Society of Dermatology Hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.

Painful lumps in the axilla.

The location of these lesions and the odorous fluid that drained from them pointed to the diagnosis. The acne on the patient's back was another clue.

Investigational drugs in phase II clinical trials for moderate to severe plaque psoriasis - potential new treatments on the horizon.

INTRODUCTION: Psoriasis is a common immune disorder for which there are many FDA-approved therapies. Older oral drugs had limited efficacy and considerable side effects. Biologics have been a major advance but require self-administered injections, and many patients prefer oral options. Because many patients fear needles, oral drugs are a welcome option. This review provides an update on oral drugs in Phase II development for psoriasis. AREAS COVERED: A literature review was performed to identify these drugs by using search terms such as 'psoriasis', 'agents', 'drugs', and 'phase 2 development'. Baricitinib and KDO 25 are the oral drugs that appear to hold the most promise due to the balance they maintain between efficacy and adverse effects. If a RORγt inhibitor can be identified that has no hepatotoxicity, then that may be the most promising new oral treatment. EXPERT OPINION: Several new oral psoriasis medications are currently being investigated. One major challenge remains medication cost and insurance coverage. Phase III studies are needed to determine efficacy and safety in large cohorts of psoriasis patients. An increase in the number of approved oral medications for psoriasis would mean more choice for psoriasis patients.