Dermatology
Stevens-Johnson Syndrome
스티븐스-존슨 증후군
Drug-induced epidermal necrosis (<10% BSA)
- How common
- Rare but life-threatening
- Typical age
- All ages
What is it?
Drug-specific CD8+ T cells release granulysin causing widespread keratinocyte apoptosis.
Commonly affected: Mucosa (≥2 sites) + skin
How it develops
- Drug exposureSulfonamides, allopurinol, anticonvulsants
- T-cell activationHLA-B–restricted drug recognition
- Granulysin releaseInduces keratinocyte apoptosis
- Mucocutaneous sheddingWidespread mucocutaneous detachment
Symptoms
- Mucosal involvementOral, ocular, genital ulcers
- Positive NikolskyEpidermal detachment
- Target lesionsAtypical targets
- Fever/prodromeFever 1–3 days before rash
How it is examined
- Drug historyNew drug 4–28 days prior
- BSA detachment<10% SJS, >30% TEN
- Ophthalmology consultRisk of vision loss
Imaging
Imaging not needed.
- Clinical
For complications (e.g., pneumonia).
- Pulmonary complications
Non-surgical care
- Stop offending drugKey prognostic factor
- Burn center admissionFluid, electrolyte, pain mgmt
- Eye care, multidisciplinaryOphth, surgery, derm involved
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
None (supportive)
Procedures that may be discussed
- IVIG, cyclosporine (controversial)
Outlook
SJS mortality 5%, TEN 25–50%. Predict with SCORTEN.