Question 1

At what point during the SJS/TEN course should ALDEN be applied?

Accepted Answer

As early as possible after diagnosis, ideally during the index hospitalisation. Early culprit drug withdrawal reduces mortality.

Question 2

Can ALDEN identify drugs causing SJS/TEN after months of use?

Accepted Answer

Yes — points are assigned for drug intake beyond 28 days, though likelihood is lower. Delayed hypersensitivity is possible, especially if the drug formulation changed.

Question 3

How should I score over-the-counter or brief-exposure drugs?

Accepted Answer

Include all drugs in the 4-week window, including OTC medications, herbal remedies, and short-course antibiotics. Score them using the same timeline rules.

Question 4

What if multiple drugs have similar ALDEN scores?

Accepted Answer

All drugs with probable/very probable scores should be permanently avoided. Cross-reactivity between related classes (e.g., aromatic anticonvulsants) should be assumed.