Introduction
Toxic epidermal necrolysis (TEN) and Steven–Johnson syndrome (SJS) are
rare but life-threatening mucocutaneous conditions induced by immune
system activation mostly caused by certain drugs and their metabolites,
Associated with widespread keratinocyte death causing full-thickness
denudation of the skin and mucosa, which results in a high susceptibly
to sepsis with a mortality rate of 30% (1) . The cutaneous and
mucosal manifestations are commonly preceded by many non-specific
symptoms including fever, rhinitis, headache, conjunctivitis and sore
throat lasting approximately one week . Complications include
infections, eye involvement (potentially leading to blindness) , scars
involving the mouth, pharynx, oesophagus, rectus, middle airways and
genitourinary tract (phimosis, vaginal stenosis, dysuria) . Other deadly
complications include renal and/or hepatic failure, dehydration, and
sepsis (2) . There are two entities of the same clinical
condition differing only in their percentage involved in their body
surface. The percentage of the body surface involved is the only
difference between SJS and TEN. Where, body surface area
(<10%) involvement is reported in SJS, 10-30% BSA in SJS-TEN
overlap and >30% BSA detachment is reported in TEN(3) . The most common trigger for TEN/SJS are medications and
usually triggers the disease within 8 weeks in both adults and children;
however, the typical exposure period ranges from 4 days to 4 weeks.
Commonly accused medications include non-steroidal anti-inflammatories,
allopurinol, anticonvulsants such as lamotrigine, phenytoin and
carbamazepine, antibacterial sulphonamides and the antiretroviral
nevirapine (3) .