Stevens Johnson syndrome is a serious condition that affects the skin and external linings (mucus membranes) of the body, but fortunately, it is a rare condition. It is usually associated with an abnormal response to some medicine you have been taking, such as antibiotics, pain killers and anticonvulsants. Furthermore, infection, vaccinations or other diseases may also lead to Stevens Johnson syndrome.
Symptoms of Stevens Johnson Syndrome (SJS)
Before any skin symptoms show up, you are more likely to experience fever or chills for up to two weeks. You may feel eyes burning, cough a lot, have sore throat and feel usual tiredness.
Then when symptom shows up later, you may spot the following symptoms of Stevens-Johnson syndrome:
- Swelling of the face
- Swelling of the tongue
- Hives
- Pain on the skin
- Skin rash that looks red or purple and spreads within hours or days
- Skin blisters, including mucous membranes of the mouth, eyes, nose, and genitals
- Skin shedding
When to see a doctor
Go to emergency room in your local hospital and seek immediate medical cares and attention if you are having any of the following symptoms:
- Widespread skin pain with unclear reasons
- Swelling face or tongue
- Spreading red or purplish skin rash
- Blisters on your skin or mucous membranes
- Shedding skin
Causes of Stevens Johnson Syndrome (SJS)
Stevens Johnson syndrome is unpredictable and its exact cause may be difficult to identify. However, the condition is usually triggered by some medication or an ongoing infection.
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Stevens Johnson Syndrome caused by Medications |
Stevens Johnson Syndrome caused by Infections |
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Allopurinoland other anti-gout medications Pain relievers Antibiotics, such as penicillin Medications used to treat mental illness, such as Antipsychotics Radiation therapy |
Herpes simplex / herpes zoster HIV Pneumonia Hepatitis |
Note: Medications that are most likely to cause SJS in kids include Tylenol, sulfa antibiotics, and carbamazepine (Tegretol,Carbatrol), which is used to treat seizures.
Treatments of Stevens Johnson Syndrome (SJS)
Management of Stevens Johnson syndrome is usually done in intensive care units (ICUs) or specialized burn centers. There are no specific treatments for Stevens Johnson syndrome, so patients are usually given symptomatic treatment only. These treatments do not differ from those given to patients suffering from extensive burns.
1. Infection Control
Stevens Johnson syndrome increases your risk of infection. Therefore, reverse-isolation and sterile nursing techniques must be practiced to reduce your risk of acquiring infection.
To treat Stevens Johnson syndrome, you must avoid using silver sulfadiazine, which is often used in burn units. Use 0.05% chlorhexidine or 0.5% silver nitrate, another antiseptic to paint the affected skin. The use of antibiotics to prevent infection is not recommended, but they may be used in case you develop urinary tract or skin infections, which can lead to complications.
2. Supportive Care
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Supportive Care |
Description |
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Skin Care |
Debridement or removal of dead skin is necessary, followed by application of biologic dressings, which include covering the affected eye with amniotic membrane and covering the affected skin that has not peeled off with biologic dressings. In some cases, skin transplantation could be done to reduce pain, minimize fluid loss, improve heat control and prevent infection. |
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Fluid Management |
During the first day of treatment, fluid infusion with saline solutions and macromolecules will be provided during the first 24 hours of your hospitalization. About 2 days later, oral fluid intake will be provided through a nasogastric tube until intravenous fluids can be progressively reduced and discontinued. |
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Parenteral Nutrition |
Massive intravenous nutrition to replace protein loss and promote healing. |
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Pulmonary Care |
Includes use of aerosols, performing bronchial aspiration, and physical therapy. |
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Eye Care |
To treat acute ocular eye problems, your doctor will begin with aggressive lubrication on the eye surface, meanwhile antibiotics and topical steroids are used to prevent scarring. Tarsorrhaphy, a surgical procedure in which the eyelids are partially sewn together to narrow the opening, may be required. Furthermore, visual rehabilitation may be done in patients with visual impairment. |
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Body Temperature |
Environmental temperature in your room will be maintained at 30-32°C to reduce heat loss through skin. Fluidized air beds will also be used if a large area of the skin on your backside is affected. Also, you can require heat shields or infrared lamps to reduce heat loss. |
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Anticoagulation |
Heparin will be used to prevent blood clotting. You may also be prescribed with antacids to prevent gastric bleeding. |
3. Medications
The goals of treatment for Stevens Johnson syndrome include preventing symptoms from getting worse. You need to stay in the hospital for treatment. Your doctor will ask you to stop taking the medicine you were taking which may have caused your condition. However, you may need to take any of these medications:
- Antacids, to treat sores that cause bleeding in your stomach.
- Antibiotics, to help treat blood infection (intravenous) or prevent skin infection (topical).
- Blood thinners, to help stop formation of clots while you are not able to get out of your bed.
- Pain medicines, to help reduce or eliminate your pain.
- Eye drops, to help heal eye sores and prevent infection.
- Immune globulins, to help support your immune system or to treat or prevent infection.
- Pressors, to improve your blood pressure to protect your brain, heart, lungs, kidneys, and other vital organs.