👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: SJS · drug rash · severe drug reaction · toxic epidermal necrolysis · TEN · Stevens Johnson
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Use this quick-reference guide to spot, treat, and prevent Stevens-Johnson Syndrome on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
⚠️ Cause
Drug rxn: sulfa, allopurinol, AEDs
Lamotrigine, phenytoin triggers
🩺 Signs
Flu-like, then painful rash
Blisters, skin sloughs off
+Nikolsky, mucous membranes
✅ Do
Stop offending drug now
Burn-unit care, fluids, wound care
🚩 Report
> 30% skin = TEN, fatal
📚 Stevens-Johnson Syndrome — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Stevens-Johnson syndrome (SJS) is a rare, life-threatening hypersensitivity reaction, usually triggered by medications, that causes the epidermis to detach from the dermis. It begins with flu-like symptoms followed by a painful blistering rash and sloughing of skin and mucous membranes. When more than 30% of body surface is involved it is called toxic epidermal necrolysis (TEN). It is a dermatologic emergency managed much like a severe burn, with fluid loss and infection as major dangers.
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Key points
Understand these first
Common triggers include sulfonamides, anticonvulsants (lamotrigine, carbamazepine, phenytoin), allopurinol, NSAIDs, and antibiotics.
Prodrome of fever, sore throat, and malaise precedes the rash by 1 to 3 days.
Painful erythematous or purpuric macules progress to blisters and widespread epidermal sloughing.
A positive Nikolsky sign means the skin shears off with light lateral pressure.
Mucous membranes of the mouth, eyes, and genitals are involved, causing severe pain and potential blindness.
Massive skin loss causes fluid and electrolyte loss, hypothermia, and high infection/sepsis risk.
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Nursing priorities
What to do, in order
Stop the causative drug immediately and ensure it is documented as an allergy.
Maintain airway, fluid, and electrolyte balance; manage the patient like a major burn, often in a burn or ICU unit.
Use strict aseptic technique and protective isolation to prevent sepsis through denuded skin.
Provide meticulous skin and mucous-membrane care, pain control, and warm environmental temperature.
Coordinate ophthalmology care to protect the eyes and prevent permanent vision loss.
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Red flags — report now
Escalate immediately
Continuing or restarting the offending medication can be fatal; verify it is discontinued.
Airway involvement, signs of sepsis, or rapid skin sloughing require emergency escalation.
Eye involvement can cause permanent blindness; obtain urgent ophthalmology consult.
Never apply adhesive dressings or tape directly to fragile skin.
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Labs & values
Numbers to know
WBC: may be elevated with secondary infection (normal 5,000 to 10,000/mm3)
Electrolytes: monitor for imbalances from fluid loss
Albumin: low from protein loss through skin (normal 3.5 to 5.0 g/dL)
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Patient teaching
What patients must know
Wear a medical alert bracelet listing the causative drug and never take it again.
Inform all future providers and pharmacists of the drug allergy.
Seek immediate care for any new rash with blistering, mouth sores, or eye pain after starting a medication.
❓ Stevens-Johnson Syndrome: NCLEX FAQs
What are the priority nursing interventions for Stevens-Johnson Syndrome?
Stop the causative drug immediately and ensure it is documented as an allergy. Maintain airway, fluid, and electrolyte balance; manage the patient like a major burn, often in a burn or ICU unit. Use strict aseptic technique and protective isolation to prevent sepsis through denuded skin. Provide meticulous skin and mucous-membrane care, pain control, and warm environmental temperature.
What are the warning signs of Stevens-Johnson Syndrome a nurse must report?
Continuing or restarting the offending medication can be fatal; verify it is discontinued. Airway involvement, signs of sepsis, or rapid skin sloughing require emergency escalation. Eye involvement can cause permanent blindness; obtain urgent ophthalmology consult. Never apply adhesive dressings or tape directly to fragile skin.
What do I need to know about Stevens-Johnson Syndrome for the NCLEX?
Common triggers include sulfonamides, anticonvulsants (lamotrigine, carbamazepine, phenytoin), allopurinol, NSAIDs, and antibiotics. Prodrome of fever, sore throat, and malaise precedes the rash by 1 to 3 days. Painful erythematous or purpuric macules progress to blisters and widespread epidermal sloughing. A positive Nikolsky sign means the skin shears off with light lateral pressure.
What patient teaching is important for Stevens-Johnson Syndrome?
Wear a medical alert bracelet listing the causative drug and never take it again. Inform all future providers and pharmacists of the drug allergy. Seek immediate care for any new rash with blistering, mouth sores, or eye pain after starting a medication.
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Quick Tip
Common triggers include sulfonamides, anticonvulsants (lamotrigine, carbamazepine, phenytoin), allopurinol, NSAIDs, and antibiotics.