Their reduced rate of metabolism may cause them to accumulate reactive metabolites. These metabolic by-products may act as haptens, adhering to proteins on epidermal cells and inducing an immunologic response. This leads into the second possible mechanism of the reaction, which is a cell-mediated cytotoxic reaction directed toward the epidermis. It has been proposed that the immunologic reaction is directed toward epidermal cells that have drug particles bound to them. As might be expected, elderly patients and those with more extensive lesions have a higher mortality rate.
Sepsis is the most common cause of death, followed by pulmonary complications.
5 Patients who survive the reaction typically heal in three to four weeks. The most important aspect of patient management is to immediately withdraw the offending drug . It has been suggested that the environmental temperature should be raised to decrease the patient's caloric losses. Many sources also suggest that these should receive anticoagulants due to the risk of thromboembolism during recovery. Clinicians should use aseptic techniques when applying topical products to the skin to avoid infection.