb;24(1):89-94. doi: 10.1177/17511437221111603. Epub 2022 Jul 18. PMID: 36761108; PMCID: PMC9895011.
* Davis CC, et al. Staphylococcal Toxic Shock Syndrome. Clin Microbiol Rev. 2024 Mar 13;37(1):e0004023. doi: 10.1128/cmr.00040-23. Epub 2024 Jan 10. PMID: 38206109; PMCID: PMC10935515.
* Jiménez-Treviño L, et al. Streptococcal Toxic Shock Syndrome. Curr Opin Infect Dis. 2024 Jun 1;37(3):209-216. doi: 10.1097/QCO.0000000000000966. Epub 2024 Apr 9. PMID: 38592398.
* Möller A, et al. Toxic shock syndrome: New insights into an old disease. J Infect. 2023 Jan;86(1):15-21. doi: 10.1016/j.jinf.2022.10.009. Epub 2022 Oct 19. PMID: 36270425.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1References
Oakley AM, Krishnamurthy K. Stevens-Johnson Syndrome. 2023 Apr 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29083827.
https://pubmed.ncbi.nlm.nih.gov/29083827/Frantz R, Huang S, Are A, Motaparthi K. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management. Medicina (Kaunas). 2021 Aug 28;57(9):895. doi: 10.3390/medicina57090895. PMID: 34577817; PMCID: PMC8472007.
https://pubmed.ncbi.nlm.nih.gov/34577817/