THERAPEUTIC MANAGEMENT OF STEVENS-JOHNSON SYNDROME: APPROACH AND CRITICAL CARE
DOI:
https://doi.org/10.56238/levv17n57-014Keywords:
Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, SCORTEN, Adverse Drug Reaction, Etanercept, Critical CareAbstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare dermatological emergencies, but associated with high morbidity and mortality, especially when there is a delay in recognition and implementation of appropriate therapeutic measures (Shah et al., 2024; Watanabe & Hama, 2025). This study aimed to critically review recent scientific evidence related to the therapeutic management of SJS/TEN, with emphasis on intensive support, prognostic stratification, and available immunomodulatory therapies. This is a narrative literature review, based on articles published in the last five years in the PubMed database, selected according to criteria of clinical and methodological relevance. The findings indicate that immediate discontinuation of the causative agent, management in specialized units, the use of prognostic tools such as the SCORTEN score, and the application of drug causality algorithms such as ALDEN are fundamental for prognostic stratification and clinical management guidance. Furthermore, recent evidence suggests the benefit of the judicious use of systemic therapies, such as cyclosporine and tumor necrosis factor alpha inhibitors, although there is still no definitive consensus regarding the standardization of therapeutic protocols. It is concluded that the management of SJS/TEN should be multidisciplinary, individualized, and based on updated evidence, and further prospective studies are needed to optimize therapeutic strategies and clinical outcomes.
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References
CHUNG, W. H. et al. Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis. Nature Medicine, v. 14, n. 12, p. 1343-1350, 2008. DOI: https://doi.org/10.1038/nm.1884
FRANTZ, R. et al. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Diagnosis and Management. Medicina, v. 57, n. 895, 2021. DOI: https://doi.org/10.3390/medicina57090895
GOMES FERREIRA, S. et al. Dipyrone (Metamizole)-Induced Stevens-Johnson Syndrome. Cureus, v. 16, n. 1, e53122, 2024. DOI: https://doi.org/10.7759/cureus.53122
HASEGAWA, A.; ABE, R. Stevens-Johnson syndrome and toxic epidermal necrolysis: Updates in pathophysiology and management. Chinese Medical Journal, 2025. DOI: https://doi.org/10.1097/CM9.0000000000003250
JACOBSEN, A. et al. Systemic interventions for treatment of Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome. Cochrane Database of Systematic Reviews, n. 3, CD013130, 2022. DOI: https://doi.org/10.1002/14651858.CD013130.pub2
SHAH, H. et al. Update on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management. American Journal of Clinical Dermatology, v. 25, p. 891-908, 2024. DOI: https://doi.org/10.1007/s40257-024-00889-6
STEVENS, A. M.; JOHNSON, F. C. A new eruptive fever associated with stomatitis and ophthalmia. American Journal of Diseases of Children, v. 24, n. 6, p. 526-533, 1922. DOI: https://doi.org/10.1001/archpedi.1922.04120120077005
THE JOURNAL OF DERMATOLOGY. Guidelines for the Management of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis 2025 Supplement. v. 53, n. 1, 2026.
WATANABE, Y.; HAMA, N. Recent advances in the diagnosis and treatment of Stevens-Johnson syndrome/toxic epidermal necrolysis. Allergology International, v. 74, p. 345-355, 2025. DOI: https://doi.org/10.1016/j.alit.2025.05.008
YAO, L. et al. Recent developments in the research of Stevens-Johnson syndrome and toxic epidermal necrolysis: pathogenesis, diagnosis and treatment. European Journal of Medical Research, v. 30, n. 453, 2025. DOI: https://doi.org/10.1186/s40001-025-02664-7
PALMIERI, T. L. et al. Nutrition support in patients with severe skin failure. Journal of Burn Care & Research, 2022.
Yao Z, Chen R, Li X, et al. Performance and limitations of the ALDEN algorithm in drug causality assessment of Stevens–Johnson syndrome and toxic epidermal necrolysis. Frontiers in Pharmacology. 2025;16:1298472. doi:10.3389/fphar.2025.1298472.
Watanabe H, Hama R. Drug causality assessment in severe cutaneous adverse reactions: current status and future perspectives. Drug Safety. 2025;48(2):115–128. doi:10.1007/s40264-024-01467-9. DOI: https://doi.org/10.1007/s40264-024-01467-9
Shah M, et al. Current perspectives on Stevens–Johnson syndrome and toxic epidermal necrolysis. Clinical Reviews in Allergy & Immunology, 2024.
MURILLO-CASAS, A. D.; et al. Latin American guidelines for the diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis. World Allergy Organization Journal, v. 18, n. 4, 26 mar. 2025. DOI: 10.1016/j.waojou.2025.101046. DOI: https://doi.org/10.1016/j.waojou.2025.101046
FRANCA M D, et al. Estudo dos achados oculares na síndrome de Stevens-Johnson em pacientes de centro de referência de atendimento terciário. Arq. Bras. Oftalmol. 72 (3) • Jun 2009. DOI: https://doi.org/10.1590/S0004-27492009000300017
BULISANI A C P, et al. Síndrome de Stevens-Johnson e necrólise epidérmica tóxica em medicina intensiva. Artigo de revisão. Revista Brasileira de Terapia Intensiva Vol. 18 Nº 3, Julho – Setembro, 2006. DOI: https://doi.org/10.1590/S0103-507X2006000300012
DERMATOLOGIA AZULAY Azulay Dermatologia / Rubem David Azulay (in memoriam), David Rubem Azulay, Luna Azulay- Abulafia. - 8. ed. - Rio de Janeiro : Guanabara Koogan, 2022. 1280 p. : il. ; 28 cm.
