Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare and life-threatening mucocutaneous diseases that occur almost exclusively as a result of adverse drug reactions, although there are rare cases associated with infection, immunization, or malignancy. Stevens-Johnson syndrome and toxic epidermal necrolysis are often accompanied by fever, malaise, upper respiratory symptoms, difficulty swallowing, and pain or a burning sensation of the skin and mucous membranes. These symptoms may precede skin manifestations for up to 3 days. Detachment of the epidermis usually begins on the trunk, then spreads to the limbs, head and neck. In addition, more than 90% of patients have lesions of the oral mucosa, eyes or genitals. Less commonly, the mucosa of the respiratory tract and gastrointestinal tract may be affected, resulting in significant morbidity and mortality. Stevens-Johnson syndrome and toxic epidermal necrolysis usually occur between days 7 and 21 after starting treatment, increasing the dose, or changing the brand of the responsible drug. In addition, certain groups of patients are at increased risk of developing these diseases when exposed to certain medications, including patients with human immunodeficiency virus infection, patients receiving concomitant radiation therapy, and anticonvulsant medications. The article provides etiopathogenetic aspects and features of the management of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.