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Stevens-Johnson Syndrome Clinical Presentation

  • Author: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Nov 09, 2015
 

History

Typically, Stevens-Johnson syndrome (SJS) begins with a nonspecific upper respiratory tract infection. This usually is part of a 1- to 14-day prodrome during which fever, sore throat, chills, headache, and malaise may be present. Vomiting and diarrhea are occasionally noted as part of the prodrome.

Mucocutaneous lesions develop abruptly. Clusters of outbreaks last from 2-4 weeks. The lesions are typically nonpruritic.

A history of fever or localized worsening should suggest a superimposed infection; however, fever has been reported to occur in up to 85% of cases.

Involvement of oral and/or mucous membranes may be severe enough that patients may not be able to eat or drink. Patients with genitourinary involvement may complain of dysuria or an inability to void.

A history of a previous outbreak of Stevens-Johnson syndrome or of erythema multiforme may be elicited. Recurrences may occur if the responsible agent is not eliminated or if the patient is reexposed.

Typical prodromal symptoms are as follows:

  • Cough productive of a thick purulent sputum
  • Headache
  • Malaise
  • Arthralgia

Patients may complain of a burning rash that begins symmetrically on the face and the upper part of the torso. This may be accompanied by ocular symptoms.

In addition to the skin, lesions in Stevens-Johnson syndrome may involve the following parts of the body:

  • Oral mucosa
  • Esophagus
  • Pharynx
  • Larynx
  • Anus
  • Trachea
  • Vagina
  • Urethra

Ocular symptoms include the following:

  • Red eye
  • Tearing
  • Dry eye
  • Pain
  • Blepharospasm
  • Itching
  • Grittiness
  • Heavy eyelid
  • Foreign body sensation
  • Decreased vision
  • Burn sensation
  • Photophobia
  • Diplopia

Delineation of a drug exposure timeline is essential, especially in the 1-3 weeks preceding the cutaneous eruption.

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Physical Examination

The rash can begin as macules that develop into papules, vesicles, bullae, urticarial plaques, or confluent erythema. The center of these lesions may be vesicular, purpuric, or necrotic.

The typical lesion has the appearance of a target; this is considered pathognomonic. However, in contrast to the typical lesions of erythema multiforme, these lesions have only two zones of color. The core may be vesicular, purpuric, or necrotic; that zone is surrounded by macular erythema. Some have called these targetoid lesions.

Lesions may become bullous and later rupture, leaving denuded skin. The skin becomes susceptible to secondary infection. Extensive sloughing is shown in the image below.

Note extensive sloughing of epidermis from Stevens Note extensive sloughing of epidermis from Stevens-Johnson syndrome. Courtesy of David F. Butler, MD.

Urticarial lesions typically are not pruritic. Infection may be responsible for the scarring associated with morbidity.

Although lesions may occur anywhere, the palms, soles, dorsum of the hands, and extensor surfaces are most commonly affected. Desquamation on the foot is shown in the image below.

Sheetlike desquamation on the foot in a patient wi Sheetlike desquamation on the foot in a patient with toxic epidermal necrolysis. Courtesy of Robert Schwartz, MD.

The rash may be confined to any one area of the body, most often the trunk.

Mucosal involvement may include erythema, edema, sloughing, blistering, ulceration, and necrosis. An example of this type of involvement is shown in the image below.

Hemorrhagic crusting of the mucous membranes in to Hemorrhagic crusting of the mucous membranes in toxic epidermal necrolysis. Similar lesions are seen in Stevens-Johnson syndrome. Courtesy of Robert Schwartz, MD.

For more information, see the Medscape Reference article Dermatologic Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

Although some have suggested the possibility of Stevens-Johnson syndrome without skin lesions, most believe that mucosal lesions alone are not enough to establish the diagnosis. Cases without skin lesions have been termed "atypical" or "incomplete."[17] These authors suggested that the combination of urethritis, conjunctivitis, and stomatitis established the diagnosis of Stevens-Johnson syndrome in a patient with Mycoplasma pneumonia– induced signs and symptoms.

The following signs may be noted on examination:

  • Fever
  • Orthostasis
  • Tachycardia
  • Hypotension
  • Altered level of consciousness
  • Epistaxis
  • Conjunctivitis
  • Corneal ulcerations
  • Erosive vulvovaginitis or balanitis
  • Seizures
  • Coma

The following signs may be noted on external examination:

  • Conjunctival hyperemia (ie, red eye)
  • Entropion
  • Skin lesions
  • Nasal lesions
  • Mouth lesions
  • Discharge (ie, catarrhal, mucous, membranous)

The following ocular signs may be noted on slit lamp examination (see the images below):

  • Eyelids: Trichiasis, distichiasis, meibomian gland dysfunction, blepharitis
  • Conjunctiva: Papillae, follicles, keratinization, subepithelial fibrosis, conjunctival shrinkage, foreshortening of fornices, symblepharon, ankyloblepharon
  • Cornea: Superficial punctate keratitis, epithelial defect, stromal ulcer, neovascularization, keratinization, limbitis, conjunctivalization, stromal opacity, perforation
    A patient with severe eye involvement associated w A patient with severe eye involvement associated with Stevens-Johnson syndrome. Note corneal neovascularization and conjunctivalization of the ocular surface.
    Epithelial defect of the cornea with neovasculariz Epithelial defect of the cornea with neovascularization and surface conjunctivalization.
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Complications

Of patients with Stevens-Johnson syndrome, 27-50% progress to severe ocular disease. Ocular complications of Stevens-Johnson syndrome include the following:

  • Chronic cicatrizing conjunctivitis
  • Corneal epithelial defects
  • Corneal stromal ulcers
  • Corneal perforation
  • Endophthalmitis

Other complications may include the following:

  • Gastroenterologic - Esophageal strictures
  • Genitourinary - Renal tubular necrosis, renal failure, penile scarring, vaginal stenosis
  • Pulmonary - Tracheobronchial shedding with resultant respiratory failure
  • Cutaneous - Scarring and cosmetic deformity, recurrences of infection through slow-healing ulcerations

Lesions may continue to erupt in crops for as long as 2-3 weeks. Mucosal pseudomembrane formation may lead to mucosal scarring and loss of function of the involved organ system. Esophageal strictures may occur when extensive involvement of the esophagus exists. Mucosal shedding in the tracheobronchial tree may lead to respiratory failure.

Blindness may develop secondary to severe keratitis or panophthalmitis in 3-10% of patients. Vaginal stenosis and penile scarring have been reported. Renal complications are rare.

Cutaneous lesions may resolve with a patchwork of hyperpigmentation and hypopigmentation. Fingernails and toenails may regrow abnormally. Lesions of the genitourinary system may lead to phimosis or vaginal synechiae.

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Contributor Information and Disclosures
Author

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Steven J Parrillo, DO, FACOEP, FACEP Clinical Adjunct Professor, Medical Director and Faculty, Disaster Medicine and Management Masters Program, Philadelphia University College of Health Sciences; Associate Professor, Clinical and Educational Scholarship Track, Jefferson Medical College of Thomas Jefferson University; Director, Division of EMS and Disaster Medicine, Albert Einstein Healthcare Network

Steven J Parrillo, DO, FACOEP, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Association, World Association for Disaster and Emergency Medicine

Disclosure: Nothing to disclose.

Erik Letko, MD Corneal Consultants of Colorado

Disclosure: Nothing to disclose.

Rola Ba-Abbad, MBBS, FRCS(Glasg) Doctoral Candidate and Medical Retina Fellow, Department of Visual Neuroscience and Moorfields Eye Hospital, UCL Institute of Ophthalmology, University of London, UK

Rola Ba-Abbad, MBBS, FRCS(Glasg) is a member of the following medical societies: Association for Research in Vision and Ophthalmology, Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

Daniel J Dire, MD, FACEP, FAAP, FAAEM Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, School of Medicine, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Talecris Biotherapeutics Honoraria Speaking and teaching

Mark T Duffy, MD, PhD Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Kilbourn Gordon III, MD, FACEP Urgent Care Physician

Kilbourn Gordon III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology and Wilderness Medical Society

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Catherine V Parrillo, DO, FACOP, FAAP, Retired Clinical Assistant Professor, Department of Pediatrics, Philadelphia College of Osteopathic Medicine

Catherine V Parrillo, DO, FACOP, FAAP, is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Matthew M Rice, MD, JD, FACEP Senior Vice President, Chief Medical Officer, Northwest Emergency Physicians of TeamHealth; Assistant Clinical Professor of Medicine, University of Washington School of Medicine

Matthew M Rice, MD, JD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Washington State Medical Association

Disclosure: Team Health Salary Employment

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. French LE. Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. Allergol Int. 2006 Mar. 55(1):9-16. [Medline].

  2. Roujeau JC. Stevens-Johnson syndrome and toxic epidermal necrolysis are severity variants of the same disease which differs from erythema multiforme. J Dermatol. 1997 Nov. 24(11):726-9. [Medline].

  3. Rotunda A, Hirsch RJ, Scheinfeld N, Weinberg JM. Severe cutaneous reactions associated with the use of human immunodeficiency virus medications. Acta Derm Venereol. 2003. 83(1):1-9. [Medline].

  4. Gruchalla RS. 10. Drug allergy. J Allergy Clin Immunol. 2003 Feb. 111(2 Suppl):S548-59. [Medline].

  5. Ahmed AR, Dahl MV. Consensus statement on the use of intravenous immunoglobulin therapy in the treatment of autoimmune mucocutaneous blistering diseases. Arch Dermatol. 2003 Aug. 139(8):1051-9. [Medline].

  6. Assier-Bonnet H, Aractingi S, Cadranel J, Wechsler J, Mayaud C, Saiag P. Stevens-Johnson syndrome induced by cyclophosphamide: report of two cases. Br J Dermatol. 1996 Nov. 135(5):864-6. [Medline].

  7. De Rojas MV, Dart JK, Saw VP. The natural history of Stevens Johnson syndrome: patterns of chronic ocular disease and the role of systemic immunosuppressive therapy. Br J Ophthalmol. 2007 Aug. 91(8):1048-53. [Medline]. [Full Text].

  8. Morel E, Escamochero S, Cabañas R, Díaz R, Fiandor A, Bellón T. CD94/NKG2C is a killer effector molecule in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J Allergy Clin Immunol. 2010 Mar. 125(3):703-10, 710.e1-710.e8. [Medline].

  9. Inachi S, Mizutani H, Shimizu M. Epidermal apoptotic cell death in erythema multiforme and Stevens-Johnson syndrome. Contribution of perforin-positive cell infiltration. Arch Dermatol. 1997 Jul. 133(7):845-9. [Medline].

  10. Foster CS, Fong LP, Azar D, Kenyon KR. Episodic conjunctival inflammation after Stevens-Johnson syndrome. Ophthalmology. 1988 Apr. 95(4):453-62. [Medline].

  11. Murata J, Abe R, Shimizu H. Increased soluble Fas ligand levels in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis preceding skin detachment. J Allergy Clin Immunol. 2008 Nov. 122(5):992-1000. [Medline].

  12. French LE, Trent JT, Kerdel FA. Use of intravenous immunoglobulin in toxic epidermal necrolysis and Stevens-Johnson syndrome: our current understanding. Int Immunopharmacol. 2006 Apr. 6(4):543-9. [Medline].

  13. Halevy S, Ghislain PD, Mockenhaupt M, et al. Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol. 2008 Jan. 58(1):25-32. [Medline].

  14. Schlienger RG, Shapiro LE, Shear NH. Lamotrigine-induced severe cutaneous adverse reactions. Epilepsia. 1998. 39 Suppl 7:S22-6. [Medline].

  15. Mockenhaupt M, Messenheimer J, Tennis P, Schlingmann J. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology. 2005 Apr 12. 64(7):1134-8. [Medline].

  16. Horne NS, Narayan AR, Young RM, Frieri M. Toxic epidermal necrolysis in systemic lupus erythematosus. Autoimmun Rev. 2006 Feb. 5(2):160-4. [Medline].

  17. Hillebrand-Haverkort ME, Budding AE, bij de Vaate LA, van Agtmael MA. Mycoplasma pneumoniae infection with incomplete Stevens-Johnson syndrome. Lancet Infect Dis. 2008 Oct. 8(10):586-7. [Medline].

  18. Sendi P, Graber P, Lepère F, Schiller P, Zimmerli W. Mycoplasma pneumoniae infection complicated by severe mucocutaneous lesions. Lancet Infect Dis. 2008 Apr. 8(4):268. [Medline].

  19. Hällgren J, Tengvall-Linder M, Persson M, Wahlgren CF. Stevens-Johnson syndrome associated with ciprofloxacin: a review of adverse cutaneous events reported in Sweden as associated with this drug. J Am Acad Dermatol. 2003 Nov. 49(5 Suppl):S267-9. [Medline].

  20. Mockenhaupt M, Messenheimer J, Tennis P, Schlingmann J. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis in new users of antiepileptics. Neurology. 2005 Apr 12. 64(7):1134-8. [Medline].

  21. Metry DW, Lahart CJ, Farmer KL, Hebert AA. Stevens-Johnson syndrome caused by the antiretroviral drug nevirapine. J Am Acad Dermatol. 2001 Feb. 44(2 Suppl):354-7. [Medline].

  22. Halevy S, Ghislain PD, Mockenhaupt M, et al. Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol. 2008 Jan. 58(1):25-32. [Medline].

  23. Belkahia A, Hillaire-Buys D, Dereure O, Guillot B, Raison-Peyron N. Stevens-Johnson syndrome due to mirtazapine - first case. Allergy. 2009 Oct. 64(10):1554. [Medline].

  24. Salama M, Lawrance IC. Stevens-Johnson syndrome complicating adalimumab therapy in Crohn's disease. World J Gastroenterol. 2009 Sep 21. 15(35):4449-52. [Medline]. [Full Text].

  25. Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol. 2007. 87(2):144-8. [Medline].

  26. Fernando SL, Broadfoot AJ. Prevention of severe cutaneous adverse drug reactions: the emerging value of pharmacogenetic screening. CMAJ. 2010 Mar 23. 182(5):476-80. [Medline]. [Full Text].

  27. Hynes AY, Kafkala C, Daoud YJ, Foster CS. Controversy in the use of high-dose systemic steroids in the acute care of patients with Stevens-Johnson syndrome. Int Ophthalmol Clin. 2005 Fall. 45(4):25-48. [Medline].

  28. Khalili B, Bahna SL. Pathogenesis and recent therapeutic trends in Stevens-Johnson syndrome and toxic epidermal necrolysis. Ann Allergy Asthma Immunol. 2006 Sep. 97(3):272-80; quiz 281-3, 320. [Medline].

  29. Meth MJ, Sperber KE. Phenotypic diversity in delayed drug hypersensitivity: an immunologic explanation. Mt Sinai J Med. 2006 Sep. 73(5):769-76. [Medline].

  30. Strom BL, Carson JL, Halpern AC, et al. A population-based study of Stevens-Johnson syndrome. Incidence and antecedent drug exposures. Arch Dermatol. 1991 Jun. 127(6):831-8. [Medline].

  31. Bastuji-Garin S, Fouchard N, Bertocchi M, et al. SCORTEN: a severity-of-illness score for toxic epidermal necrolysis. J Invest Dermatol. 2000 Aug. 115(2):149-53. [Medline].

  32. de Prost N, Ingen-Housz-Oro S, Duong T, et al. Bacteremia in Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiology, risk factors, and predictive value of skin cultures. Medicine (Baltimore). 2010 Jan. 89(1):28-36. [Medline].

  33. Sekula P, Dunant A, Mockenhaupt M, Naldi L, Bouwes Bavinck JN, Halevy S, et al. Comprehensive Survival Analysis of a Cohort of Patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. J Invest Dermatol. 2013 Feb 7. [Medline].

  34. Vera LS, Gueudry J, Delcampe A, et al. In vivo confocal microscopic evaluation of corneal changes in chronic Stevens-Johnson syndrome and toxic epidermal necrolysis. Cornea. 2009 May. 28(4):401-7. [Medline].

  35. Shammas MC, Lai EC, Sarkar JS, Yang J, Starr CE, Sippel KC. Management of acute Stevens-Johnson syndrome and toxic epidermal necrolysis utilizing amniotic membrane and topical corticosteroids. Am J Ophthalmol. 2010 Feb. 149(2):203-213.e2. [Medline].

  36. Tseng SC. Acute management of Stevens-Johnson syndrome and toxic epidermal necrolysis to minimize ocular sequelae. Am J Ophthalmol. 2009 Jun. 147(6):949-51. [Medline].

  37. Paquet P, Paquet F, Al Saleh W, Reper P, Vanderkelen A, Piérard GE. Immunoregulatory effector cells in drug-induced toxic epidermal necrolysis. Am J Dermatopathol. 2000 Oct. 22(5):413-7. [Medline].

  38. Sotozono C, Ueta M, Koizumi N, et al. Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. Ophthalmology. 2009 Apr. 116(4):685-90. [Medline].

  39. Sotozono C, Ueta M, Kinoshita S. Systemic and local management at the onset of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. Am J Ophthalmol. 2010 Feb. 149(2):354; author reply 355. [Medline].

  40. Araki Y, Sotozono C, Inatomi T, et al. Successful treatment of Stevens-Johnson syndrome with steroid pulse therapy at disease onset. Am J Ophthalmol. 2009 Jun. 147(6):1004-11, 1011.e1. [Medline].

  41. Koh MJ, Tay YK. Stevens-Johnson syndrome and toxic epidermal necrolysis in Asian children. J Am Acad Dermatol. 2010 Jan. 62(1):54-60. [Medline].

  42. Patterson R, Dykewicz MS, Gonzalzles A, et al. Erythema multiforme and Stevens-Johnson syndrome. Descriptive and therapeutic controversy. Chest. 1990 Aug. 98(2):331-6. [Medline].

  43. Power WJ, Ghoraishi M, Merayo-Lloves J, Neves RA, Foster CS. Analysis of the acute ophthalmic manifestations of the erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis disease spectrum. Ophthalmology. 1995 Nov. 102(11):1669-76. [Medline].

  44. Hebert AA, Bogle MA. Intravenous immunoglobulin prophylaxis for recurrent Stevens-Johnson syndrome. J Am Acad Dermatol. 2004 Feb. 50(2):286-8. [Medline].

  45. Schneck J, Fagot JP, Sekula P, et al. Effects of treatments on the mortality of Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective study on patients included in the prospective EuroSCAR Study. J Am Acad Dermatol. 2008 Jan. 58(1):33-40. [Medline].

  46. Pehr K. The EuroSCAR study: cannot agree with the conclusions. J Am Acad Dermatol. 2008 Nov. 59(5):898-9; author reply 899-900. [Medline].

  47. Power WJ, Saidman SL, Zhang DS, et al. HLA typing in patients with ocular manifestations of Stevens-Johnson syndrome. Ophthalmology. 1996 Sep. 103(9):1406-9. [Medline].

  48. FDA Drug Safety Communication. FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetaminophen. Available at http://www.fda.gov/Drugs/DrugSafety/ucm363041.htm. Accessed: August 4, 2013.

  49. Lowes R. Acetaminophen poses risk for rare but fatal skin reactions. Medscape Medical News. August 1, 2013. [Full Text].

  50. Dodiuk-Gad RP, Chung WH, Valeyrie-Allanore L, Shear NH. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Update. Am J Clin Dermatol. 2015 Oct 19. [Medline].

 
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A patient with severe eye involvement associated with Stevens-Johnson syndrome. Note corneal neovascularization and conjunctivalization of the ocular surface.
Epithelial defect of the cornea with neovascularization and surface conjunctivalization.
Note extensive sloughing of epidermis from Stevens-Johnson syndrome. Courtesy of David F. Butler, MD.
Sheetlike desquamation on the foot in a patient with toxic epidermal necrolysis. Courtesy of Robert Schwartz, MD.
Hemorrhagic crusting of the mucous membranes in toxic epidermal necrolysis. Similar lesions are seen in Stevens-Johnson syndrome. Courtesy of Robert Schwartz, MD.
Note early cutaneous slough with areas of violaceous erythema.
Extensive sloughing on the face.
Note the presence of both 2-zoned atypical targetoid lesions and bullae.
Extensive blistering and sloughing on the back.
Extensive sloughing on the back.
Note extensive sloughing.
Low-power view showing full-thickness epidermal necrosis.
 
 
 
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