A fictional 36-year-old develops fever, painful dusky skin lesions, blistering and oral and ocular erosions two weeks after starting a new medicine.
Frame the danger first.
- Skin pain, epidermal detachment and prominent mucosal involvement are emergency warning features.
- Build a precise medicine timeline, including recently stopped and non-prescription products.
- Consider important mimics, but do not delay withdrawal of plausible culprit medicines and specialist review.
Act, escalate, reassess.
- Call senior, dermatology and appropriate critical-care/burns support and begin ABCDE assessment.
- Stop suspected culprit medicines safely and document the exposure timeline.
- Assess skin extent, mucosal sites, fluid balance, temperature and infection while providing careful supportive care.
- Arrange early ophthalmology and other specialty input according to affected mucosa and local pathway.
Red flags that change pace.
- Rapidly progressing detachment, haemodynamic instability or organ dysfunction
- Ocular pain/visual symptoms, airway involvement or extensive oral disease
- Sepsis concern, major fluid loss or uncertainty about the diagnosis
What makes care less safe.
- Calling the eruption a simple drug rash despite skin pain and mucosal disease
- Continuing a non-essential possible culprit medicine
- Delaying eye assessment until visual loss occurs
Say the concern plainly.
Suspected SJS/TEN with onset [date], detachment/mucosal sites [summary] and medicine timeline [key exposures]. Culprit medicines are stopped and supportive measures are [status]. I need urgent dermatology-led multidisciplinary review.