Symptoms & Treatment of Stevens Johnson Syndrome (SJS)
Stevens-Johnson Syndrome (SJS) is a severe medical condition affecting the skin and mucous membranes. Causes of SJS often develop by an allergic reaction to drugs that can include brand names like Bextra (Bextra and SJS), Daypro (Daypro and SJS), Motrin (Motrin and SJS), Ibuprofen (Ibuprofen and SJS) and Advil (Advil and SJS). The disease can also be caused as a result of contraction of an illness or infection of some kind, and in some cases, it can result from unknown causes.
An immune-complex-mediated hypersensitivity (allergic) condition, SJS sufferers experience inflammation of the skin and mucous membranes. Stevens Johnson Syndrome typically affects people over the age of 40, though cases have been reported involving sufferers as young as three months old. Men are more likely to contract SJS than women at a ratio of two to one. A potentially life-threatening condition, SJS yields a fatal result in approximately 3% to 15% of all victims.
Stevens-Johnson Syndrome is one of three conditions of a similar nature, having varying severity. Erythema multiforme is a lesser form of the condition (SJS is occasionally referred to as erythema multiforme major), while toxic epidermal necrolysis (TEN) is a more serious form of the condition.
Erythema multiforme: A type of skin condition that can be characterized by the development of symmetrically raised red skin areas without displaying whole-body symptoms, erythema multiforme is associated with a number of infections, drug sensitivities, allergies and pregnancy. This condition occurs frequently in children and young adults.
Toxic epidermal necrolysis: A type of life-threatening skin condition that can be characterized by the blistering and peeling of the top layer of skin. Associated with immune complex hypersensitivity, TEN is the most serious of the three related skin conditions.
Symptoms of Stevens Johnson Syndrome
The physical symptoms associated with SJS vary from one sufferer to the next dependent on the severity of the disease and the extent of the person's hypersensitivity. In the earliest stage of the condition, SJS symptoms can include headache, general discomfort and chronic cough with secretions of the lungs, bronchi or trachea (purulent sputum). As the condition progresses and spreads throughout the body, rashes and lesions begin to develop on the surface of the skin as well as on the mucous membranes of the lungs, digestive system, genitals, eyes and mouth.
Simple dermatological lesions (macules) that can only be seen and not felt develop into conically raised lesions (papules) that can be both seen and felt. Papule development can be accompanied by large, fluid-filled blisters (bullae) or redness of the skin (erythema). Rashes and lesion development can be localized or it can spread to other areas of the body. Advanced lesions can bulge and rupture, baring large sections of flesh (denuded skin) and leaving it susceptible to infection. Severe cases of SJS can lead to blindness resulting from corneal blistering and lesion development in the mouth and digestive system can make eating and drinking difficult to the point of impossible.
Symptoms that are associated with Stevens-Johnson Syndrome lead sufferers to a consultation with a doctor. A diagnostic examination can yield a variety of SJS related signs, including:
- Hypotension
- Fever
- Conjunctivitis
- Seizures
- Corneal ulcerations
- Nose bleeds (epistaxis)
- Increased heart rate (tachycardia)
Treating Stevens Johnson Syndrome
Treatment of SJS revolves around a prompt diagnosis of the condition. A high percentage of SJS sufferers contract the disease as a result of an allergic reaction to a drug of some kind. The first step in SJS treatment is therefore targeting the cause of the disease and isolating it. After establishing the source of the problem, intravenous fluid (macromolecules and saline solutions) replacement is used to help offer preliminary relief for the lesions/blisters of the skin and mucous membranes. Sufferers must then be admitted to an intensive care center where their risk of infection is greatly reduced.
Specific care depends on the exact nature of a case of SJS, in addition to the degree to which it has spread throughout the body. The use of topical antiseptics to dress denuded skin is an essentially component in staving off infection. Corticosteroids are occasional used to reduce tissue inflammation, though their use is viewed as a somewhat controversial subject as they can lead to a number of additional problems such as increased risk of developing infection (corticosteroids suppress immune system response to prevent inflammation).
Currently, there is no effective treatment modality for stopping the spread of Stevens-Johnson Syndrome.