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Year : 1992  |  Volume : 58  |  Issue : 1  |  Page : 55-56

SJS-TEN overlap

Correspondence Address:
C Arun Inamadar

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How to cite this article:
Inamadar C A. SJS-TEN overlap. Indian J Dermatol Venereol Leprol 1992;58:55-6

How to cite this URL:
Inamadar C A. SJS-TEN overlap. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Dec 5];58:55-6. Available from:

To the Editor,

 Stevens-Johnson syndrome More Details (SJS) and Toxic Epidermo Necrolysis (TEN) are usually described as separate reactive erythemas.

Usually a patient suffers from either of these two. Present case is reported here because of the overlap of both.

One-year-old male child being treated for fever with penicillin presented with typical clinical picture of SJS and was getting treatment accordingly. On third day of admission child developed flaccid bullous lesions with positive Nikolsky's sign [Figure - 1]. Skin was coming out like a sheet leaving behind a raw area over back of the trunk, abdomen and face. Child became more toxic and febrile. Tzanck smear demonstrated cells typical of TEN. Routine investigations were normal except slight eosinophilia and moderate rise in ESR. Gradually lesions subsided on administration of high dose of steroids, intravenous fluids and oral erythromycin.

TEN may be related to EM. [1] Some reported patients presented with clinical features that overlapped between TEN and SJS, suggesting that TEN in more severe form of SJS and that some cases of TEN may start as SJS with target lesions. [2],[3] This position has been contested by other observers [4] to support their opinion that TEN and SJS are unrelated pathogenetically.

The present case with denuded skin area of more than 10 percent confirmed to the criteria set by Revuz et al [5] to define TEN. But it does not fit into traditional definition of TEN due to the presence of target lesions even after the starting of epidermal necrolysis. [6] According to Goldstein et al [7] cases with features of EM and widespread blistering should be separated out and be labelled as "EM-TEN overlap", or "EM with widespread blistering". Absence of target lesion is an important criteria for defining TEN in their proposal.

In view of the above discussion the present case fits into "EM-TEN overlap" group.

  References Top

1.Chan H.Observations on drug induced toxic epidermal necrolysis in Singapore. J Am Acad Dermatol 1984;10 : 973 - 8.  Back to cited text no. 1    
2.Kumar AS, Pandhi R K. Stevens-Johnson syndrome transforming into toxic epidermonecrolysis. Ind J Dermatol Venereol Leprol 1984; 50: 174.  Back to cited text no. 2    
3.Meena H S, Khare A K. Toxic epidermo­necrolysis following Stevens-Johnson syndrome. Ind J Dermatol Venereol Leprol 1986; 52: 291 - 2.  Back to cited text no. 3    
4.Snyder R A, Elias P M. Toxic epidermal necrolysis and staphylococcal scalded skin syndrome. Dermatol clin 1983; 1 : 235-48.  Back to cited text no. 4    
5.Revuz J, Penso D, Roujeu J C, et al. Toxic epidermal necrolysis: Clinical findings and prognosis factors in 87 patients. Arch Dermatol 1987; 123: 1 160 - 5.  Back to cited text no. 5    
6.Sneddon IB. Bullous Eruption. In:Text book of Dermatology, (Rook A, Wilkinson DS, Ebling FJG eds), 3rd edn Boston : Blackwell Scientific publications, 1979; 1477.  Back to cited text no. 6    
7.Goldstein SM, Wintroub BW, Elias PM. Toxic Epidermal Necrolysis-unmuddying the Water. Arch Dermatol 1987; 123: 1 153 - 6.  Back to cited text no. 7    


[Figure - 1]


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