Reference — Med-Surg
Stevens-Johnson Syndrome & TEN Reference
The dermatologic emergency: a severe drug reaction in which the skin blisters and sloughs in sheets. SJS and TEN are the same disease at different scales — and the single most important action is recognizing it and stopping the drug.
Educational use only. SJS/TEN is a life-threatening emergency requiring ICU or burn-unit management. Drug discontinuation, fluid resuscitation, and specialist care follow provider orders urgently. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The SJS / TEN Spectrum
| Feature | SJS | Overlap | TEN |
|---|---|---|---|
| Skin detachment (%BSA) | < 10% | 10–30% | > 30% |
| Severity | Severe | Severe | Most severe; high mortality |
| Shared features | Prodrome (fever, flu-like), painful skin, ≥2 mucosal sites (eyes, mouth, genitals), positive Nikolsky sign, sloughing | — | Same, with widespread full-thickness epidermal loss |
Nikolsky sign: gentle lateral pressure causes the epidermis to shear off — positive in SJS/TEN.
Common Culprit Drugs
- •Antibiotics — sulfonamides (e.g., sulfamethoxazole), penicillins
- •Anticonvulsants — lamotrigine, carbamazepine, phenytoin
- •Allopurinol
- •NSAIDs (oxicam type)
- •Nevirapine and some other antivirals
Reaction usually begins 1–4 weeks after starting the culprit drug.
Nursing Care — Burn-Unit Principles
STOP the offending drug immediately — the single most important intervention. Transfer to ICU/burn unit.
Manage like a major burn: aggressive fluid and electrolyte replacement, temperature regulation, meticulous sterile wound care, pain control, and nutrition. The denuded skin loses the barrier function — infection and sepsis are the leading causes of death, so infection prevention is paramount.
Protect the mucous membranes: ophthalmology for eye involvement (prevents blindness/scarring), oral and genital care. Document the culprit as a serious allergy and educate the patient to avoid that drug (and cross-reactors) for life.
NCLEX Pearls
- ✦SJS and TEN are a drug-reaction spectrum: SJS <10% BSA detachment, TEN >30%.
- ✦First and most important action: STOP the offending drug.
- ✦Positive Nikolsky sign (skin shears with pressure) + mucosal involvement + sloughing = SJS/TEN.
- ✦Top culprits: sulfa antibiotics, anticonvulsants (lamotrigine, carbamazepine, phenytoin), allopurinol.
- ✦Manage like a major burn — fluids, sterile wound care, infection prevention; sepsis is the main killer.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →