What is the role of emergency department (ED) care in the treatment of Stevens-Johnson syndrome (SJS)?

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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Most patients present early and prior to obvious signs of hemodynamic compromise. The single most important role for the ED physician is to detect Stevens-Johnson syndrome/toxic epidermal necrolysis early and initiate the appropriate ED and inpatient management.

Withdrawal of the suspected offending agent is critically important. Timing of withdrawal has been linked to outcome. Underlying diseases and secondary infections must be identified and treated.

Patients should be treated with special attention to airway and hemodynamic stability, fluid status, wound/burn care, and pain control. Care in the ED must be directed to fluid replacement and electrolyte correction. Treatment is primarily supportive and symptomatic. Some have advocated corticosteroids, cyclophosphamide, plasmapheresis, hemodialysis, and immunoglobulin.

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