Although patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are now routinely referred to burn centers for definitive care, not all cases of SJS or even SJS-TEN overlap automatically warrant burn center admission. However, the more extensive the degree of exfoliation (especially in TEN), the greater is the need for and benefit from providing care in a burn center setting.

Diagnosis of SJS and TEN relies on careful documentation of systemic, cutaneous, and mucosal features obtained from a detailed history and physical examination, combined with histologic confirmation by biopsy.

The treatment bundle in the burn center should include cessation of the causative medication; careful airway assessment and protection, if indicated; directed (rather than routine) fluid replacement for hypovolemia; early enteral nutrition; wound coverage with skin substitutes; urgent ophthalmologic consultation; careful surveillance for infection; avoidance of prophylactic antibiotics; and consideration of a pharmacologic intervention to attempt to halt the disease process.

Pharmacologic interventions to halt the disease process have not been examined through large high-quality studies and consensus on use of these agents is lacking.