ABSTRACT
Toxic epidermal necrolysis (TEN, Lyell’s syndrome) is a rare adverse cutaneous drug reaction characterized by an average mortality of 30%1. Stevens-Johnson syndrome (SJS) is a severe mucocutaneous disease that is frequently drug-induced and can progress to TEN2. SJS and TEN are in fact considered to be part of a spectrum of adverse cutaneous drug reactions with increasing severity and extent of skin detachment, ranging from SJS (less than 10% body surface area skin detachment) to SJS-TEN overlap syndrome (10-30% skin detachment) and TEN (greater than 30% skin detachment)3. Both SJS and TEN are characterized morphologically by ongoing apoptotic keratinocyte cell death that results in the separation of the epidermis from the dermis. Although mortality rates in SJS are not as high as in TEN (on average 30%), fatal outcomes have been reported in about 1-5% of patients1,4. Furthermore, visceral complications, and especially ocular complications which can occasionally lead to permanent impairment of eyesight, can be as severe in SJS as in TEN, since mucous membrane involvement is similar in both.
