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학습 자료 둘러보기 →When assessing a patient for suspected Stevens-Johnson syndrome (SJS), a systematic approach is critical. The hallmark findings are widespread skin detachment, a positive Nikolsky's sign, and severe mucosal involvement. Mucosal erosions, often affecting the oral, ocular, and genital areas, are present in over 90% of cases and may precede skin lesions.
Key Assessment Technique: To test for Nikolsky's sign, apply gentle lateral pressure with your thumb on an area of seemingly normal skin adjacent to a lesion. A positive sign is indicated by the skin wrinkling and shearing off, leaving a moist, painful erosion. This reflects pathological separation at the dermal-epidermal junction.
The differential diagnosis should include other severe cutaneous adverse reactions (SCARs) and conditions like erythema multiforme, staphylococcal scalded skin syndrome, and acute graft-versus-host disease. A thorough medication history is essential, focusing on common triggers such as sulfonamides, beta-lactam antibiotics, anticonvulsants, and NSAIDs. Early recognition and immediate discontinuation of the offending agent are paramount to improving outcomes.
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