- Stevens-Johnson syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
STEVENS-JOHNSON SYNDROME (SJS)/TOXIC EPIDERMAL NECROLYSIS (TEN)
L51.1/ L51.2
DESCRIPTION
An acute, systemic condition with vesico-bullous lesions involving the skin and mucous membranes (≥ 2 mucosal surfaces), but occasionally only the mucous membranes.
The eruption may start as widespread red irregular macules and patches. There may be a vesicle or bulla in the central area of the lesion. The blisters rupture leaving denuded areas of skin. Mucous membrane erosions often with slough covering the surface are frequently seen.
Toxic epidermal necrolysis (TEN) is a more severe form of the condition and is suggested if the skin lesions cover > 30% of the body surface area. The mucous membranes such as the mouth, eyes and vagina are also more severely affected.
The condition is usually caused by medicines e.g. sulphonamides, anti-retrovirals (nevirapine), anti-epileptics (phenytoin, phenobarbitone, carbamazepine, lamotrigine). Systemic involvement with multi-organ dysfunction is common.
GENERAL MEASURES
Immediate withdrawal of offending medicine.
Patients usually require care in a high or intensive care unit with dedicated nursing.
REFERRAL
All patients.
DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS)
L27.0 + (D72.0)
DESCRIPTION
Severe hypersensitivity reaction to a medicine.
Typically occurs within 3 months of starting the offending medicine.
Clinical symptoms include:
- maculopapular rash
- fever > 38° C
- lymphadenopathy
- hepatitis or other organ involvement
- blood count abnormalities especially eosinophilia
Medicines that commonly induce the DRESS syndrome include phenobarbital, carbamazepine, phenytoin, lamotrigine, allopurinol, sulphonamides, abacavir, nevirapine.
REFERRAL
All patients.