Advances in the management of Stevens–Johnson syndrome and toxic epidermal necrolysis: intensive support and immunomodulatory therapies

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions, predominantly drug-induced, associated with high morbidity and mortality and significant systemic involvement. This study aimed to critically analyze advances in the management of these conditions, with emphasis on intensive supportive care and immunomodulatory therapies. This is a critical narrative review of the literature with a systematized search conducted in PubMed/MEDLINE, Scopus, and Web of Science, including studies published between 2016 and 2025. After applying the eligibility criteria, 13 studies were included addressing therapeutic strategies and clinical management of SJS/TEN. The findings indicate that early and specialized intensive supportive care remains the main determinant of favorable outcomes, including control of systemic complications and reduction of mortality. In contrast, immunomodulatory therapies, such as corticosteroids, intravenous immunoglobulin, cyclosporine, and TNF-α inhibitors, show inconsistent and context-dependent results, without clear superiority over supportive care alone. The critical appraisal of the studies reveals a predominance of low- to moderate-quality evidence, with methodological limitations that hinder therapeutic standardization. Despite advances in the understanding of immunopathogenesis, intensive supportive care remains the cornerstone of treatment, while the role of immunomodulatory therapies still depends on more robust evidence to establish their effectiveness.