, 11 tweets, 7 min read Read on Twitter
In preparation of my upcoming talk on #dermatology emergencies for the @SHMlive conference, I thought I'd put together my first #tweetorial on Stevens Johnson Syndrome (SJS). Having never done this, apologies in advance for subpar tweeting! Here we go!
#medtwitter #dermtwitter
SJS and its more severe cousin, Toxic Epidermal Necrolysis (TEN), are life-threatening dermatologic toxicities, usually caused by a drug trigger. In rare cases, they can be triggered by infection (more commonly seen in the #pediatric population).

#SJS usually presents with an atypical targetoid macular (flat) eruption with +nikolsky. This is in contrast to another entity on the ddx, erythema multiforme, which has classic target papular (raised) lesions. See the difference? (hands are EM, back is SJS). CC @dermnetnz!

A brief interlude - how do you tell the difference between classic "targets" and "targetoid" lesions? Target lesions have three zones - Red outside, then white, then red center (think of the logo for Target stores). Targetoid usually are more "blobby," and 2 zones of color.

SJS/TEN classically presents with mucocutaneous involvement. The hemorrhagic lips here are classic for SJS/TEN. The eyes are often injected and patients complain of a foreign body sensation. Sequelae from mucous membrane involvement can be severe, so beware! cc @dermnetnz

So what's the difference between SJS and TEN? SJS is defined by <10% BSA skin detachment or impending detachment. TEN is >30%, and in between 10 and 30 is SJS/TEN overlap syndrome. Importantly, the BSA is of detached skin, NOT of total BSA of rash! CC:@dermnetnz

A recent collaborative study by #dermatologists from the @dermhospitalist group looked at a cohort of patients hospitalized with SJS/TEN in the US. What do you think was the most common culprit drug to be implicated?

This paper found Trimethoprim/Sulfamethoxasole to be the most common culprit. Another interesting point: patients seemed to do better than what would have been predicted based on old prediction models (SCORTEN)!


Treatment? First, stop the drug trigger, and consider the burn unit, especially if severe! If you've got an SJS/TEN patient, please consider consulting your friendly dermatologist! We can help direct possible drug therapy and guide supportive wound care.

Ultimately, a #multidisciplinary approach is critical, often involving ophtho and GYN/urology. Avoid unnecessary medications, and beware of infection. The broken skin barrier makes sepsis both highly possible, and potentially deadly.

Was this helpful? Would more #skin #tweetorials be good? Let me know, and if you'll be at the SHM 2019 annual meeting, I'll be discussing more details and more diseases there. Thanks all, and thanks to @tony_breu for the initial inspiration!

@Massgeneralnews #MedEd @harvardmed
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