What are the types of Stevens-Johnson syndrome (SJS) and why is the classification scheme the subject of debate?

Updated: Jan 17, 2019
  • Author: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

Although several classification schemes have been reported, the simplest breaks the disease down as follows [1] :

  • Stevens-Johnson syndrome - A "minor form of TEN," with less than 10% body surface area (BSA) detachment
  • Overlapping Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) - Detachment of 10-30% BSA
  • Toxic epidermal necrolysis - Detachment of more than 30% BSA

An argument against this unifying concept was that HSV infection had been described as a frequent cause of Stevens-Johnson syndrome/erythema multiforme major but not of toxic epidermal necrolysis. However, reports showed that HSV infection has not definitively been related to Stevens-Johnson syndrome and suggested that clinical manifestations and pathology results support the linking of Stevens-Johnson syndrome and toxic epidermal necrolysis together with their differentiation from erythema multiforme.


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