Classification of Bastuji-Garin et al for Toxic Epidermal Necrolysis (TEN), Stevens-Johnson Syndrome (SJS) and Erythema Multiforme (EM)

Description

Bastuji-Garin developed a consensus classification for classifying the acute bullous disorders of toxic epidermal necrolysis (TEN), Stevens-Johnson Syndrome (SJS), and erythema multiforme (EM). This is intended to help reduce the confusion related to the use of these terms. The authors are from multiple university hospitals in Europe and North America.

NOTE: The authors developed an illustrated atlas to help standardize the diagnosis of these conditions.

Diagnostic terms:

(1) bullous erythema multiforme

(2) Stevens-Johnson Syndrome

(3) Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

(4) toxic epidermal necrolysis with spots

(5) toxic epidermal necrolysis without spots

Parameters:

(1) percent of body surface area with bullous detachment

(2) other skin lesions

Percent BSA with Skin Detachment	Skin Lesions	Diagnosis
< 10%	localized typical target lesions or raised atypical target lesions	bullous erythema multiforme
< 10%	widespread erythematous or purpuric macules or flat atypical target lesions	Stevens-Johnson Syndrome
10 - 30%	widespread purpuric macules or flat atypical target lesions	mixed Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis
> 30%	widespread purpuric macules or flat atypical target lesions	Toxic Epidermal Necrolysis with spots
> 10%	large epidermal sheets but without purpuric macules or target lesions	Toxic Epidermal Necrolysis without spots

Skin Lesion	Shape	Zones and Border	Palpability
typical target lesion	regular, round and < 3 cm in diameter	>= 3 zones with well-defined border	palpable
raised atypical target lesion	round and edematous	2 zones and/or poorly defined border	palpable
flat atypical target lesion	round	2 zones and/or poorly defined border	nonpalpable unless blister present
macule with or without blister	erythematous or purpuric macules	irregular shape and size, often confluent	nonpalpable unless blister present

where:

• The 3 zones in a typical target lesion has a central zone surrounded by 2 concentric rings.

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Description

Specialty

ICD-10