Toxic epidermal necrolysis
Last reviewed: May 2026
Outline
Toxic epidermal necrolysis is a life-threatening, delayed-type hypersensitivity reaction characterized by ≥30% body surface area (BSA) epidermal detachment, widespread mucosal erosions, and systemic toxicity, with mortality rates of 25–50%. [1-3] It represents the most severe end of the SJS/TEN spectrum and is a true dermatologic emergency requiring immediate recognition, drug withdrawal, and transfer to a burn/ICU center. [4-5]
The following figure illustrates the clinical spectrum from SJS to TEN based on extent of epidermal detachment:
1. History
- Medication exposure within 4–28 days is the single most critical HPI element — obtain a complete drug list including new prescriptions, OTCs, and supplements [2][7]
- Prodromal phase: 1–3 days of fever, malaise, myalgias, sore throat, cough ("flu-like" symptoms) preceding skin findings [1][7]
- Skin pain often described as burning, disproportionate to visible findings early on
- Mucosal symptoms: odynophagia, dysuria, eye pain/photophobia, genital pain [7]
- Progression: erythematous macules → atypical targetoid lesions → confluent blisters → sheet-like epidermal sloughing [7]
- Ask about prior episodes of SJS/TEN, known drug allergies, and any recent infections (especially Mycoplasma pneumoniae) [8-9]
2. Alarm Features
- Rapidly progressive skin detachment (>10% BSA and expanding)
- Positive Nikolsky sign (epidermis sloughs with lateral pressure on erythematous skin) [2][10]
- Mucosal involvement of ≥2 sites (oral, ocular, genital) [7]
- Respiratory distress — suggests bronchial epithelial involvement or aspiration [7]
- Hemodynamic instability, high-output fluid losses
- Signs of sepsis (leading cause of death in TEN) [1][7]
- Altered mental status, oliguria, or DIC [11]
3. Medications
High-risk culprit drugs (onset typically 4–28 days after initiation): [1][8][12]
- Anticonvulsants: carbamazepine, phenytoin, lamotrigine, phenobarbital
- Allopurinol
- Sulfonamide antibiotics: TMP-SMX
- NSAIDs (oxicam type especially)
- Antibiotics: β-lactams, fluoroquinolones, cephalosporins
- Others: nevirapine, immune checkpoint inhibitors [13]
Contraindicated: Thalidomide — an RCT was stopped early due to increased mortality in TEN. [14] Prophylactic systemic antibiotics are not recommended without evidence of infection. [5]
Systemic therapies (controversial, no consensus): [14-15]
- Cyclosporine 3–5 mg/kg/day (some evidence of mortality benefit vs. IVIG) [7][15]
- Systemic corticosteroids (pulse methylprednisolone 1–2 mg/kg/day) [7][13]
- IVIG 2 g/kg over 2–5 days [13][16]
- Etanercept (single dose 25–50 mg SC) — emerging data showing possible benefit [7][15][17]
4. Diet
- NPO initially if significant oral mucosal involvement or airway concerns
- Early enteral nutrition via NG/NJ tube if unable to tolerate PO — critical for wound healing and metabolic demands [5]
- High-calorie, high-protein diet (similar to burn nutrition protocols) [5]
- Aggressive IV fluid resuscitation — use burn-like fluid calculations but typically less than equivalent BSA burns (Parkland formula adjusted to ~2/3 of burn estimates) [5]
- Gastric ulcer prophylaxis recommended [5]
5. Review of Systems
- Skin: rash distribution, blistering, pain, peeling
- Eyes: redness, tearing, photophobia, blurred vision, discharge (ocular involvement in 40–84% of cases) [18]
- Oral: odynophagia, oral erosions, inability to eat/drink
- GU: dysuria, genital erosions, urinary retention
- Respiratory: cough, dyspnea, stridor (bronchial epithelial sloughing)
- GI: diarrhea, abdominal pain (GI mucosal involvement)
- Constitutional: fever, malaise, weight loss
- Psychiatric: anxiety, fear (PTSD develops in ~30–50% of survivors) [7][19]
6. Collateral History and Family History
- Confirm exact medication names, doses, and start dates from pharmacy records
- Prior drug allergies or adverse drug reactions — previous drug allergy is a significant risk factor (OR 5.21) [12]
- Family history of SJS/TEN or drug hypersensitivity reactions
- Ethnic background — relevant for HLA-associated risk:
- HLA-B15:02: carbamazepine-induced SJS/TEN (Southeast Asian/Han Chinese ancestry) [7][20]
- HLA-B58:01: allopurinol-induced SJS/TEN (higher prevalence in Black and Asian populations) [21]
- HLA-A31:01: carbamazepine-induced SCARs (Northern European, Japanese) [7][20]
- HIV status (increased SJS/TEN risk) [6]
7. Risk Factors
- New medication within past 4–28 days (most important risk factor) [2]
- HIV/AIDS (100-fold increased incidence) [3]
- Active malignancy [12][22]
- Autoimmune disease: SLE (OR 17.41), psoriasis (OR 10.28) [12]
- Prior drug allergies (OR 5.21) [12]
- Epilepsy (OR 4.92 — likely confounded by anticonvulsant use) [12]
- Diabetes mellitus, history of CVA [12]
- Genetic susceptibility (HLA alleles as above) [7]
- Slow acetylator phenotype [3]
- Concurrent radiation therapy
8. Differential Diagnosis
- Staphylococcal scalded skin syndrome (SSSS): superficial (subcorneal) cleavage plane vs. full-thickness necrosis in TEN; no mucosal involvement; more common in infants; Nikolsky sign positive but biopsy distinguishes [23-24]
- Erythema multiforme major: typical target lesions with 3 concentric rings, acral distribution, often HSV-related [6-7]
- Generalized bullous fixed drug eruption (GBFDE): well-demarcated round plaques, eosinophils on biopsy, dermal melanophages [23]
- Acute graft-versus-host disease: requires transplant history; satellite cell necrosis on biopsy [23]
- Linear IgA bullous dermatosis: positive direct immunofluorescence (linear IgA at BMZ) [7][23]
- Paraneoplastic pemphigus: positive DIF distinguishes [24]
- AGEP: subcorneal pustules, less mucosal involvement [24]
- Autoimmune blistering diseases (pemphigus vulgaris, bullous pemphigoid): DIF positive [3]
- Drug hypersensitivity syndrome/DRESS: eosinophilia, organ involvement, less epidermal detachment [10]
9. Past Medical History
- Prior SJS/TEN episodes (absolute contraindication to re-exposure to culprit drug)
- Autoimmune conditions (SLE, psoriasis)
- Malignancy (especially if on chemotherapy or immunotherapy)
- HIV/immunosuppression
- Chronic kidney disease (affects drug clearance and prognosis)
- Epilepsy and current anticonvulsant regimen
- Gout and allopurinol use
- Prior HLA testing results
10. Physical Exam
Vital signs: Fever (often >38.5°C), tachycardia, hypotension in severe cases
Skin:
- Dusky erythematous or violaceous macules, often starting on face/trunk [7]
- Atypical targetoid lesions (flat, irregular, dusky center — NOT classic EM targets) [2]
- Flaccid bullae, confluent epidermal detachment in sheets
- Nikolsky sign: positive on erythematous areas [7][10]
- Asboe-Hansen sign: lateral extension of blister with pressure
- Estimate %BSA detachment (TEN = ≥30%) [1][8]
Mucosal exam (involved in ~80% of cases): [7]
- Oral: hemorrhagic erosions, pseudomembranes, crusted lips
- Ocular: conjunctival hyperemia, pseudomembranes, chemosis, corneal erosions [7][18]
- Genital/urethral: erosions, dysuria
- Nasal/pharyngeal: erosions
Systemic: Lung auscultation (crackles suggest bronchial involvement), abdominal exam
11. Lab Studies
- CBC: lymphopenia is characteristic and predictive of SJS/TEN; neutrophilia may indicate secondary infection [10]
- BMP/CMP: BUN/creatinine (renal function — SCORTEN parameter), glucose >252 mg/dL (SCORTEN), bicarbonate <20 mmol/L (SCORTEN/ABCD-10) [25-26]
- LFTs: transaminases often elevated (hepatic involvement)
- Coagulation studies: PT/INR, fibrinogen, D-dimer (DIC screening) [11]
- Blood cultures: if sepsis suspected
- Lactate: sepsis workup
- Serum albumin: marker of severity and nutritional status
- Procalcitonin: may help distinguish infection from sterile inflammation
- Mycoplasma pneumoniae serology/PCR: especially in children or cases without drug trigger [8]
12. Imaging
- Chest X-ray: baseline and if respiratory symptoms present — evaluate for pneumonia, ARDS, bronchial epithelial sloughing [27]
- CT chest if concern for pulmonary complications not seen on CXR
- Imaging is NOT diagnostic for TEN — diagnosis is clinical [4]
- Imaging is primarily used to identify complications (pneumonia, effusions)
13. Special Tests
Diagnostic:
- Skin biopsy: full-thickness epidermal necrosis with subepidermal cleavage; sparse dermal inflammatory infiltrate [3][7]
- Direct immunofluorescence (DIF): negative — essential to rule out autoimmune blistering diseases [7]
- Frozen section biopsy: can provide rapid confirmation in the ED/ICU setting
Scoring systems:
- SCORTEN (Score of Toxic Epidermal Necrolysis): 7 parameters assessed within 24 hours of admission — predicts in-hospital mortality [8][25][28]
- Age >40, malignancy, HR >120, initial BSA detachment >10%, BUN >28 mg/dL, glucose >252 mg/dL, bicarbonate <20 mmol/L
- Score 0–1: 3.2% mortality; Score ≥5: 90% mortality [1][14]
- ABCD-10: alternative scoring (age, bicarbonate, cancer, dialysis, 10% BSA) [25-26]
- ALDEN score: algorithm to identify the most likely culprit drug when multiple drugs are involved [2]
Pharmacogenomic testing (pre-prescription screening): [20]
- HLA-B15:02 before carbamazepine in patients of Southeast Asian descent (FDA-recommended) [20]
- HLA-B58:01 before allopurinol (ACR-recommended in high-risk populations) [21]
14. ECG
- ECG is indicated to evaluate for tachycardia (SCORTEN parameter: HR >120 bpm) and to screen for cardiac complications [22]
- Myocardial involvement is uncommon acutely but case reports describe myocardial infarction during acute TEN [11]
- SJS/TEN survivors have elevated long-term cardiovascular morbidity and mortality persisting 4–7 years post-event, attributed to sustained proinflammatory and hypermetabolic states [11]
- Monitor for DIC-related cardiac complications [11]
15. Assessment
TEN is classified by ≥30% BSA epidermal detachment (SJS <10%, overlap 10–30%). [1][8] It is a delayed-type (Type IV) hypersensitivity reaction mediated by drug-specific cytotoxic T cells and NK cells, with granulysin as the key effector molecule causing keratinocyte apoptosis. [1][25]
Severity stratification: SCORTEN should be calculated within 24 hours and repeated at day 3. [25][28] Mortality ranges from 3.2% (SCORTEN 0–1) to 90% (SCORTEN ≥5). [1] Recent data suggest SCORTEN may overestimate mortality in contemporary cohorts due to improvements in supportive care. [25][28]
Complications to anticipate: sepsis (leading cause of death), ARDS, acute renal failure, DIC, GI hemorrhage, electrolyte derangements, and multiorgan failure. [1][7] Long-term sequelae affect >80% of survivors — cutaneous (82%), ocular (59%), oral (48%), and psychological (depression 49%, anxiety 47%, PTSD 37%). [19]
The following figure shows the frequency of long-term sequelae in SJS/TEN survivors:
16. Treatment Plan
Immediate stabilization (ED):
- Discontinue ALL suspected culprit drugs immediately — this is the single most impactful intervention [1][4][8]
- Airway assessment — early intubation if oropharyngeal/laryngeal involvement or respiratory distress [4]
- IV fluid resuscitation (crystalloid, burn-like protocols at ~2/3 Parkland formula) [5]
- Pain management (IV opioids often required; avoid NSAIDs if suspected culprit)
- Temperature regulation (warm environment, 28–32°C) [5]
Wound care:
- Nonadherent dressings; avoid debridement of intact blisters [5]
- Gentle handling — minimize shear forces
- Topical antiseptics; silver-based dressings may be used [17]
Mucosal care:
- Eyes: urgent ophthalmology consult; preservative-free lubricants, topical corticosteroid drops (0.1% betamethasone within 4 days of onset reduces sequelae), consider amniotic membrane transplantation [18][29]
- Oral: mouthwashes, topical anesthetics, soft diet
- GU: Foley catheter if urethral involvement; gynecology/urology consult [13]
Systemic immunomodulatory therapy (no consensus; institution-dependent): [14-15]
- Cyclosporine 3–5 mg/kg/day for 7–14 days — meta-analysis suggests mortality benefit vs. IVIG (RR 0.18) [15]
- Systemic corticosteroids: methylprednisolone 1–2 mg/kg/day — controversial but widely used [7][13]
- IVIG 2 g/kg over 2–5 days — evidence mixed; may be beneficial combined with corticosteroids [15-16]
- Etanercept 25–50 mg SC single dose — emerging evidence of benefit (RR 0.32 vs. supportive care) [7][15][17]
- Thalidomide is contraindicated (increased mortality) [14]
Supportive measures: DVT prophylaxis, stress ulcer prophylaxis, nutritional support, infection surveillance [5]
The following figure shows the distribution of culprit drugs and treatment approaches across European centers:
17. Disposition
- All patients with suspected TEN require admission — ideally to a burn unit or ICU with multidisciplinary access (burn surgery, dermatology, ophthalmology, critical care) [4-5]
- Transfer to a burn center if not available at presenting facility [4]
- SCORTEN ≥3 or BSA >10% detachment warrants ICU-level care [25]
- No patient with TEN should be discharged from the ED
Specialist consultations (all urgent): [4][13]
- Dermatology
- Ophthalmology
- Burn surgery
- Critical care/ICU
- Urology/gynecology (if GU involvement)
- Pulmonology (if respiratory involvement)
18. Follow Up / Return Precautions
Post-discharge follow-up (multidisciplinary, prolonged): [7][30]
- Dermatology: 2–4 weeks, then every 3–6 months for 1–2 years — monitor for cutaneous sequelae (dyspigmentation, scarring, nail dystrophy)
- Ophthalmology: within 1–2 weeks post-discharge and regularly for years — up to 65% develop chronic ocular complications (dry eye, symblepharon, corneal scarring, visual impairment) [7][18][31]
- Psychiatry/psychology: screen for PTSD, depression, anxiety — affects ~50% of survivors [19]
- Allergy/immunology: formal drug causality assessment (ALDEN score), documentation of culprit drug, MedicAlert bracelet [2]
Return precautions:
- Fever, new rash, worsening skin pain, eye redness/vision changes, difficulty breathing, signs of infection at wound sites
- Expected re-epithelialization: begins ~1 week after disease onset, completes in 2–3 weeks [7]
Lifelong precautions:
- Absolute avoidance of the culprit drug and structurally related compounds
- Pharmacogenomic testing and documentation in medical records
- Patient education regarding OTC medications (especially NSAIDs, cold medications) [32]
- Awareness of increased long-term cardiovascular risk [11]
References
- 1.Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clinical Reviews in Allergy & Immunology. 2018. Link
- 2.Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clinical Reviews in Allergy & Immunology. 2018. Link
- 3.Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clinical Reviews in Allergy & Immunology. 2018. Link
- 4.Lee EY, Knox C, Phillips EJ. Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis. JAMA Dermatology. 2023. Link
- 5.Lee EY, Knox C, Phillips EJ. Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis. JAMA Dermatology. 2023. Link
- 6.Harr T, French LE. Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. Orphanet Journal of Rare Diseases. 2010. Link
- 7.Harr T, French LE. Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome. Orphanet Journal of Rare Diseases. 2010. Link
- 8.van Nispen C, Long B, Koyfman A. High Risk and Low Prevalence Diseases: Stevens Johnson Syndrome and Toxic Epidermal Necrolysis. The American Journal of Emergency Medicine. 2024. Link
- 9.van Nispen C, Long B, Koyfman A. High Risk and Low Prevalence Diseases: Stevens Johnson Syndrome and Toxic Epidermal Necrolysis. The American Journal of Emergency Medicine. 2024. Link
- 10.Surowiecka A, Barańska-Rybak W, Strużyna J. Multidisciplinary Treatment in Toxic Epidermal Necrolysis. International Journal of Environmental Research and Public Health. 2023. Link
- 11.Surowiecka A, Barańska-Rybak W, Strużyna J. Multidisciplinary Treatment in Toxic Epidermal Necrolysis. International Journal of Environmental Research and Public Health. 2023. Link
- 12.Auquier-Dunant A, Mockenhaupt M, Naldi L, et al. Correlations Between Clinical Patterns and Causes of Erythema Multiforme Majus, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis: Results of an International Prospective Study. Archives of Dermatology. 2002. Link
- 13.Auquier-Dunant A, Mockenhaupt M, Naldi L, et al. Correlations Between Clinical Patterns and Causes of Erythema Multiforme Majus, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis: Results of an International Prospective Study. Archives of Dermatology. 2002. Link
- 14.Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O. Severe Cutaneous Adverse Reactions to Drugs. Lancet. 2017. Link
- 15.Duong TA, Valeyrie-Allanore L, Wolkenstein P, Chosidow O. Severe Cutaneous Adverse Reactions to Drugs. Lancet. 2017. Link
- 16.Kridin K, Brüggen MC, Chua SL, et al. Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Insights From a Pan-European Multicenter Study. JAMA Dermatology. 2021. Link
- 17.Kridin K, Brüggen MC, Chua SL, et al. Assessment of Treatment Approaches and Outcomes in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Insights From a Pan-European Multicenter Study. JAMA Dermatology. 2021. Link
- 18.Iriarte C, Karim SA, Nassim JS, Grenier PO, Massey KJ. Infantile Stevens Johnson syndrome and toxic epidermal necrolysis: A systematic review of clinical features and outcomes in children ages 12 months and under. Pediatric Dermatology. 2022. Link
- 19.Iriarte C, Karim SA, Nassim JS, Grenier PO, Massey KJ. Infantile Stevens Johnson syndrome and toxic epidermal necrolysis: A systematic review of clinical features and outcomes in children ages 12 months and under. Pediatric Dermatology. 2022. Link
- 20.Weinkle A, Pettit C, Jani A, et al. Distinguishing Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis From Clinical Mimickers During Inpatient Dermatologic Consultation-a Retrospective Chart Review. Journal of the American Academy of Dermatology. 2019. Link
- 21.Weinkle A, Pettit C, Jani A, et al. Distinguishing Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis From Clinical Mimickers During Inpatient Dermatologic Consultation-a Retrospective Chart Review. Journal of the American Academy of Dermatology. 2019. Link
- 22.Chiu HY, Chiu YM. Risk of Cardiovascular Morbidity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Survivors. JAMA Dermatology. 2025. Link
- 23.Chiu HY, Chiu YM. Risk of Cardiovascular Morbidity and Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Survivors. JAMA Dermatology. 2025. Link
- 24.Gronich N, Maman D, Stein N, Saliba W. Culprit Medications and Risk Factors Associated With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Population-Based Nested Case-Control Study. American Journal of Clinical Dermatology. 2022. Link
- 25.Gronich N, Maman D, Stein N, Saliba W. Culprit Medications and Risk Factors Associated With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Population-Based Nested Case-Control Study. American Journal of Clinical Dermatology. 2022. Link
- 26.Updated 2025-10-23. Management of Immune Checkpoint Inhibitor-Related Toxicities. National Comprehensive Cancer Network. Link
- 27.Updated 2025-10-23. Management of Immune Checkpoint Inhibitor-Related Toxicities. National Comprehensive Cancer Network. Link
- 28.Jacobsen A, Olabi B, Langley A, et al. Systemic Interventions for Treatment of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS/TEN Overlap Syndrome. The Cochrane Database of Systematic Reviews. 2022. Link
- 29.Jacobsen A, Olabi B, Langley A, et al. Systemic Interventions for Treatment of Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS/TEN Overlap Syndrome. The Cochrane Database of Systematic Reviews. 2022. Link
- 30.Heuer R, Paulmann M, Mockenhaupt M, Nast A. Systemic Immunomodulating Therapies for Epidermal Necrolysis (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis): A Systematic Review and Meta-Analysis. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. 2025. Link
- 31.Heuer R, Paulmann M, Mockenhaupt M, Nast A. Systemic Immunomodulating Therapies for Epidermal Necrolysis (Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis): A Systematic Review and Meta-Analysis. Journal Der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. 2025. Link
- 32.Miyamoto Y, Ohbe H, Kumazawa R, et al. Evaluation of Plasmapheresis vs Immunoglobulin as First Treatment After Ineffective Systemic Corticosteroid Therapy for Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. JAMA Dermatology. 2023. Link
- 33.Miyamoto Y, Ohbe H, Kumazawa R, et al. Evaluation of Plasmapheresis vs Immunoglobulin as First Treatment After Ineffective Systemic Corticosteroid Therapy for Patients With Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. JAMA Dermatology. 2023. Link
- 34.Martinez Villarreal JD, Cardenas-de la Garza JA, Ionescu MA, et al. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Current Management and Innovative Therapies. International Journal of Dermatology. 2025. Link
- 35.Martinez Villarreal JD, Cardenas-de la Garza JA, Ionescu MA, et al. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Current Management and Innovative Therapies. International Journal of Dermatology. 2025. Link
- 36.Sotozono C, Ueta M. Updates on the Ocular Manifestations and Treatment of SJS/TEN. Allergology International : Official Journal of the Japanese Society of Allergology. 2025. Link
- 37.Sotozono C, Ueta M. Updates on the Ocular Manifestations and Treatment of SJS/TEN. Allergology International : Official Journal of the Japanese Society of Allergology. 2025. Link
- 38.Hoffman M, Chansky PB, Bashyam AR, et al. Long-term Physical and Psychological Outcomes of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. JAMA Dermatology. 2021. Link
- 39.Hoffman M, Chansky PB, Bashyam AR, et al. Long-term Physical and Psychological Outcomes of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. JAMA Dermatology. 2021. Link
- 40.Tayeh MK, Gaedigk A, Goetz MP, et al. Clinical Pharmacogenomic Testing and Reporting: A Technical Standard of the American College of Medical Genetics and Genomics (ACMG). Genetics in Medicine : Official Journal of the American College of Medical Genetics. 2022. Link
- 41.Tayeh MK, Gaedigk A, Goetz MP, et al. Clinical Pharmacogenomic Testing and Reporting: A Technical Standard of the American College of Medical Genetics and Genomics (ACMG). Genetics in Medicine : Official Journal of the American College of Medical Genetics. 2022. Link
- 42.Campbell CN, Krantz MS, Yu A, Phillips EJ, Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) Survivor Study Collaborators. HLA-B*58:01 and Risk of Allopurinol-Induced Severe Cutaneous Adverse Reactions in the US. JAMA Dermatology. 2025. Link
- 43.Campbell CN, Krantz MS, Yu A, Phillips EJ, Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) Survivor Study Collaborators. HLA-B*58:01 and Risk of Allopurinol-Induced Severe Cutaneous Adverse Reactions in the US. JAMA Dermatology. 2025. Link
- 44.Nikitina E, Dushkin A, Streltsov Y, et al. Predictive Value of a Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) Factors for in-Hospital Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Frontiers in Medicine. 2025. Link
- 45.Nikitina E, Dushkin A, Streltsov Y, et al. Predictive Value of a Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) Factors for in-Hospital Mortality in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Frontiers in Medicine. 2025. Link
- 46.Orime M. Immunohistopathological Findings of Severe Cutaneous Adverse Drug Reactions. Journal of Immunology Research. 2017. Link
- 47.Orime M. Immunohistopathological Findings of Severe Cutaneous Adverse Drug Reactions. Journal of Immunology Research. 2017. Link
- 48.Roujeau JC, Stern RS. Severe Adverse Cutaneous Reactions to Drugs. The New England Journal of Medicine. 1994. Link
- 49.Roujeau JC, Stern RS. Severe Adverse Cutaneous Reactions to Drugs. The New England Journal of Medicine. 1994. Link
- 50.Koh HK, Fook-Chong SMC, Lee HY. Improvement of Mortality Prognostication in Patients With Epidermal Necrolysis: The Role of Novel Inflammatory Markers and Proposed Revision of SCORTEN (Re-SCORTEN). JAMA Dermatology. 2022. Link
- 51.Koh HK, Fook-Chong SMC, Lee HY. Improvement of Mortality Prognostication in Patients With Epidermal Necrolysis: The Role of Novel Inflammatory Markers and Proposed Revision of SCORTEN (Re-SCORTEN). JAMA Dermatology. 2022. Link
- 52.Koh HK, Fook-Chong S, Lee HY. Assessment and Comparison of Performance of ABCD-10 and SCORTEN in Prognostication of Epidermal Necrolysis. JAMA Dermatology. 2020. Link
- 53.Koh HK, Fook-Chong S, Lee HY. Assessment and Comparison of Performance of ABCD-10 and SCORTEN in Prognostication of Epidermal Necrolysis. JAMA Dermatology. 2020. Link
- 54.Zhou L, Lu Y, Zou Y, et al. Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Ten-Year Retrospective Study of 103 Cases. Clinical and Experimental Dermatology. 2025. Link
- 55.Zhou L, Lu Y, Zou Y, et al. Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Ten-Year Retrospective Study of 103 Cases. Clinical and Experimental Dermatology. 2025. Link
- 56.Torres-Navarro I, Briz-Redón Á, Botella-Estrada R. Accuracy of SCORTEN to Predict the Prognosis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Systematic Review and Meta-Analysis. Journal of the European Academy of Dermatology and Venereology : JEADV. 2020. Link
- 57.Torres-Navarro I, Briz-Redón Á, Botella-Estrada R. Accuracy of SCORTEN to Predict the Prognosis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Systematic Review and Meta-Analysis. Journal of the European Academy of Dermatology and Venereology : JEADV. 2020. Link
- 58.Thorel D, Ingen-Housz-Oro S, Benaïm D, et al. Ocular Sequelae of Epidermal Necrolysis: French National Audit of Practices, Literature Review and Proposed Management. Orphanet Journal of Rare Diseases. 2023. Link
- 59.Thorel D, Ingen-Housz-Oro S, Benaïm D, et al. Ocular Sequelae of Epidermal Necrolysis: French National Audit of Practices, Literature Review and Proposed Management. Orphanet Journal of Rare Diseases. 2023. Link
- 60.Ingen-Housz-Oro S, Matei I, Gaillet A, et al. Diagnosing and Managing Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Adults: Review of Evidence 2017-2023. The Journal of Investigative Dermatology. 2025. Link
- 61.Ingen-Housz-Oro S, Matei I, Gaillet A, et al. Diagnosing and Managing Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Adults: Review of Evidence 2017-2023. The Journal of Investigative Dermatology. 2025. Link
- 62.de Alcântara RJA, Wakamatsu TH, Hirai FE, et al. Chronic Ocular Complications in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical Features and Surgical Management in a Brazilian Tertiary Center. Cornea. 2025. Link
- 63.de Alcântara RJA, Wakamatsu TH, Hirai FE, et al. Chronic Ocular Complications in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical Features and Surgical Management in a Brazilian Tertiary Center. Cornea. 2025. Link
- 64.Ueta M, Inoue C, Nakata M, et al. Severe Ocular Complications of SJS/TEN and Associations Among Pre-Onset, Acute, and Chronic Factors: A Report From the International Ophthalmology Collaborative Group. Frontiers in Medicine. 2023. Link
- 65.Ueta M, Inoue C, Nakata M, et al. Severe Ocular Complications of SJS/TEN and Associations Among Pre-Onset, Acute, and Chronic Factors: A Report From the International Ophthalmology Collaborative Group. Frontiers in Medicine. 2023. Link