Stevens johnson syndrome Flashcards
What is Stevens Johnson syndrome
Stevens-Johnson syndrome is a severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction.
What are the causes
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
What viral infections can cause Stevens Johnson syndrome
It can also be caused by viral infection including herpes simplex virus, Epstein Barr virus, HIV, influenza and hepatitis.
What are the prodrome symptoms
SJS usually presents within a week of taking a drug with symptoms resembling an upper respiratory tract infection (cough, cold, fever, sore throat).
What occurs after a few days
After a few days, erythematous macules appear which later become target-shaped.
What is nikolsky sign
Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when rubbed
What is the difference between SJS and TEN
In SJS <10% of the body surface is affected whereas TEN is defined as >30% of skin involvement.
What is affected
There is mucosal ulceration affecting at least 2 of conjunctiva, mouth, urethra, pharynx or gastrointestinal tract. SJS has a 10% mortality rate (TEN has a 30% mortality rate) due to dehydration, infection or disseminated intra-vascular coagulation.
How is diagnosis confirmed
Clinical and biopsy
What is the management
The management is supportive with skin and eye care. An ophthalmology referral is important to prevent ocular complications.
What treatment is given
ITU/Burns unit care; Withdraw all drugs where
possible; Occlusive dressings; Treatment is
controversial, with IVIg, Steroids and/or Immunosuppression
What is TEN
Toxic epidermal necrolysis (TEN) is a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction
Drugs that induce TEN
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
TEN supportive treatment
stop precipitating factor
supportive care
often in an intensive care unit
volume loss and electrolyte derangement are potential complications
