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Triage and immediate risk stratification
Severity triage
Unstable vitals
Airway compromise from angioedema or mucosal edema
Hypotension or shock
Altered mental status
Extensive skin pain
Blistering or epidermal detachment
Mucosal involvement
Facial edema
Fever with systemic symptoms
Rapid progression over hours to days
Red flag phenotypes
SJS or TEN phenotype
Skin pain out of proportion to visible rash
Dusky erythema or targetoid lesions
Positive Nikolsky sign
Oral ocular genital mucositis
DRESS phenotype
Fever
Facial edema
Lymphadenopathy
Eosinophilia or atypical lymphocytosis
Hepatitis or nephritis or pneumonitis or myocarditis concern
AGEP phenotype
Numerous small nonfollicular pustules on erythema
Fever
Neutrophilia
Anaphylaxis phenotype
Urticaria with respiratory or cardiovascular involvement
Hypotension
Bronchospasm
Vasculitis phenotype
Palpable purpura
Necrosis
Hematuria or proteinuria
Immediate actions and monitoring
Medication cessation and exposure control
Immediate stop of suspected culprit drug
Class I recommendation based on expert consensus
Hold all nonessential medications in suspected SCAR
Avoid rechallenge during acute episode
Document reaction in allergy list with phenotype and date
Supportive stabilization targets
Continuous pulse oximetry for systemic involvement
Cardiac monitoring for systemic involvement
IV access for systemic involvement
Temperature management for extensive skin loss
Fluid balance targets for extensive skin loss
Pain control plan for skin pain or erosions
Early consultation and transfer triggers
Specialty escalation
Dermatology consult for uncertain diagnosis or suspected SCAR
Skin biopsy support for SCAR confirmation
Burn or ICU consult for SJS or TEN with detachment or high risk
Burn unit care association with improved outcomes in many protocols
Ophthalmology consult for any ocular symptoms or SJS or TEN
Gynecology or urology consult for genital mucosal involvement
Allergy or immunology referral planning for non SCAR confirmation and future avoidance counseling
Transfer criteria
Suspected SJS or TEN
Epidermal detachment
Rapidly progressive blistering rash
Hemodynamic instability
Significant mucosal involvement
Need for ICU or burn capable wound care
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.