Stevens-Johnson Syndrome – Diagnosis and Treatment
Diagnosis
Doctors start by reviewing a person’s medical history, including any recent medications, infections, or underlying conditions that might trigger Stevens-Johnson syndrome (SJS).
They perform a physical exam, looking for common symptoms such as a red or purple rash, blisters, peeling skin, and mucosal involvement affecting the eyes, mouth, nose, or genitals.
Early symptoms often resemble the flu, with fever, chills, sore throat, cough, and headache before the rash and skin changes appear.
To confirm the diagnosis, doctors often perform a skin biopsyโa small sample of affected skin examined under a microscope.
This helps distinguish SJS from other similar conditions like toxic epidermal necrolysis (TEN), erythema multiforme, autoimmune blistering diseases, or infections.
Additional tests may include:
- Cultures of skin lesions or blister fluid to check for bacterial or viral infections.
- Blood tests to monitor inflammation, organ function, and electrolyte balance.
- Chest X-rays if there are respiratory symptoms, to look for pneumonia or lung involvement.
Diagnosis also involves evaluating the extent of skin detachment (percentage of body surface area affected), as this helps determine disease severity and guides treatment decisions.
A prompt and accurate diagnosis is crucial because SJS can progress quickly and may require hospitalization or care in a burn unit or intensive care setting.
Treatment
Stopping Unneeded Medicines
Health professionals act quickly to stop any unneeded drugs that could be causing the skin reaction. This step is very important in managing Stevens-Johnson syndrome.
Some common drugs linked to this condition include certain antibiotics, sulfonamides, antiepileptics, NSAIDs, and allopurinol. Since it can be hard to know which drug is the cause, doctors often stop all nonessential medicines right away.
Support Measures
Hospital staff usually care for patients in an intensive care or burn unit because of the risk of serious complications. Support focuses on helping the body heal and lowering risks like sepsis or organ failure.
Important supportive steps include:
| Support Type | Purpose |
|---|---|
| Fluids/Nutrition | Prevent dehydration |
| Wound Care | Soothe and protect skin |
| Eye Care | Prevent eye injury |
| Physical Therapy | Retain mobility and function |
- Fluids and Nutrition: Patients may need fluids and nutrients through a tube in the nose if they cannot eat or drink. This replaces losses caused by damaged skin.
- Wound Management: Staff clean wounds gently, use cool compresses for comfort, and cover affected areas with bandages or petroleum jelly dressings. They often remove dead skin through debridement.
- Eye Care: An eye specialist may provide care, and patients might need eye drops to prevent complications.
- Physical Therapy: Therapists help patients maintain movement and strength if recovery takes a long time.
Medicines for Treatment
Doctors use several types of medicine to manage this illness:
- Pain Relief: Medicines like acetaminophen help with discomfort.
- Antibiotics: Doctors use these if infection develops.
- Anti-Inflammatories: Doctors may give corticosteroids or immune globulins by mouth or IV.
- Immune Modulators: Drugs such as intravenous immune globulin, cyclosporine, and sometimes etanercept can slow down the immune systemโs attack on the skin.
- Others: In severe cases, doctors have tried treatments like plasmapheresis.
Doctors keep monitoring for complications such as low blood pressure or blood clots. They may give blood thinners, pressors, or antacids as needed.
Each medicine choice depends on how severe the condition is and which organs are involved.
Self-Care
Taking steps at home is important during recovery from Stevens-Johnson syndrome. Patients should keep a list of any medications or substances that caused their reaction and share this information with all health professionals.
Wearing a medical alert bracelet or necklace can help others quickly understand their medical needs in case of emergency.
Basic mouth care is also necessary. Using a soft toothbrush and rinsing the mouth with mild solutions may help soothe discomfort and support healing. Staying hydrated and resting often can help the body repair itself.
Getting Ready for Your Medical Visit
If you notice symptoms of Stevens-Johnson syndrome, seek emergency medical attention right away.
If you have time before going to the hospital or emergency room, take a few steps to make your visit more effective. These steps can help provide useful information to the health care team.
Bring a List of Recent Medications
Gather all prescription and nonprescription drugs you have taken in the past three weeks.
Put these medications in a bag and bring them with you. This helps doctors at Healthnile find out if a certain drug caused the reaction.
Ask Someone to Go With You
Invite a family member or friend to come with you.
Share important health details with this person. They can support you and talk with the health care provider if needed.
Be Ready to Answer Key Questions
Doctors may ask:
| Question |
|---|
| Have you had any recent flu-like sickness? |
| Do you have other ongoing health issues? |
| What medicines did you use in the last three weeks? |
Prepare to Ask Your Own Questions
- What caused this problem?
- How can I prevent future reactions?
- Are there activities or foods I should avoid?
- How does this affect my other health issues?
- How long will my skin take to recover?
- Is there a risk of permanent damage?
Write down your questions or keep them on your phone. This helps you remember to ask everything important during the appointment.
