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.
Specialty: Dermatology, Pharmacology, clinical
ICD-10: ,