What Is the Treatment of Stevens-Johnson Syndrome? First-Line Protocol
Stevens-Johnson syndrome demands immediate action: identifying and removing the causative agent and securing specialist inpatient care are the first priorities. The protocol below outlines the structure of evidence-based first-line management.
Clinical Situation
This protocol applies to patients presenting with Stevens-Johnson syndrome requiring urgent specialist management. Early escalation to an appropriate inpatient setting is a defining feature of the initial response.
Treatment Approach (Partial Overview)
Management begins with immediate discontinuation of the culprit drug and admission to a burn centre or an ICU experienced in treating SJS/TEN. From there, a structured programme of acute supportive care is initiated — encompassing fluid management, nutritional support, wound care, and several targeted prophylactic and symptomatic measures.
The complete sequencing, specific interventions, and monitoring parameters are detailed in the full structured protocol.
Key Clinical Goals
Treatment targets adequate urine output as a primary end-point of fluid replacement, and effective control of cutaneous pain evaluated using a validated pain assessment tool at least once daily.
References
DOI: 10.1111/bjd.14530Digital
- Patients with SJS/TEN with > 10% BSA epidermal loss should be admitted without delay to a burn centre or to an ICU with experience of treating patients with SJS/TEN and facilities to manage the logistics of extensive skin loss/wound care.
- A study by Shiga and Caforio of 21 patients with TEN with extensive epidermal loss recorded fluid requirements over the first 3 days of admission and estimated that replacement volumes can be determined by the following formula: 2 mL kg⁻¹ body weight/% BSA epidermal detachment.
- Fluid replacement can be guided by urine output and other end-point measurements.
- Provide continuous enteral nutrition throughout the acute phase of SJS/TEN, either by the oral route or via nasogastric feeding if the former is precluded by buccal mucositis.
- Patients with SJS/TEN who are insensible in bed should receive low molecular weight heparin as prophylactic anticoagulation against venous thromboembolism.
- During the acute phase of SJS/TEN, patients in whom enteral nutrition cannot be established may benefit from a proton pump inhibitor to protect against upper gastrointestinal stress ulceration.
- Patients with SJS/TEN who are neutropenic may benefit from the administration of recombinant human G-CSF.
- Use a patient-appropriate validated pain tool to assess pain in all conscious patients at least once a day.
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