Mortality in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), while substantial, was significantly lower than predicted, according to a recent study that investigated this rare, severe, mucocutaneous reaction. The multicenter retrospective study included patients with SJS/TEN (n=377) seen by inpatient consultative dermatologists at 18 academic medical centers in the US. Patients with SJS/TEN between January 1, 2000, and June 1, 2015, were entered, including 69.0% from 2010 onward. Researchers found:

• The most frequent cause of SJS/TEN was medication reaction (89.7%), most often trimethoprim/sulfamethoxazole (27.2%).
• The majority of patients were managed in an intensive care (27.2%) or burn unit (41.0%).
• Most received pharmacologic therapy (70.7%) vs supportive care alone (29.3%)—typically corticosteroids (42.5%), intravenous immunoglobulin (IVIG) (35.3%), or both therapies (20.3%).
• Based on predicted mortality, 78 in-hospital deaths were expected (21%), while the observed mortality of 54 patients (14.7%) was significantly lower.
• Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and IVIG.