Download SJS/TEN discharge letter

Dear Colleague,
Re: ……………………………………………………. (patient’s name)
Your patient was recently admitted to hospital following an episode of Stevens-Johnson
syndrome/toxic epidermal necrolysis (SJS/TEN). SJS/TEN is a rare, severe muco-cutaneous
reaction, usually to drugs, characterised by blistering and epithelial sloughing of skin and
mucous membranes. During the acute phase, patients are extremely ill, often requiring
admission to an ICU or to a Burn Centre. The chronic phase of SJS/TEN is characterised by
symptoms which develop insidiously over the weeks and months following presentation and
usually persist after discharge from hospital. The most common sequelae are:
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Fatigue, especially in the initial weeks and months after discharge
Eye complications, including dryness, pain, photophobia, corneal scarring and visual
impairment
Skin dyspigmentation (both hyper- and hypopigmentation)
Loss of nails (sometimes with dystrophic regrowth)
Urogenital problems, including dryness and complications from scarring
Mouth problems, including dryness, dental caries and complications from scarring
Post-traumatic stress disorder, including nightmares, anxiety and depression
Other complications include bronchiectasis and other sequelae of lung involvement;
stenosis of the gastrointestinal tract; loss of muscle mass
Your vigilance in monitoring for these complications is vital; many of the long-term outcomes,
particularly ocular disorders, can be improved by early recognition and prompt intervention.
In the event of any of the above sequelae please contact our department and we will refer
the patient to the appropriate specialist.
SJS/TEN is most often caused by a medication. In the case of your patient the cause of
SJS/TEN has been identified as ………………..……………...….... It is essential that your
patient is not prescribed …………………..…………..…..., or drugs of the same class. We
have informed him/her about which medication(s) to avoid. We would appreciate if you could
order a MedicAlert bracelet or amulet identifying the culprit medication(s) above and
indicating the reaction he/she suffered (SJS/TEN). Some patients develop a reluctance to
take new medicines, however, recurrences are extremely rare and are almost always due to
a repeat exposure to the offending drug or another in the same class.
If appropriate: In approximately 15% of SJS/TEN cases no drug can be implicated.
Please contact the department if you wish to discuss your patient’s illness, or for further
information about SJS/TEN.
Yours sincerely,
…………………………………………………….