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Understanding SJS and TEN Presented by Jacynta F Pepin (RN)

What is stevens johnson syndrome?

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A brief presentation in understanding of SJS.

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Page 1: What is stevens johnson syndrome?

Understanding SJS and TEN

Presented byJacynta F Pepin (RN)

Page 2: What is stevens johnson syndrome?

Stevens-Johnson Syndrome (SJS) andToxic Epidermal Necrolysis (TEN)

Life-threatening mucocutaneous diseases Within the spectrum of SCAR

• Resemble erythema multiforme majus (EMM)• Mucosal involvement• Epidermal necrosis

Page 3: What is stevens johnson syndrome?

SJS and TEN

• SJS usually less severe• Etiology, genetic susceptibility and

pathomechanism are same• Mainly cause by drugs, infection or unknown• Presents as medical emergency

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Signs and Symptoms

Early sign:• Fever• Sore throat• Cough• Burning eyes

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Signs and Symptoms

• Facial swelling• Tongue swelling• Hives• Skin pain• A red or purple skin rash that spreads within

hours to days• Blisters on skin and mucous membranes• Shedding (sloughing) of skin

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Clinical Presentation

• Typical Targets with three concentric zones

Page 7: What is stevens johnson syndrome?

Clinical Presentation

• Confluent purpuric macules and limited areas of skin detachment

• Nikolsky sign is positive in SJS/TEN

Page 8: What is stevens johnson syndrome?

Nikolsky Sign

• skin can be pushed slightly aside by pressure of fingers

• refer to the base of the blister, and thus to the level of epidermal separation

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Clinical Presentation• Detachment of large epidermal sheets in

SJS/TEN overlap

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Drug Causes

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Infectious causes

• Herpes (herpes simplex or herpes zoster)• Influenza• HIV• Diphtheria• Typhoid• Hepatitis

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Risk Factor

• Almost equal in ratio men:female• Mortality rate: – SJS 10%– SJS / TEN ovelap 30%– TEN 50%

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Therapeutic Consideration

• Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications.

• Recovery can take weeks to months, depending on the severity of condition.

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Topical Treatment

• Blister should be left in place• Erosion: Chlorhexidine, octenisept,

polyhexanide• High room temp• Debride skin under GA and apply allograft

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Supportive Treatment

• ICU / Burn Unit• Fluid replacement 0.7ml/kg/%BSA affected• Albumin 1ml/kg/%skin detachment• Nutritional

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Medications

• Analgesic• Antihistamines• Antibiotics, when needed• Steroids (topical/oral)• Intravenous corticosteroids• Immunoglobulin intravenous (IVIG)

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Complication

• Transdermal fluid loss- hypovolumia• Electrolyte imbalance- katabolic metabolism• Septicemia – usually induced from CVL • Multiorgan failure

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Summary

• SJS and TEN are considered as one disease entity of different severity.

• SJS/TEN is mainly caused by drugs, but also by infections and probably other risk factors not yet identified.

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Summary

• The cytolytic protein granulysin was identified a marker for the severity of the disease based on skin detachment.

• No treatment has been identified to be capable of halting the progression of skin detachment yet.

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Summary

• supportive management is crucial to improve the patient’s state.

• Despite all therapeutic efforts, mortality is high and increases with disease severity, patients’ age and underlying medical conditions.

Page 22: What is stevens johnson syndrome?

Thank You

I SURVIVED SJS