Comment on: Proposal for a new diagnostic classification of photodistributed Stevens–Johnson syndrome and toxic epidermal necrolysis, European Journal of Medical Research

Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap (SJS/TEN), collectively referred to SJS/TEN, form a spectrum of severe life-threatening adverse drug reactions whose pathomechanism is not fully understood. The article "Photodistributed Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Proposal for a New Diagnostic Classification" by McKinley et. al., discusses a distinct distribution of epidermal necrosis in SJS/TEN, attributable to preceding exposure to ultraviolet radiation (UVR), and relative sparing of photo-protected areas. After reviewing numerous cases within the Immune-mediated Adverse drug Reactions in African HIV endemic setting Register and Biorepository (IMARI-SA) at the University of Cape Town with a similar clinical pattern as those published by McKinley et. al., we propose that the relative sparing of some areas giving an impression of photo-distribution is due to localised increase in skin pressure that reduces the blood supply in that area below a critical threshold. A dip in blood supply below this critical threshold quantitively limited T lymphocytes and cytokines that drive SJS/TEN to reach and damage the skin.

Comment on: Proposal for a new diagnostic classification of

Frontiers Stevens-Johnson syndrome and toxic epidermal

Study Selection Process to Identify Cases of Photodistributed

Analysis of the efficacy of a single subumbilical stoma for

PDF) Severe Delayed Cutaneous and Systemic Reactions to Drugs: A Global Perspective on the Science and Art of Current Practice

Guidelines for the management of Stevens–Johnson syndrome/toxic

Stevens-Johnson syndrome/toxic epidermal necrolysis in patients

Management of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis

A bioinformatic approach to identify pathogenic variants for

Guidelines for the management of Stevens–Johnson syndrome/toxic

Figure 2 from Stevens-Johnson syndrome induced by doxycycline

Recent advances in managing and understanding Stevens-Johnson

Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis

McKees Pathology of The Skin, PDF, Cutaneous Conditions

Frontiers Stevens-Johnson syndrome and toxic epidermal