Chart — Med-Surg
Stevens-Johnson Syndrome vs TEN Chart
Same disease, two scales. SJS and toxic epidermal necrolysis differ mainly by how much skin detaches — and both start with the same action: stop the drug.
Educational use only. SJS/TEN is a life-threatening emergency. Drug discontinuation and ICU/burn-unit management are urgent and provider-directed. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Side by Side
| Feature | Stevens-Johnson (SJS) | Toxic epidermal necrolysis (TEN) |
|---|---|---|
| Skin detachment (%BSA) | < 10% | > 30% (10–30% = SJS/TEN overlap) |
| Severity / mortality | Severe | Most severe; high mortality |
| Trigger | Drug reaction (sulfa, anticonvulsants, allopurinol, NSAIDs) | Same drug triggers — more extensive reaction |
| Onset | ~1–4 weeks after the culprit drug; flu-like prodrome | Same; then rapid widespread sloughing |
| Hallmark signs | Positive Nikolsky sign, painful skin, ≥2 mucosal sites (eyes/mouth/genitals) | Same, with full-thickness epidermal loss in sheets |
| Management | STOP the drug; supportive/wound care | STOP the drug; ICU/burn unit; fluids, sterile wound care, infection prevention |
Exam Traps
- ✦SJS <10% BSA, TEN >30% BSA detachment; 10–30% is overlap — it's one spectrum.
- ✦First action for both: STOP the offending drug.
- ✦Positive Nikolsky sign + mucosal involvement + painful sloughing skin after a new drug = SJS/TEN.
- ✦Manage like a major burn — fluids, sterile wound care, infection prevention; sepsis is the main killer.
- ✦Document the culprit drug as a lifelong allergy and teach avoidance of it and cross-reactors.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →