Page 1818 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 129: Dermatologic Conditions 1287

FIGURE 129-10. Acute generalized exanthematous pustulosis. Multiple nonfollicular,
sterile pustules. (Used with permission of Dr Aisha Sethi.)

and topical steroids are not necessary; however, they may shorten the
duration of the disease.

SEVERE CUTANEOUS ADVERSE DRUG REACTIONS
■ STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS

CADRs are classified by the WHO as severe when they are life threat-
ening, require hospitalization, or lead to permanent disability. Stevens-
Johnson syndrome (SJS) (Fig. 129-11) and toxic epidermal necrolysis
(TEN) (Fig. 129-12) are rare, serious CADRs, with calculated incidences
of 1 to 6 and 0.4 to 1.2 cases per million person-years, respectively. SJS
39

FIGURE 129-12. Toxic epidermal necrolysis (TEN). A. Mucosal involvement with ero-
sions and hemorrhagic crusts. B. Large, intact bullae on erythematous skin. C. Detachment
of full-thickness epidermis has led to areas of denuded skin. (Used with permission of
Drs. Christopher R. Shea and Vesna Petronic-Rosic.)

and TEN are histopathologically identical diseases that are differentiated
by the extent of epidermal detachment: less than 10% in SJS, 10% to 29%
in transitional SJS/TEN, and greater than 30% in TEN. In addition to the
hypersensitivity syndrome/drug reaction with eosinophilia and systemic
symptoms, SJS and TEN constitute the major groups of severe CADRs
40
(Table 129-7).
SJS and TEN are caused almost exclusively by medications. The
41
FIGURE 129-11. Stevens-Johnson syndrome (SJS). Erosive involvement of the lips. implicated medication is usually started within 3 weeks of the eruption.
(Used with permission of Dr Aisha Sethi.) An increased risk for SJS and TEN has been found with the use of the

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