The Adequate Evaluation Teams, Treatment Plans for Stevens-Johnson Syndrome

As previously discussed on HCPLive, Stevens-Johnson Syndrome (SJS) is an often under-recognized and under-addressed, potentially fatal rare skin condition. In fact, the severe cutaneous drug reaction often falls on the shoulders of dermatologists identifying signs and symptoms and initiating care as soon as possible.

But what is the full SJS care team, and what treatment options are available?

In the second segment of an interview with HCPLive during the Society of Dermatology Physician Assistants (SDPA) 2022 Annual Meeting, Travis Vandergriff, MD, associate professor in the department of dermatology at UT Southwestern Medical Center, discussed the value of swift progression from diagnosis to care in patients with suspected SJS.

“Days are definitely important,” Vandergriff said. “It can progress very quickly, and even just 1 or 2 days make a big difference.” Vandergriff advised clinicians always check back on uncertain patients within a day of initial symptoms, and to be sure to monitor for changes in appearance at the site of scarring.

Vandergriff additionally discussed the roles of the unique cross-specialty care team involved with SJS, including ophthalmologists, urologists, and gynecologists—teams that he stressed his team at UT Southwestern always utilize for follow-up evaluations at least.

“All SJS patients should be evaluated by an ophthalmologist, and that’s looking for eye involvement, and that could lead to scarring,” he explained. “It may not be clinically obvious that there’s inflammation in the eye, but they can detect that through an eye exam.”

Regarding urologists and gynecologists, Vandergriff stressed the risk of erosion in the mucosal parts of the genital and urinary systems. It could require topical treatments or post-recovery monitoring for strictures and scarring.

“Those 2 teams are really important to consult and involve, during the acute process and then to follow up with afterwards and ensure there is no long-term sequelae or scarring in the affected areas,” he said.

On the subject of long-term outpatient care, Vandergriff said the timeline depends on patient risk factors, comorbidities, and total surface area impacted by the disease. Some patients who survive may be following up with specialists for 6-plus months.

He also discussed the current state of research into potential value of immunotherapies versus standard care for patients with SJS, and the significance of clinicians contributing data toward necessary clinical trials.

“The 2 biggest points to make would be is to recognize the early presentation, and I think that’s an opportunity for education, and then no. 2 is to really pursue the clinical trials that are just beginning to find the best treatment protocols,” Vandergriff said.