Stevens-Johnson syndrome is a rare, severe disorder of the skin and mucous membranes that can be caused by infection or the body’s response to certain medications. It initially presents with flu-like symptoms, followed by a painful, red rash that gradually spreads and eventually blistering.
Symptoms of Stevens-Johnson Syndrome
In the early stages, patients may have fever and chills, along with coughing, sore throat, headache, body aches, eye irritation, or fatigue. Then, within 2-3 days or no more than 2 weeks, skin abnormalities begin to appear. Observe as follows:
- Feeling pain in the body for no apparent reason
- A red rash appears with a dark center and lighter surrounding areas. The rash then spreads and increases in number.
- Blisters develop on the skin and mucous membranes around the lips, mouth, nose, eyes, and genitals.
- The outer layer of skin peels off, revealing the inner skin that looks like sunburn.
Causes of Stevens-Johnson Syndrome
Doctors currently do not know the exact cause of Stevens Johnson Syndrome, but they believe that infections and certain medications may be triggers.
Drug use: Patients may experience abnormal symptoms immediately after taking the drug or for 2 weeks after stopping the drug. Types of drugs that may cause Stevens Johnson Syndrome include:
- Anti-infective drugs such as penicillin,cotrimoxazole
- Pain relievers such as paracetamol , ibuprofen, naproxen
- Anticonvulsants or psychiatric medications such as phenobarbital, phenytoin, sertraline, carbamazepine, and may be at increased risk if undergoing radiation therapy.
- Drugs for treating gout, such as allopurinol, etc.
Infections such as hepatitis A, pneumonia, herpes , shingles , or HIV (human immunodeficiency virus). People with HIV are 100 times more likely to develop Stevens Johnson Syndrome than the general population.
In addition to the above causes, there are some factors that may increase the risk of developing Stevens Johnson Syndrome, including:
- Immune system dysfunction can be caused by organ transplants, chemotherapy, HIV infection, or autoimmune diseases.
- Genetics: People who have a family history of Stevens Johnson Syndrome or Toxic Epidermal Necrolysis, a skin condition that has similar symptoms but is less severe.
- People with a history of Stevens Johnson Syndrome who have previously suffered from this disease due to medication use may experience recurrence of the disease if they need to take similar medications.
- The HLA-B 1502 gene is commonly found in Chinese, Southeast Asian, and Indian people. People with this gene may be at increased risk if they take anticonvulsants, psychiatric medications, or gout medications.
Stevens-Johnson syndrome diagnosis
Stevens Johnson Syndrome is diagnosed by a dermatologist, starting with a review of symptoms, a physical examination, and a medical history, including medication history. Additional laboratory tests, such as blood tests and biopsy, may be required to confirm the diagnosis.
Treatment of Stevens-Johnson syndrome
Stevens Johnson Syndrome is a severe skin and mucous membrane disorder. Patients must be hospitalized or treated in an emergency room. If the diagnosis is made that the illness is a response to a drug, the doctor will advise the patient to stop taking the suspected drug and related drugs immediately. Or may stop taking all drugs that are not essential to the patient. After that, supportive treatment will be given to relieve symptoms. Several methods may be used together as follows:
- Apply a cold compress to help remove dead skin, then wrap a sterile bandage around the affected area.
- Give fluids and nutrients through the nose, abdomen, or veins because skin loss causes the body to lose more water and nutrients than normal.
- Use moisturizing products or moisturizers regularly.
- Use a mouthwash that contains anesthetics or antibiotics to help make swallowing easier.
- For patients with abnormal symptoms around the eyes, the doctor may recommend using eye drops or eye ointments.
- Use strong painkillers to relieve body pain.
- Give antibiotics if the patient has symptoms of septicemia.
- Corticosteroids are given to control skin inflammation.
After receiving the above treatment, the patient’s body will gradually create new skin to replace the abnormal skin. The treatment period depends on the severity of the symptoms. In some cases, it may take several weeks or months.
Complications of Stevens-Johnson Syndrome
In addition to Stevens Johnson Syndrome causing abnormalities in the skin and mucous membranes throughout the body, it may also result in other complications, as follows:
- Cellulitis is a condition that can lead to serious complications, such as septicemia.
- Sepsis occurs when the bacteria that cause the infection enter the bloodstream and spread to different parts of the body, which can lead to shock and internal organ failure.
- Permanent skin damage. New skin growth may be different in color, develop bumps, scar, and in the long term, may cause hair loss and abnormal fingernail and toenail growth.
- Inflammation of internal organs, such as pneumonia, myocarditis, nephritis, esophagitis, and esophageal stenosis may follow.
- Conjunctivitis: Patients with mild symptoms may experience eye irritation or dryness, but in cases where the eye tissue is severely damaged, vision can be affected and blindness can occur.
- Problems with the reproductive organs , such as scar tissue-induced vaginal stenosis, scar tissue formation in the penis, etc.
- Lung dysfunction can lead to acute respiratory failure.
Stevens-Johnson Syndrome Prevention
Stevens Johnson Syndrome is quite difficult to prevent because each person responds differently to each type of medication. For those at risk who may have the HLA-B 1502 gene, doctors may recommend testing for the gene before taking certain medications that may trigger the disease, such as carbamazepine and allopurinol. Those who have previously suffered from the disease should stop taking medications that trigger abnormal symptoms and consult a doctor before taking other medications, including always wearing an allergy bracelet. In addition, genetics is another risk factor for Stevens Johnson Syndrome. Therefore, family members of patients should also avoid taking medications that cause abnormal symptoms.
