Which clinical sequence is most characteristic of the onset of Stevens-Johnson syndrome and toxic epidermal necrolysis?

• A Mucosal erosions appear first, followed weeks later by skin lesions
• B Fever and influenza-like symptoms precede the mucocutaneous eruption by 1 to 3 days ✓
• C Pruritic urticarial wheals precede blistering by several days
• D Skin detachment occurs abruptly without any preceding constitutional symptoms

Explanation

SJS and TEN typically begin with a prodrome of fever, sore throat, malaise, and upper respiratory tract symptoms lasting one to three days before mucosal and cutaneous lesions appear. This prodrome often leads to misdiagnosis as an ordinary viral illness and continued use of the culprit drug. Option C describes urticaria, which is characteristically itchy rather than painful, whereas the prodromal stage of SJS/TEN lacks pruritus entirely.

Reference: Fitzpatrick's Dermatology, 9th ed.

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