Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management in the Emergency Department (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: July 2026 (Volume 28, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 07/01/2029.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but potentially fatal mucocutaneous emergencies that exist on a spectrum and are most commonly caused by a medication reaction. Although data guiding diagnosis and management remain limited, early recognition, prompt identification and discontinuation of the causative agent, symptomatic management, and multidisciplinary involvement are essential to improving patient outcomes. Validated prognostic tools can further guide management decisions. This review provides an evidence-based approach to the recognition and management of SJS/TEN in the emergency department.

Case Presentations

A 60-year-old man presents with fever, sore throat, and a rapidly spreading painful rash involving his face, trunk, and extremities…

• He was recently diagnosed with gout and was started on allopurinol 2 weeks ago.
• His vital signs are: temperature, 37.3°C; heart rate, 125 beats/min; blood pressure, 97/54 mm Hg; and respiratory rate, 18 breaths/min.
• The rash is erythematous with areas of blistering and sloughing. Erosions are present on the oral mucosa.
• You wonder whether this is a benign rash or a true emergency, and consider your next steps…

A 22-year-old woman presents with painful oral ulcers, conjunctival injection, and blistering skin on her torso…

• She has epilepsy and takes lamotrigine for seizure control. She reports that her dose was recently increased.
• Her vital signs are: temperature, 38.5°C; heart rate, 107 beats/min; blood pressure, 118/65 mm Hg; and respiratory rate, 19 breaths/min.
• The physical examination reveals erythematous Nikolsky-positive lesions on the torso.
• You strongly suspect SJS/TEN and consider which laboratory studies are indicated and whether a risk-stratification tool would be helpful…

An 8-year-old girl presents with fever, conjunctivitis, and a spreading, blistering rash on her trunk and extremities...

• The patient’s parents tell you that she was recently treated for a mycoplasma infection.
• Her vital signs are: temperature, 38.2°C; heart rate, 120 beats/min; blood pressure, 100/70 mm Hg; and respiratory rate, 22 breaths/min. She has mild oral erythema.
• As you consider whether this is SJS/TEN or an M pneumoniae-induced rash with mucositis, you wonder if the management of SJS/TEN for pediatric patients differs from adults…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.