The Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum: A Report of Two Contrasting Cases Managed in a Burn Unit

Background

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, potentially life-threatening mucocutaneous reactions classified based on body surface area (BSA) involvement: SJS affects less than 10% BSA, SJS/TEN overlap affects 10–30% BSA, and TEN affects more than 30% BSA. The mortality rates range from 4.8–9% for SJS to 14.8–48% for TEN. Treatment remains controversial, with corticosteroids and intravenous immunoglobulin (IVIg) being the most debated therapeutic options. While some studies suggest IVIg may block Fas-mediated keratinocyte apoptosis, meta-analyses have shown conflicting results regarding mortality benefit.