Which drug is contraindicated in SJS/TEN due to safety concerns?

• A. Thalidomide
• B. Systemic steroids
• C. IVIG
• D. Cyclosporine

Answer: (A)

In SJS/TEN, a drug with major safety concerns is contraindicated because adding it can worsen outcomes or cause irreversible harm. Thalidomide is highly teratogenic, capable of causing severe birth defects and fetal death, which alone makes it inappropriate to use in patients who could become pregnant or in settings where pregnancy cannot be ruled out. Beyond teratogenicity, thalidomide carries risks such as neuropathy, thromboembolism, and immune system effects that can complicate healing and increase infection risk in already severely damaged skin and mucous membranes. For this reason, thalidomide is avoided in SJS/TEN. Other treatments like systemic steroids, IVIG, or cyclosporine have been used in various protocols, but their use is based on clinical context and evidence, not a blanket contraindication, whereas thalidomide’s safety profile makes it unsuitable in this scenario.