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Stevens-Johnson syndrome from lamotrigine — SCE Acute Medicine MCQ

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HardDermatologyStevens-Johnson syndrome from lamotrigineSCE Acute Medicine

A 28-year-old woman started lamotrigine 3 weeks ago and now presents with fever, painful targetoid rash, conjunctivitis and oral erosions. Skin pain is prominent and Nikolsky sign is positive. She is tachycardic and dehydrated. What is the most appropriate next step in management?

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Correct answer: C — Stop lamotrigine and arrange urgent dermatology and burns or critical care input

Stevens-Johnson syndrome or toxic epidermal necrolysis is suggested by mucosal involvement, skin pain and epidermal detachment after a high-risk drug; the culprit drug must be stopped immediately and specialist supportive care arranged. Topical treatment alone is inadequate. Early fluid, temperature, pain and infection management are central.

Reference: British Association of Dermatologists SJS/TEN guidance; BNF lamotrigine