Stevens Johnson syndrome (SJS) - Stevens Johnson syndrome picture and symptoms

Stevens-Johnson syndrome and toxic epidermal necrolysis are two forms of the same life-threatening skin disease that cause rash, skin peeling, and sores on the mucous membranes.

Incidence of Stevens Johnson syndrome

Based on case registries and observational studies, the incidence of TEN is estimated to be 1-1.4 cases per million inhabitants per year. The incidence of SJS is probably of the same order (1-3 cases per million inhabitants per year).

Cause of Stevens Johnson syndrome

Nearly all cases are caused by a reaction to a drug, most often sulfa antibiotics; barbiturates; anticonvulsants, such as phenytoin
and carbamazepine; certain nonsteroidal anti-inflammatory drugs (NSAIDs); or allopurinol . A very few cases are caused by a bacterial infection.

Symptoms of Stevens Johnson syndrome (SJS)

Some of the symptoms of Stevens Johnson syndrome (SJS) are as follows:

• Multiple skin lesions
• Itching of the skin may be present
• Fever
• General ill feeling
• Joint aches

Mortin and Stevens Johnson syndrome

Motrin is a painkiller that is available in both adult and children's formulas. It comes in a range of forms, depending on whether you opt for adult. The manufacturers of Motrin and children's Motrin, a subsidiary of Johnson & Johnson, are currently battling litigation for serious health damage caused to a young girl that has been left blind after contracting Stevens Johnson Syndrome (SJS) after being given children's Motrin for a fever.

Bextra and Stevens-Johnson Syndrome

Bextra, a drug manufactured by pharmaceutical giant Pfizer, was approved in America by the Food and Drugs Administration in November 2001.

Because the cox-1 enzyme (cox-2 inhibitors like Bextra) is responsible for protecting the lining of the stomach, many patients suffered chronic gastric problems. However, this benefit was to come at a high price, and it was not long before the potentially deadly side effects of Bextra became known. In fact, it is alleged that the FDA and Pfizer officials knew about these links even before drug was approved, and yet is was still approved and widely prescribed. The side effect was known as Stevens-Johnson Syndrome. Along with another variation of the disease, Toxic Epidermal Necrolysis, this was a deadly side effect that could result from long term use of Bextra.

Treatment of Stevens Johnson Syndrome

Treatment goals include control of the underlying causes or illnesses, treatment of the symptoms, and prevention of infection. Suspected medications should be discontinued.

Treatment of mild symptoms may include:

• Moist compresses applied to skin lesions
• Medications such as antihistamines to control itching
• Over-the-counter medications (such as acetaminophen) to reduce fever and discomfort
• Topical anesthetics (especially for mouth lesions) to ease discomfort that interferes with eating and drinking

Treatment of severe symptoms may include:

• Hospitalization and treatment in an intensive care or burn care unit for severe cases, Stevens-Johnson syndrome, and toxic epidermal necrolysis
• Systemic corticosteroids to control inflammation
• Intravenous immunoglobulins (IVIG) to stop the process
• Antibiotics to control secondary skin infections

Good hygiene and isolation from others may be required to prevent secondary infections.

Extensive skin involvement may cause the loss of large quantities of body fluids, causing shock in addition to the risk of infection. Intensive care with support of body systems may be required.

Skin grafting may be helpful in cases in which large areas of the body are affected. In cases that are caused by the herpes virus, daily antiviral medications may be prescribed to prevent recurrences of erythema multiforme.

The differential diagnosis includes other diseases that can result in cutaneous and mucous membrane lesions. Diseases such as pemphigus vulgaris, erosive lichen planus, and varicella zoster may mimic SJS. Behcet syndrome and Reiter syndrome may have ocular and genital lesions that can be confused with those seen in SJS.

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