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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Stevens-Johnson syndrome history and symptoms

Introduction

Overview

Overview

Patients with Stevens-Johnson Syndrome usually have a history of recent drug use within the last 2 months or some other inciting trigger like infection or vaccination. It starts with a flu-like illness followed by skin eruptions that involve trunk and extremities mainly. Skin involvement in SJS is always <10 percent of the body surface. Blisters, erosions, vesicles and bullae are seen along with confluent redness and sloughing of skin. Mucosal lesions can be seen in 2 or more surfaces and can involve eyes, oral mucosa, nasopharynx or genitals commonly[1].

History and Symptoms

History and Symptoms

History

Patients with SJS may have a positive history of:

  • Recent drug use
  • Recent viral or bacterial infection
  • Active malignancy

Symptoms

Symptoms usually start within 2 months of starting a drug or other inciting trigger.

  • Prodome of flu like symptoms 1-3 days before skin eruptions. May include
  • Skin lesions
    • Involve less than 10 percent of body surface
    • Start as red or reddish blue macules/ papules on trunk and extremities and later increase in size and coalesce
    • Blisters/erosions/bullae and vesicles are seen
    • Confluent redness with skin sloughing
    • Nikolsky Sign is Positive- which is the detachment of superficial epidermis on gentle pressure or rubbing of skin
    • Target lesions are not typically seen (as opposed to Erythema Multiforme)
  • Mucosal Lesions
    • Can be seen before or after the skin eruptions
    • Can involve 2 or more mucosal surfaces
    • Seen in 90 percent of cases of SJS/TEN[2]
    • Involved mucosal surfaces may include[3]
      • Buccal mucosa: Painful erosions leading to Stomatitis and Mucositis
      • Ocular: Seen frequently and range from acute conjuctivitis, eyelid edema and erythema, crusting, ocular discharge, Corneal erosion to corneal ulceration[4]
      • Urogenital : Can cause Urethritis, Vulvovaginitis
      • Nasopharynx
      • Tracheo-Bronchial and intestinal involvement is uncommon[5]
References

References

  1. ↑ Harr T, French LE (2010). “Toxic epidermal necrolysis and Stevens-Johnson syndrome”. Orphanet J Rare Dis. 5: 39. doi:10.1186/1750-1172-5-39. PMC 3018455. PMID 21162721.
  2. ↑ Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS (2005). “Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature”. Ann Allergy Asthma Immunol. 94 (4): 419–36, quiz 436-8, 456. doi:10.1016/S1081-1206(10)61112-X. PMID 15875523.
  3. ↑ Harr T, French LE (2010). “Toxic epidermal necrolysis and Stevens-Johnson syndrome”. Orphanet J Rare Dis. 5: 39. doi:10.1186/1750-1172-5-39. PMC 3018455. PMID 21162721.
  4. ↑ Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z; et al. (2009). “Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications”. Ophthalmology. 116 (4): 685–90. doi:10.1016/j.ophtha.2008.12.048. PMID 19243825.
  5. ↑ Lebargy F, Wolkenstein P, Gisselbrecht M, Lange F, Fleury-Feith J, Delclaux C; et al. (1997). “Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study”. Intensive Care Med. 23 (12): 1237–44. PMID 9470079.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]