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Greg Jones
Greg Jones
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SJS, TENS and EM

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As with all illnesses, skin diseases can often be hard to diagnose. This article will help distinguish between three often confused disorders: Erythyma Multiforme (EM), Stevens Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN).

Erythyma multiforme often occurs as a result of an allergic reaction or infection. It’s fairly common, and mostly affects people between 20 and 40 years of age. EM appears as a rash. The rash looks like several pink/red blotches, each one symmetrical is shape, usually on extremities such as hands. The individual blotches consist of a white center surround by a red ring. Irritation will cause the rash to spread. Fortunately, the rash is ‘self limiting,’ which means that it will eventually disappear by itself.

The most serious form of EM is possibly related to and often confused with Stevens Johnson Syndrome. SJS is also a reaction to medication or infection, but its consequences are generally more serious than those of EM. SJS first manifests itself with flu-like symptoms, such as fatigue, sore throat, and fever. A painful purple/red rash follows, causing the top layer of the patient’s skin to blister and then fall off. Anyone suffering from SJS should be immediately taken to the hospital, where they will be taken off of all previous medications and receive similar treatment to burn victims. The best method of physical therapy and treatment is still under contention.

Most dangerous of the three disorders is Toxic Epidermal Necrolysis. As with the other two, TEN often stems from adverse drug reactions. After 1-2 weeks of fever, the patient will develop a warm, red rash over large swaths of their body. The most strongly affected areas are the mouth, which can develop blisters that make it difficult to eat, the eyes, which can become swollen, crusted, and blind, and the vagina. Eventually the patient’s skin will fall off in large pieces. Diagnosis is often difficult, and treatment, which includes several different levels of intensity based on the progression of the disorder, is far from foolproof; TEN has a mortality rate of 30-40%.

Before you get too concerned, remember that all three of these disorders are rare – TEN affects approximately only 1 out of every million cases per year. Just keep an eye out, and if you develop any of the symptoms be sure to contact your doctor right away.