• Fever or flu-like illness followed by a painful red/purple rash
• Blisters or peeling skin
• Painful sores in the mouth, eyes, genitals, or throat
• Red, painful, light-sensitive eyes
• Trouble swallowing, breathing, or drinking fluids

Latest SJS/TEN treatment guidelines and consensus sources

1. German S3 guideline, 2024
   • Part 1: diagnosis, immediate management, and systemic immunomodulating therapy, PMID: 39314017
   • Part 2: acute supportive care and post-acute follow-up, PMID: 39417754
   • These are multidisciplinary evidence-based guidelines for SJS/TEN, collectively termed epidermal necrolysis.
2. French national adult protocol, 2024: diagnosis and management of epidermal necrolysis, PMID: 38810539.
3. Latin American guideline, 2025: includes diagnostic workup, culprit-drug assessment using ALDEN, management, complication prevention, and a treatment algorithm. The full guideline is open access and indexed as PMID: 40226820.
4. Society of Dermatology Hospitalists supportive-care guideline, 2020: still a major practical adult-care reference covering triage/location of care, wound, eye, oral and urogenital care, fluids, nutrition, pain, infection surveillance, airway care, and thrombosis prevention, PMID: 32151629.

Consistent current recommendations

• Immediately stop all suspected culprit and nonessential medicines. Determine culprit-drug causality formally where feasible, commonly with the ALDEN algorithm.
• Urgently admit to a specialist setting such as ICU, burn center, or a unit experienced with epidermal necrolysis, based on severity and local capability.
• Begin multidisciplinary supportive care early. This includes fluid and electrolyte management, temperature control, nutritional support, analgesia, careful wound care, and monitoring for infection and organ failure.
• Obtain urgent ophthalmology review for every suspected case, not only when eye symptoms seem severe. Gynecology and/or urology assessment is needed when genital or urinary mucosa is involved.
• Assess airway risk early. Progressive oral/pharyngeal sloughing, inability to handle secretions, voice change, or respiratory involvement requires urgent airway management.
• Plan structured follow-up for ocular, oral, genital/urinary, pulmonary, skin, psychological, and medication-avoidance sequelae.

Systemic treatment: important uncertainty

• Cyclosporine has encouraging but not definitive evidence. A 2025 systematic review of 17 studies and 4,761 patients found most studies reported better survival and faster disease control, but some studies did not find benefit and raised safety concerns (PMID: 39470865).
• The 2025 Latin American guideline summarizes evidence suggesting possible benefit from cyclosporine, etanercept, and corticosteroid plus IVIG in selected patients, while emphasizing the lack of high-quality evidence.
• A 2025 burn-center protocol similarly advises that systemic immunomodulation, including etanercept, should be decided jointly by dermatology and the burn/critical-care team, not used routinely without specialist assessment (VUMC protocol).