Stevens-Johnson syndrome

1. Stevens-Johnson syndrome
By,
Ms. Ekta S Patel,
Assistant Professor.

3. Introduction:
▪ Stevens-Johnson syndrome is a rare, serious
disorder of your skin and mucous membranes.
▪ It's usually a reaction to a medication or an
infection.

4. ▪ Often, it begins with flu-like symptoms,
followed by a painful red or purplish rash
that spreads and blisters.
▪ Then the top layer of the affected skin dies,
sheds and then heals.

5. ▪ Stevens-Johnson syndrome is a medical
emergency that usually requires
hospitalization.
▪ Treatment focuses on eliminating the
underlying cause, controlling symptoms and
minimizing complications as skin regrows.

6. ▪ Recovery after Stevens-Johnson syndrome
can take weeks to months, depending on
the severity of condition.
▪ If it was caused by a medication, need to
permanently avoid that drug and others
closely related to it.

7. Definition
▪ A systemic skin disease, probably identical
to toxic epidermal necrolysis, that produces
fever and lesions of the oral, conjunctival,
and vaginal mucous membranes. It is
marked by a cutaneous rash that is often
widespread and severe. Skin loss may lead
to dehydration, infection, or death.

8. Causes:

9. Medication and
therapy causes
▪ Anti-gout medications,
such as allopurinol
▪ Medications to fight
infection, such as penicillin
▪ Pain relievers, such as
acetaminophen (Tylenol,
others), ibuprofen (Advil,
Motrin IB, others) and
naproxen sodium (Aleve)
▪ Medications to treat
seizures and mental illness
(anticonvulsants and
antipsychotics), with added
risk if also undergo radiation
therapy;

10. Infectious causes
▪ Herpes virus (herpes simplex or herpes zoster)
▪ Pneumonia (Mycoplasma pneumoniae)
▪ HIV
▪ Hepatitis A

11. signs and
symptoms
▪ Fever
▪ Unexplained widespread skin
pain
▪ A red or purple skin rash that
spreads
▪ Blisters on skin and the
mucous membranes of mouth,
nose, eyes and genitals
▪ Shedding of skin
within days after
blisters form

12. ▪ If patient has
Stevens-Johnson
syndrome, several
days before the rash
develops he may
experience:
▪ Fever
▪ Sore mouth and
throat
▪ Fatigue
▪ Cough
▪ Burning eyes

13. Diagnostic
Evaluation:
▪ Physical exam. Doctors often can identify
Stevens-Johnson syndrome based on
medical history and a physical exam.
▪ Skin biopsy. To confirm the diagnosis, and
rule out other possible causes, doctor may
remove a sample of skin for laboratory
testing (biopsy).

14. ▪ Culture. Skin or oral culture or culture from
other areas may be taken to confirm or rule
out infection.
▪ Imaging. Depending on symptoms, doctor
may have you undergo a chest X-ray to
check for pneumonia.
▪ Blood tests. These are used to confirm
infection or other possible causes.

15. Treatment
▪ Stevens-Johnson syndrome requires
hospitalization, often in an intensive care
unit or a burn unit.

16. ▪ Stopping nonessential medications
▪ The first and most important step in treating Stevens-
Johnson syndrome is to discontinue any medications
that may be causing it.

17. Supportive
care
▪ Supportive care while hospitalizion includes:
▪ Fluid replacement and nutrition. Because
skin loss can result in significant loss of fluid
from body, replacing fluids is an important part
of treatment.

18. ▪ Wound care. Cool, wet compresses will
help soothe blisters while they heal.
▪ Eye care.

19. Medications
▪ Pain medication to reduce discomfort.
▪ Medication to reduce inflammation of the eyes
and mucous membranes (topical steroids).
▪ Antibiotics to control infection, when needed.

20. ▪ Depending on the severity, other systemic
medications can be considered, including oral
steroids, immune globulin and other immune-
related treatments.

21. Complications
▪ Secondary skin infection (cellulitis). Cellulitis
can lead to life-threatening complications,
including sepsis.
▪ Blood infection (sepsis). Sepsis occurs when
bacteria from an infection enter bloodstream and
spread throughout body. Sepsis is a rapidly
progressing, life-threatening condition that can
cause shock and organ failure.

22. ▪ Lung involvement. The condition may lead to
acute respiratory failure.
▪ Permanent skin damage. When skin grows
back following Stevens-Johnson syndrome, it
may have abnormal bumps and coloring. And
may have scars. Lasting skin problems may
cause your hair to fall out, and fingernails and
toenails may not grow normally.

23. ▪ Eye problems. The rash caused by
Stevens-Johnson syndrome can lead to
inflammation in eyes. In mild cases, this
may cause irritation and dry eyes. In severe
cases, it can lead to extensive tissue
damage and scarring that results in visual
impairment and, rarely, blindness.