LAUSR

The prevalence of acute vulvovaginal involvement in toxic epidermal necrolysis may be as high as 70%; up to 28% of females will also develop chronic vulvovaginal sequelae. There is little consensus regarding prevention and treatment of the gynecological sequelae of both Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). We review acute and chronic sequelae including erosions, scar formation, chronic skin changes, urethral complications, adenosis and malignant transformation, vulvodynia and dyspareunia. We provide comprehensive recommendations on acute and long-term vulvovaginal care in adult and pediatric SJS/TEN patients. Acutely, vulvovaginal treatment should include ultrapotent topical steroid, followed by a non-irritating barrier cream applied to vulvar and perineal lesions. A steroid should be used intravaginally along with vaginal dilation in all adults with vaginal involvement, but should be avoided in pre-pubertal adolescents. Menstrual suppression should be considered in all reproductive age patients until vulvovaginal lesions have healed. Finally, referrals to pelvic floor physical therapy and surgical subspecialties should be offered on a case-by-case basis. This guide summarizes the current available literature, combined with expert opinion of both dermatologists and gynecologists who treat a high volume of SJS/TEN patients.