Clinical Heterogeneity in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Case Series

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening mucocutaneous disorders, characterised by extensive epidermal necrosis and severe mucosal involvement. Although drugs remain the most frequent triggers, infectious and autoimmune aetiologies may closely mimic classical SJS/TEN, leading to diagnostic delay and inappropriate management. We report three clinically heterogeneous cases of epidermal necrolysis with differing underlying aetiologies, emphasising detailed clinical presentation, serial severity-of-illness score for toxic epidermal necrolysis-based prognostic assessment, management strategies and outcomes. All patients demonstrated clinical improvement following aetiological differentiation, meticulous supportive care and individualised immunomodulatory therapy. This case series highlights the importance of comprehensive clinical evaluation, dynamic prognostication and tailored management in epidermal necrolysis.