Stevens–johnson Syndrome

Stevens–johnson Syndrome is a topic covered in the 5-Minute Emergency Consult.

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  • Stevens–Johnson syndrome (SJS) is an idiosyncratic, severe mucocutaneous disease:
    • Blistering of <10% of the body surface area (BSA)
    • 95% of patients have mucous membrane lesions:
      • Usually at 2 or more sites
    • 85% have conjunctival lesions
    • Lesions often involving face, neck, and central trunk regions become confluent over hours to days
  • On a continuum with toxic epidermal necrolysis (TEN); but thought to be a distinct disease entity from erythema multiforme (EM):
    • SJS: <10% of BSA
    • SJS–TEN overlap syndrome: 10–30% of BSA
    • TEN: >30% of BSA, can affect up to 100% BSA


  • The most common causes include medications and infections:
    • Damage to the skin is thought to be mediated by cytotoxic T lymphocytes and mononuclear cells aimed at keratinocytes expressing (drug-related) antigens
    • Cytokines from activated mononuclear cells probably contribute to cell destruction and systemic manifestations
  • Causative medications:
    • Antibiotics (e.g., penicillin, sulfonamide)
    • Anticonvulsants
    • Oxicams
    • NSAIDs
    • Allopurinol
  • Infections:
    • Mycoplasma pneumoniae
    • Herpes simplex

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