Stevens-Johnson Syndrome(SJS) and Toxic Epidermal Necrolysis(TEN) are dermatological emergencies associated with significant mortality. We aim to review the demographic features in SJS, TEN or SJS/TEN overlap amongst a cohort of patients from a large quaternary burns centre. A retrospective cohort study was performed at Alfred Health in Melbourne, Australia of patients diagnosed with SJS, TEN or SJS/TEN overlap from 01/07/2013 to 30/06/2021. 83 patients were identified (15 SJS, 26 SJS/TEN overlap, 42 TEN). 47 patients were female(56.6%). Mean age was 52.1 years (SJS 45.0 years, SJS/TEN 61.0 years, TEN 53.5 years). Majority of patients were Caucasian(51, 61.4%) or Asian (26, 31.3%). Inpatient mortality was 15.7% (13/83). Patients who presented with or developed SJS, TEN or SJS/TEN overlap whilst at the Alfred Health had lower mortality than those who initially presented or developed this at another hospital (5.56% Alfred vs 18.46% other, OR 0.2598,p=0.28). Surprisingly, patients from non-metropolitan areas transferred to the Alfred Hospital had a lower mortality rate than their metropolitan counterparts (10.5% vs 17.2%, OR 1.7642, p=0.4875) despite similar disease severity (mean SCORTEN 2.63 and 2.58 respectively). Those who developed SJS, TEN or SJS/TEN overlap during inpatient admission for another illness had significantly higher mortality rate (26.7%, 8/30) than those presenting with this as their primary complaint (9.4%, 5/53) (OR 3.491,p=0.0579). The data from this cohort demonstrates the characteristics of patients who developed SJS, TEN and SJS/TEN overlap in the Australian population.

We report a case of a 75-year-old male with indolent chronic lymphocytic leukaemia (CLL) for 8 years, who presented with a 6-month history of a painful, zosteriform eruption in a T3-4 distribution that evolved into an unusual crop of papular nodules. Upon biopsy and immunostaining of these lesions CLL was proven consistent with leukaemia cutis related to varicella-zoster virus reactivation. In the absence of other treatment indices, he was commenced on chlorambucil with successful resolution of both his pain and the lesions.

A 48-year-old man presented with a maculopapular truncal rash 9 days following intravenous amphetamine use. He subsequently developed widespread bullae over his trunk and upper limbs. Treatment was initially commenced with intravenous hydrocortisone. A diagnosis of toxic epidermal necrolysis was made and the treatment was changed to intravenous immunoglobulin at a lower dose than requested. At the height of the reaction, there was 90% body surface area involvement with tri-mucosal involvement. His response to the intravenous immunoglobulin was poor and was complicated by infection with methicillin-resistant Staphylococcus aureus, Candida albicans and Pseudomonas aeruginosa. Gradual re-epithelialization took place over the next 6 weeks.