Drug-Induced Bullous Disorders Treatment & Management

Updated: Apr 30, 2018
  • Author: David F Butler, MD; Chief Editor: William D James, MD  more...
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Medical Care

Withdrawal of the offending medication is the most important aspect of treatment of bullous drug reactions. Most reactions are self-limited. Conservative treatment of these disorders involves using wet compresses of Burrow solution and the application of moderate- to high-potency topical corticosteroids. More severe reactions may require the use of systemic corticosteroids.

The use of corticosteroids in the treatment of SJS and TEN is controversial. Patients with SJS and TEN are usually managed as inpatients in the intensive care or burn units. Fluid hydration, electrolyte balance, and nutritional support are the cornerstones of therapy. Rigorously guard against infection. Intravenous gamma globulin (IVIG) shows promise in the treatment of TEN. The IVIG reduces apoptosis by blocking CD95 on T cells. [35] In TEN, early withdrawal of precipitating drugs may reduce mortality if the drug has a short half-life. [36]



Limited forms of EM can be managed on an outpatient basis; however, careful consideration should be given to patients with SJS and TEN regarding an early referral to an intensive care unit or preferably a burn unit. Eye involvement that can occur in EM, SJS, and TEN requires an ophthalmologic evaluation.



Avoid use of the offending drug.