GuidelinesPrimary Care STG
Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)
Description General measures Referral L51.1/ L51.2 DESCRIPTION An acute, systemic condition with vesico-bullous lesions involving the skin and mucous membranes (≥ 2 mucosal surfaces), but occasionally only the mucous membranes The eruption may start as widespread red irregular macules and patches. There may be a vesicle or bulla in the central area of the lesion. The blisters rupture leaving denu
L51.1/ L51.2
DESCRIPTION
- An acute, systemic condition with vesico-bullous lesions involving the skin and mucous membranes (≥ 2 mucosal surfaces), but occasionally only the mucous membranes
- The eruption may start as widespread red irregular macules and patches. There may be a vesicle or bulla in the central area of the lesion. The blisters rupture leaving denuded areas of skin. Mucous membrane erosions often with slough covering the surface are frequently seen
- Toxic epidermal necrolysis (TEN) is a more severe form of the condition and is suggested if the skin lesions cover > 30% of the body surface area. The mucous membranes such as the mouth, eyes and vagina are also more severely affected
- The condition is usually caused by medicines e.g. sulphonamides, anti-retrovirals (nevirapine), anti-epileptics (phenytoin, phenobarbitone, carbamazepine, lamotrigine)
- Systemic involvement with multi-organ dysfunction is common
GENERAL MEASURES
- Immediate withdrawal of offending medicine
- Patients usually require care in a high or intensive care unit with dedicated nursing
REFERRAL
- All patients
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Review-Version-2.0-November-2025
Chapter 5: Skin Conditions_5.10.6.1 Stevens-Johnson syndrome (SJS)/Toxic Epidermal Necrolysis (TEN)