Distinguishing Stevens-Johnson syndrome/toxic epidermal necrolysis from clinical mimickers during inpatient dermatologic consultation—A retrospective chart review

Allison Weinkle, Cory Pettit, A. Jani, J. Keller, Yuanyuan Lu, Stephen Malachowski, John C. Trinidad, Benjamin H. Kaffenberger, Elizabeth N. Ergen, Lauren C. Hughey, D. Smith, L. Seminario-Vidal

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions that may present with similar findings to other severe dermatologic diseases. Objective: The primary objective of this exploratory study was to explore factors associated with SJS/TEN and develop a model that provides the predicted probability of SJS/TEN for patients for whom the diagnosis of SJS/TEN is considered. Methods: Retrospective review of consultations for patients with suspected SJS, TEN, or overlap at 4 academic dermatology consultation services. Results: Overall, 208 patients were included; 59 (28.4%) had a final diagnosis of SJS/TEN, and 149 (71.6%) were given a different diagnosis. The most common mimickers were drug hypersensitivity syndrome (n = 21, 10.1%), morbilliform drug eruption (n = 18, 8.7%), erythema multiforme (n = 15, 7.2%), and acute generalized exanthematous pustulosis (n = 13, 6.2%). Nikolsky sign, atypical targets, fever, and lymphopenia were included in a model for predicting the probability of SJS/TEN. Limitations: All cases were obtained from academic centers, which may limit the generalization of findings to community-based settings. This was an exploratory study with a small number of cases, and external validation of the model performance is needed. Conclusion: Early dermatologic evaluation of patients with suspected SJS/TEN is key to separating patients with this condition from those who ultimately receive diagnoses of other serious skin diseases.

Original languageEnglish (US)
Pages (from-to)749-757
Number of pages9
JournalJournal of the American Academy of Dermatology
Volume81
Issue number3
DOIs
StatePublished - Sep 2019

Keywords

  • Stevens-Johnson syndrome
  • dermatology consultation
  • inpatient
  • severe cutaneous adverse reaction
  • toxic epidermal necrolysis

ASJC Scopus subject areas

  • Dermatology

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