› ! Drug eruption → › ! Stevens-Johnson Syndrome (SJS) → › Toxic Epidermal Necrolysis (TEN) → › Immediate stabilization priorities
› If airway compromise then airway management escalation
› If hypotension then IV fluids and shock pathway
› If anaphylaxis concern then epinephrine IM 0.3 mg to 0.5 mg adult
› Continuous monitoring for unstable patients
› Two large bore IV access if extensive skin involvement or shock concern
› Medication discontinuation plan
› Stop suspected culprit medications immediately
› Stop non essential medications
› Avoid re challenge with suspected culprit
Symptomatic treatment for mild to moderate eruptions
› Symptom control
› Oral antihistamine example cetirizine 10 mg daily adult
› Breakthrough pruritus example hydroxyzine 25 mg at bedtime adult
› Topical corticosteroid medium potency for trunk and extremities
› Emollients and gentle skin care
Severe cutaneous adverse reaction management
› Severe reaction pathway
› Dermatology consult
› Ophthalmology consult if any ocular symptoms
› Burn unit consult for suspected Stevens Johnson syndrome toxic epidermal necrolysis
› Fluid and electrolyte management
› Wound care with non adherent dressings
› Temperature management
› Pain control with careful renal hepatic consideration
› DRESS management
› Systemic corticosteroid example prednisone 0.5 mg per kg per day adult for organ involvement
› Taper plan over weeks to prevent relapse
› Monitor liver enzymes and creatinine serially
› Avoid empiric antibiotics unless infection evidence
Stevens Johnson syndrome toxic epidermal necrolysis adjuncts
› Adjunctive therapies local protocol dependent
› Cyclosporine consideration in selected patients
› Etanercept consideration in selected patients
› IVIG consideration in selected patients
› Systemic corticosteroids risk benefit case based
Monitoring and reassessment loop
› Reassessment cycle
› Repeat vital signs frequency based on severity
› Repeat skin exam for new blistering or detachment
› Repeat labs within 12 to 24 hours if severe concern
› Escalate level of care if progression despite trigger removal
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