Updates in the pathogenesis of SJS/TEN

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions across a spectrum of severity characterized by widespread epidermal detachment and keratinocyte apoptosis. SJS/TEN develops due to a complex immunologic response after exposure to an associated...

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Main Authors: Joy Justice, Eric Mukherjee, Michelle Martin-Pozo, Elizabeth Phillips
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:Allergology International
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Online Access:http://www.sciencedirect.com/science/article/pii/S1323893025000528
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author Joy Justice
Eric Mukherjee
Michelle Martin-Pozo
Elizabeth Phillips
author_facet Joy Justice
Eric Mukherjee
Michelle Martin-Pozo
Elizabeth Phillips
author_sort Joy Justice
collection DOAJ
description Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions across a spectrum of severity characterized by widespread epidermal detachment and keratinocyte apoptosis. SJS/TEN develops due to a complex immunologic response after exposure to an associated drug antigen and/or its metabolite, and it results in significant morbidity and mortality. Complex immune mechanisms contribute to keratinocyte death. Drug-induced SJS/TEN has been shown to be strongly HLA class I restricted which has contributed to our understanding of mechanisms and has the potential to shape prevention and diagnosis. There is currently no evidence-based treatment outside of aggressive supportive care, and understanding the complete immunopathogenesis of SJS/TEN will be key for the development of efficacious and safe treatments that significantly reduce morbidity and mortality. This article focuses on what is new in the pathogenesis of SJS/TEN, including recent research on the mechanisms of T-cell activation, apoptotic and necroptotic mediators, other related molecules, genetic associations, and possible targeted treatment options.
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spelling doaj-art-fd700ce58d0c4eb7aeb2b53da2f676e92025-08-20T03:24:16ZengElsevierAllergology International1323-89302025-07-0174336137110.1016/j.alit.2025.05.002Updates in the pathogenesis of SJS/TENJoy Justice0Eric Mukherjee1Michelle Martin-Pozo2Elizabeth Phillips3Vanderbilt University School of Medicine, Nashville, TN, USAVanderbilt University Medical Center, Department of Dermatology, Nashville, TN, USA; Vanderbilt University Medical Center, Center for Drug Safety and Immunology, Nashville, TN, USAVanderbilt University Medical Center, Center for Drug Safety and Immunology, Nashville, TN, USAVanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, Nashville, TN, USA; Corresponding author. Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, 1161 21st Ave S, Nashville, TN, 37232, USA.Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions across a spectrum of severity characterized by widespread epidermal detachment and keratinocyte apoptosis. SJS/TEN develops due to a complex immunologic response after exposure to an associated drug antigen and/or its metabolite, and it results in significant morbidity and mortality. Complex immune mechanisms contribute to keratinocyte death. Drug-induced SJS/TEN has been shown to be strongly HLA class I restricted which has contributed to our understanding of mechanisms and has the potential to shape prevention and diagnosis. There is currently no evidence-based treatment outside of aggressive supportive care, and understanding the complete immunopathogenesis of SJS/TEN will be key for the development of efficacious and safe treatments that significantly reduce morbidity and mortality. This article focuses on what is new in the pathogenesis of SJS/TEN, including recent research on the mechanisms of T-cell activation, apoptotic and necroptotic mediators, other related molecules, genetic associations, and possible targeted treatment options.http://www.sciencedirect.com/science/article/pii/S1323893025000528CytotoxicHLA antigensStevens-Johnson syndromeT-lymphocytesToxic epidermal necrolysis
spellingShingle Joy Justice
Eric Mukherjee
Michelle Martin-Pozo
Elizabeth Phillips
Updates in the pathogenesis of SJS/TEN
Allergology International
Cytotoxic
HLA antigens
Stevens-Johnson syndrome
T-lymphocytes
Toxic epidermal necrolysis
title Updates in the pathogenesis of SJS/TEN
title_full Updates in the pathogenesis of SJS/TEN
title_fullStr Updates in the pathogenesis of SJS/TEN
title_full_unstemmed Updates in the pathogenesis of SJS/TEN
title_short Updates in the pathogenesis of SJS/TEN
title_sort updates in the pathogenesis of sjs ten
topic Cytotoxic
HLA antigens
Stevens-Johnson syndrome
T-lymphocytes
Toxic epidermal necrolysis
url http://www.sciencedirect.com/science/article/pii/S1323893025000528
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