As shown in the table, they both exhibit epidermal necrosis and karyocyte apoptosis, In SJS, the disease is confined to <10% of body surface area. TEN has both an intermediate form without multivisceral involvement and a major form in which >30% of body surface area is involved. With that, the severe form of TEN carries a significant mortality, >70% in adults.
The accompanying pictures show the typical skin and mucus membrane problems with SJS/TEN. Patients have bullae, involving up to 10% of their surface area in SJS, which can coexist with macules and papules. The pathology on a skin biopsy is characteristic.
The treatment principles in general are to stop the causative agent. ICU admission is occasionally needed in very sick patients. Resuscitation similar that of a burn is required with vigorous correction of their fluid and electrolyte deficits. Significant attention to suctioning and pulmonary toilet must be paid. It is very hard for these patients to swallow and, as stated, some have involvement of their tracheal mucosa and may require intubation and mechanical ventilation. It is very important to have stable IV access, either with placement of a CVC or PICC line. Pressors may be needed to support the circulation.