SJS/TEN Guidelines

Published in Dermatology

Journal Scan / Consensus and Guidelines · March 25, 2020

Supportive Care Guidelines for the Management of SJS/TEN in Adults

Journal of the American Academy of Dermatology

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• These consensus guidelines were developed by a modified Delphi process conducted by the Society of Dermatology Hospitalists in response to the highly varied practices in the supportive care of patients with SJS/TEN. Patients with SJS/TEN should be cared for by multidisciplinary teams in an ICU or burn unit setting with specific wound care methods to minimize detachment of epidermis and bacterial colonization.

• The guidelines recommend routine ophthalmologic evaluation in all SJS/TEN patients even if there is no apparent ocular involvement and daily oral care with topical pain relief, an oral rinse, and ultrapotent topical corticosteroids. Patients should also be monitored for signs of infection including increasing skin pain, confusion, hypotension, reduced urinary output, and reduced oxygen saturation.

– Margaret Hammond, MD

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists (SDH) with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. 9-point Likert scale questionnaires regarding 135 statements were administered. The RAND/UCLA appropriateness method was employed to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5-9 and disagreement index ≤1 were included in the guideline. For the final round, the guidelines were appraised by all the participants. An evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN are included.

Journal of the American Academy of Dermatology

Society of Dermatology Hospitalists Supportive Care Guidelines for the Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in Adults

J Am Acad Dermatol 2020 Mar 06;[EPub Ahead of Print], L Seminario-Vidal, D Kroshinsky, SJ Malachowski, J Sun, A Markova, TM Beachkofsky, BH Kaffenberger, EN Ergen, M Mauskar, A Bridges, C Calhoun, AR Cardones, ST Chen, J Chodosh, J Cotliar, MDP Davis, KL DeNiro, AR Dominguez, J Eljure-Téllez, A Femia, LP Fox, A Guda, C Mitchell, A Mostaghimi, AG Ortega-Loayza, C Owen, H Pasieka, S Rahnama-Moghadam, HN Saeed, RB Saunderson, S Shanbhag, VR Sharon, L Strowd, S Venkatesh, KA Wanat, DA Wetter, S Worswick, RG Micheletti 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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