SJS TEN
| it's like a burn, but not quite < 10% BSA = SJS 10-30% BSA = SJS/ TEN overlap syndrome > 30%= TEN |
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|---|---|
| Etiology | Drugs: phenytoin, penicillins, quinolones, NSAIDs Non-drugs: Mycoplasma pneumonia, HIV, HSV, Mumps... |
| Epidemiology | |
| Clinical presentation | - mucocutaneous lesions: papules/vesicles → clusters, nonpruritic involving all mucous membranes (oropharynx, airway, urethra, cornea) -> rupture leaving denuded skin - looks like an extreme sunburn |
| Pathogenesis | |
| Diagnostic investigations | Clinical diagnosis Ddx: staph scalded skin syndrome/toxic shock syndrome |
| Management | Like a severe burn: A: may require sedation → intubation B: may have tracheal involvement?! C: hypovolaemic, hyperdynamic circulation. will require long lines, care with dressings D: analgesia++ requirements E: hypophosphataemia due to tissue regrowth; free water losses++ F: not as much as burns, really G: high protein and calorie requirements H: VTE risk complicated by lack of skin to place TEDS and IPCs I: abx-coated lines, no steroids |
SCORTEN = prognostic criteria
Age > 40 years
Presence of a malignancy
Heart rate > 120
Initial percentage of epidermal detachment > 10%
Serum urea level > 10 mmol/L
Serum glucose level > 14 mmol/L
Serum bicarbonate level < 20 mmol/L.