ABSTRACT

This chapter presents a case study of a 18-year-old woman who attends the Emergency Department with her mother with a history of painful ulcers in her mouth and skin peeling. She reports it starting as a small lip ulcer, but has progressed rapidly and has become increasingly painful, especially when eating or drinking. Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered to be part of a continuous spectrum of a life-threatening mucocutaneous reaction. SJS/TEN is an acute, potentially life-threatening mucocutaneous disorder characterised by progressive dermal loss and inflammation of mucosal surface. Patients with SJS/TEN should be referred to intensive or high dependency care units for specialist nursing. Patient with severe eating difficulties due to oral involvement should have nasogastric tube inserted and feeding initiated. Wounds are often difficult to manage without general anaesthesia or potent analgesia such as opioids or ketamine. However, regular warm saline irrigation can be performed with greasy emollient cover and topical antibiotics.