Stevens‐Johnson Syndrome and Toxic Epidermal Necrolysis: A Review of Current Management and Innovative Therapies

ABSTRACT There is no consensus regarding the treatment of Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Supportive care remains the preferred approach internationally, while the efficacy of topical/systemic therapies is subject to controversy. We reviewed published guidelines and recommendations on SJS/TEN management and assessed supportive care involving topical and systemic therapies in a series of SJS patients. We included several specialty departments from different countries to determine the consensus in the management of SJS/TEN. We also included SJS patients and provided supportive care including silver nitrate at 0.5% sprayed on denuded areas, in conjunction with a single dose of subcutaneous etanercept. Based on our literature review and experience, we propose a management algorithm for SJS/TEN. Our review confirmed the importance of supportive care, including specific topical and systemic treatments, for SJS/TEN. Systemic corticotherapy, cyclosporine A, intravenous immunoglobulin, tumor necrosis factor‐alpha (TNF‐α) blockers, or combinations are subject to controversies. In our pilot series of seven adult patients with SJS, we obtained good clinical results within 1 week, with mucosal and skin clearance at Week 2, along with a good safety profile. This was achieved by spraying topical silver nitrate at a concentration of 0.5% on denuded areas, following a single dose of etanercept. This consensus led to the recommendation of a combination of supportive care along with several possible topical and systemic therapies for SJS/TEN. Corticosteroids, immunoglobulins, cyclosporine A, and TNF‐alpha blockers were used in our centers alone or in combination, with good results associated with 0.5% topical silver nitrate. In our series of SJS patients, silver nitrate at 0.5% associated with etanercept showed a good response.