Bibliographic Info
GuidelineGuidelines on the treatment of skin and oral HIV-associated conditions in children and adults
Year of Publication2014
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended in favor
Strong
Certainty of evidence
Very low
In HIV-infected children and adults with Stevens-Johnson syndrome or toxic epidermal necrolysis, the suspected causative drug should be promptly discontinued and supportive therapies should be offered.
Notes and Remarks
- 1)ART: if the patient is not already on ART, initiation should be done with caution.
- 2)Relevant drug interactions are described in annex 2.
- 3)Drugs initiated in the last one to three weeks prior to illness should be considered as potential causes and careful consideration of all drugs the patient is receiving is needed, including over-the-counter and non prescription as well as herbal and traditional medicine.
- 4)There is no reliable laboratory test to determine the offending drug; diagnosis is based on the patient’s history and the temporal relationship of suspected drugs (those initiated in the last one to three weeks prior to illness). Provocation tests are not indicated since re-exposure is likely to elicit a new episode of increased severity.
- 5)Supportive care includes intravenous fluids, environmental control, sepsis monitoring, oral antibiotics, wound dressing, dietary support, emollients and physiotherapy, monitoring for eye complications, vaginal complications, and skin-directed medical therapies including topical antibiotics, topical steroids and debridement. Sepsis monitoring, but not prophylactic antibodies, is part of this care.