The Use of Systemic Immunomodulating Drugs and Management Practices in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis among Dermatologists in the Philippines: A Cross-sectional Survey Study

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are rare, life-threatening cutaneous adverse drug reactions with potential morbidity and mortality. Despite increasing use of systemic immunomodulatory therapies, consensus regarding optimal medical management remains lacking, particularly in resource-limited settings. We evaluated management practices and treatment preferences for SJS/TEN among board-certified dermatologists in the Philippines using a clinical vignette-based (CV) survey approach. METHODS: A cross-sectional online survey was conducted among Philippine board-certified dermatologists from January to June 2025. The survey assessed res-pondent characteristics, clinical experience with SJS/TEN, management practices, referral patterns, and treatment preferences across six6 standardized CVs. Ordinal data were analysed using weighted scores, Friedman tests, and Kendall's coefficient of concordance to assess inter-physician agreement.. RESULTS: There were forty-eight48 dermatologists participated. Most respondents reported prior SJS/TEN experience and inpatient clinical exposure. Corticosteroids were the most commonly used systemic therapy (85.4%), while 35.4 % reported managing selected cases with supportive care alone. Significant differences in treatment rankings were observed across all six6 vignettes (all p<0.001). Agreement was large for CV1 (W=0.516), moderate for CV2-5 (W=0.398-0.465), and small for CV6 (W=0.236). Corticosteroids and IVIG consistently ranked highest, while other immunosuppressants showed scenario-dependent variability. CONCLUSIONS: The use of systemic immunosuppressants remains to be preferred in SJS/TEN treatment. However, treatment practices among Filipino dermatologists demonstrate substantial heterogeneity especially in complex cases. These findings highlight the need for stratified treatment frameworks and persistent uncertainty in SJS/TEN management.