Paediatric-History taking & Physical examination of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)

Paediatric-History taking & Physical examination of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN)Created OnApril 30, 2020Last Updated OnApril 30, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) < All Topics Table of Contents History taking and physical examination: History Taking: Enquire about the risk factors Exposure to medications above Possibility of infection as listed above Onset of symptoms usually 2 weeks in drug related cases Prodromal symptoms – Fever usually >39°C, influenza-like, malaise, sore throat, lethargy, myalgia and arthralgia Skin tenderness, photophobia, and conjunctival discomfort may be present in early phase of the disease. Physical examination: Skin manifestation Painful, ill-defined erythematous and purpuric macules, may be diffused in TEN. May have a targetoid Typically seen over the face and thorax, symmetrically distributed with sparing of scalp, palms and soles. Severe burning pain of the skin or paresthesias are common Lesions then progress to become vesicles and bullae and sloughing within days Positive Nikolsky’s sign Nikolsky’s sign- shearing of epidermal with skin detachment that occurs with gentle pressure on skin (seen in Toxic Epidermal Necrolysis, Staphylococcal Scalded Skin Syndrome, Pemphigus Vulgaris, Steven Johnson Syndrome) Extensive, full-thickness epidermal necrosis and sloughing nearly 100% of the epidermis in fulminant TEN. Mucosal membrane manifestation Involved in >90% of cases Painful crusts and erosions may occur in any mucosal surfaces Oral, pharyngeal, esophageal mucosa membrane Stomatitis, cheilitis, oral ulcers, Odynophagia, dysphagia Ocular involvement Conjunctival lesions Corneal ulcer Uveitis Urogenital Urethritis, dysuria genital ulcers or urinary retention. Pulmonary Dyspnea, hypoxia May cause pulmonary edema, bacterial pneumonitis, and bronchiolitis obliterans Taken from Doctrina Perpetua guides on Paediatric

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