Stevens Johnson Syndrome

What is Stevens-Johnson Syndrome?

This is a very serious, rare condition where the mucous membranes as well as the skin respond severely to infection or drugs. This syndrome starts with symptoms that are flu-like, and then followed by a red or purplish painful rash that will spread and blisters, ultimately making the top layer of skin die and shed.

This syndrome causes a medical emergency that normally needs hospitalization. Treatment centers on removing the underlying cause, symptom control and reducing complications.

Healing from this syndrome may take weeks to even months and is dependent on how severe the condition is. If the physician decides that a case of this syndrome was triggered by medication, the individual will need to perpetually avoid this drug and others that are related to it.

Stevens Johnson Syndrome Symptoms

Symptoms and signs of this syndrome consist of:

• Swelling of the tongue
• Swelling of the face
• Skin pain
• Hives
• A purple or red skin rash which spreads within only hours to days
• Blisters on the skin and mucous membranes, specifically in the mouth, eye, and nose
• Shedding of the skin

If an individual has this syndrome, prior to the rash developing there can be several days when the individual can experience:

• Sore throat
• Fever
• Burning of the eyes
• Cough

This syndrome needs immediate treatment medically. Emergency are needs to be sought immediately if an individual has any of the following symptoms or signs:

• Widespread pain of the skin that is unexplained
• Swelling of the face
• Blisters on mucous membranes as well as the skin
• Swelling of the tongue
• Hives
• A purple or red rash on the skin that spreads
• Skin shedding

Stevens Johnson Syndrome Causes

Exactly what causes this syndrome cannot be known in every case. Normally, this problem is a reaction allergically to drugs, illness or infection.

Medications are normally the most often cause of this syndrome. Medications normally linked with this syndrome include:

• Medications for gout for instance allopurinol
• Non-steroidal anti-inflammatory pain medications – NSAIDs
• Penicillins used to treat infections
• Anticonvulsants used to treat seizures

Infections that may cause this syndrome include:

• Herpes simplex or herpes zoster
• HIV
• Influenza
• Diphtheria
• Typhoid
• Hepatitis

In certain cases, this syndrome can be caused by some physical stimuli for instance ultraviolet light or radiation therapy

Stevens Johnson Syndrome Complications

Complications that are possible with this syndrome can include:

Skin infections that are secondary – cellulitis

This acute infection may lead to complications that are life-threatening, such as meningitis – which is an infection of the fluid and membranes surrounding the spinal cord and brain – and sepsis.

Sepsis

This happens when bacteria from an infection that is huge enter the blood system and spreads thru out the body. Sepsis progresses rapidly and can cause organ failure and shock.

Eye problems

The rash that is linked to Stevens-Johnson syndrome can lead to inflammation of the eyes. Mild cases may cause dry and irritation of the eyes but in severe cases, it may lead to damage of the tissue and scarring inside the eyes that may end in blindness.

Internal organ damage

This syndrome may cause lesions on internal organs and can result in inflammation of the lungs, heart, kidney as well as liver.

Permanent damage to the skin

As the skin grows back following this syndrome, there may be abnormal coloring and bumps. Scars can remain on the skin. Skin problems which are lasting can cause hair to fallout and toenails and fingernails may not be able to grow normally.

Stevens Johnson Syndrome Treatment

This syndrome needs hospitalization, most frequently in intensive care or a burn unit.

The first step and most significant in treating this syndrome is stopping any drugs that could be causing the problem. Since it is difficult to decide which medication can be triggering the difficulty, the physician will probably recommend stopping all medications that are non-essential.

There is no recommended treatment that is standard with this syndrome. The supportive care an individual will receive in the hospital include:

Replacement of fluid and nutrition

Any skin loss causes significant fluid loss from the body so replacing fluids is a vital amount of treatment. The individual may get nutrients and fluids thru a tube which is placed thru the nose and into the stomach – known as nasogastric tube.

Care of wounds

Wet, cool compresses help soothe the blisters as they heal. The healthcare team will lightly remove skin that is dead and then replace the area with a dressing having topical anesthetic, if needed.

Care of eyes

Since there is a risk of damage to the eye, treatment will include consulting with a specialist in eye problems or ophthalmologist.

Drugs used commonly in the management of this syndrome include:

• Medication for pain to relief or lessen discomfort
• Antibiotics to manage any infections
• Antihistamines to reduce any itching
• Steroids that are topical to control skin inflammation

Additionally, the individual may be given one of the below drugs that are being studied for the management of Stevens-Johnson syndrome:

Corticosteroids Intravenously

With adults, these medications can lessen how severe the symptoms are as well as shortening the recovery time especially when begun in a day or so after symptoms first develop. For children, these could increase any threat of problems.

Intravenous Immunoglobulin or IVIG

This drug will contain antibodies that can help the immune system stop the course of this syndrome.

When big parts of the body are involved, skin grafting –taking skin from one region of the body and attaching it to another area or using substitute synthetic skin – might be needed to aid in healing. This type management is only needed in rare cases.

When the underlying reason for the syndrome is removed and the reaction to the skin stops, the skin can start to produce again within a few days. When cases are severe, total recovery can take a number of months.

Is it Contagious?

Many ask if Steven-Johnson syndrome is contagious. And the answer is a simple no. None of the symptoms of this disorder are contagious to another person.

Stevens Johnson Syndrome Pictures