Otherwise, routine plain films are not indicated. Skin biopsy demonstrates that the bullae are subepidermal. Epidermal cell necrosis may be noted. Perivascular areas are infiltrated with lymphocytes. Paramedics should recognize the presence of severe fluid loss and should treat SJS patients as they would victims of thermal burns.
Most cases present early and prior to obvious signs of hemodynamic compromise.
Perhaps the single most important role for the ED physician is to detect SJS early and initiate the appropriate ED and inpatient management. Care in the ED must be directed to fluid replacement and electrolyte correction. Skin lesions are treated as burns. Treatment of SJS is primarily supportive and symptomatic. Oral lesions should be managed with mouthwashes.