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SJS/TEN — SCE Dermatology MCQ

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EasyDrug ReactionsSJS/TENSCE Dermatology

A 60-year-old woman develops widespread fixed erythema with skin tenderness following a new medication. Over 48 hours she develops flaccid blisters and 15% body surface area epidermal detachment. Nikolsky sign is positive. Mucosal involvement is present. According to the classification, this is best described as?

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Correct answer: A — SJS/TEN overlap

The classification of SJS/TEN is based on maximum body surface area of epidermal detachment: SJS <10%, SJS/TEN overlap 10-30%, TEN >30%. With 15% BSA detachment, this falls into the SJS/TEN overlap category. All three entities share the same pathogenesis (drug-induced cytotoxic T-cell and NK-cell mediated keratinocyte apoptosis) and are managed similarly with immediate drug withdrawal, SCORTEN assessment, supportive care in a specialist unit, and consideration of immunomodulatory therapy. Staphylococcal scalded skin syndrome occurs in young children and involves cleavage within the granular layer (not full-thickness epidermal necrosis).

Reference: BAD 2016 SJS/TEN Guidelines; Bastuji-Garin Classification