Diagnosis and Treatment
The diagnosis of SJS/TEN is made based upon the clinical features described above. If you or anyone you know has developed these symptoms, go to the emergency room right away or call for an ambulance.
If you are suspected of having SJS/TEN, the physician would want to know the drug that has caused the symptoms, so that it can be withdrawn as early as possible, and improve the prognosis. It’s also important that this drug is identified so that the patient is not re-exposed in the future. At their disposal, physicians will have a tool to use called the algorithm of drug causality for epidermal necrolysis (ALDEN). For patients taking multiple medications, this tool is used to determine the likelihood of which of the many drugs the patient is on is the offending one.
Physicians may also perform a routine skin biopsy so that they can examine it under a type of lighting called immunofluorescence and confirm that they have the correct diagnosis of SJS/TEN, and not a mimic of SJS/TEN. The doctor may also order other tests, such as bacterial and fungal cultures, and blood tests to determine if there are any signs of infection.
Patients with SJS/TEN are treated in the hospital, and this typically lasts 2 to 4 weeks. The management of patients requires a multidisciplinary team of healthcare providers including doctors (intensivist, specialized dermatologist, and plastic surgeon), nurses, and other professionals. The following steps will be taken by the treatment team:
- Prompt discontinuation of the offending medication that caused SJS/TEN (if it was induced by medication).
- Appropriate wound care: the skin will be kept as healthy and clean as possible by removing dead skin and applying different kinds of dressings.
- Patients will be intubated with a feeding tube to obtain proper nutrition and fluids. A great deal of fluid is lost in patients with SJS/TEN, and it is necessary to replace this fluid.
- Physicians can provide strong pain medication to help alleviate the intensity of the pain associated with this skin infection.
- Patients are at very high risk of developing an infection, and it is imperative that physicians help in reducing your risk of developing them. Sterile handling is essential in patients with SJS. Antiseptic solutions can be prepared before dressing any wounds. Antibiotics can be given to treat any infections as well.
- Medication can also be given to reduce inflammation.