|
| Fig. 64.1 A, Stevens-Johnson syndrome demonstrating typical mucosal inflammation of the mouth, lips, and conjunctiva. B, Fatal case of captopril-induced toxic epidermal necrolysis showing violaceous discoloration with sheets of epidermis peeling away from the skin. (Courtesy of James E. Fitzpatrick, MD.) |
Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome are commonly confused entities, in part because many clinicians use the two terms interchangeably. Because these two diseases have significantly different prognoses and treatments, it is important to differentiate between them (Table 64-1). The diseases can usually be distinguished by their clinical presentation (Fig. 64-1), histologic findings, and course.
The relationship between TEN and Stevens-Johnson syndrome is one of the great controversies in dermatology. Some in vitro research suggests that they are different diseases based on pathogenic mechanisms, but some authorities regard TEN as a more severe form of Stevens-Johnson syndrome. It is universally accepted that Stevens-Johnson syndrome is a more severe form of erythema multiforme.
Wolf R, Orion E, Marcos B, Matz H: Life-threatening acute adverse cutaneous drug reactions,
Clin Dermatol 23:171–181, 2005.
| Table 64-1. Clinicopathologic Features of Toxic Epidermal Necrolysis (TEN) versus Stevens-Johnson Syndrome (SJS) |
| | | | TEN | | SJS |
| | Maximal intensity | | 1–3 days | | 7–15 days |
| | Skin pain | | Severe | | Minimal |
| | Mucosal involvement | | Mild | | Severe |
| | Lesional pattern | | Diffuse erythema, desquamation | | Annular and targetoid lesions |
| | Skin histology | | Few inflammatory cells | | Numerous inflammatory cells |
| | Prognosis | | Poor | | Excellent |
