Stevens-Johnson syndrome

Stevens-Johnson syndrome's disease overview

Steven-Johnson syndrome (Stevens-Johnson Syndrome, SJS) was first described by two American doctors Albert Mason Stevens and Frank Chambliss Johnson in 1922.

This is a form of allergic reactions, usually allergies to the drug. Although the disease is uncommon but very severe, the risk of life -threatening patients. The frequency of disease in the population is only 2/1,000,000, but the mortality rate is up to 5-30%. 

Common illness in children, young men have a higher incidence than young women, the rate of disease appears high in summer and spring.

Causes of Stevens-Johnson syndrome's disease

The pathogenesis Stevens-Johnson syndrome consists of many causes, including:

The common cause is due to an allergic reaction to the drug. The drugs that are in use or drugs used in a month earlier can be the cause of the disease. Most of the drugs are at risk of Stevens-Johnson syndrome , but there are some higher risks, namely:

  • Some antibiotics such as penicillin, cotrimoxazol, Sulfamid antibiotics (sulfasalazin, sulfonamid). Amoxicillin antibiotics, cephalosporin groups, and quinolones are less likely to cause disease.
  • anti -epileptic drugs, convulsions: carbamazepin, phenytoin, phenobarbital
  • Gout treatment: Allopurinol
  • Paracetamol analgesics, Nonsteroid anti-inflammatory (NSAIDs) such as Ibuprofen, Naproxen, Meloxicam, ...

    • Due to the infection of viruses such as:

  • Herpes virus (Herpes Simple or Herpes Zoster)
  • HIV virus
  • Hepatitis A virus

    • Due to bacterial diseases such as pneumonia, encephalitis, meningitis, oral bacteria. Have parasites, malaria, whipes, fungal infections, immunodeficiency diseases such as erythema lupus, ...

    Endocrine disorders during pregnancy or menstrual disorders are also a cause of the disease.

    Symptoms of Stevens-Johnson syndrome's disease

  • Stevens-Johnson syndrome: The disease usually starts with a sudden high fever of 39-40 degrees Celsius, headache, fatigue, sore throat, inflammation mouth. The symptoms are getting worse.
  • Signs of stomatitis is an early sign of the disease, the blisters appear in the lips, tongue, oral mucosa, around the mouth. These blisters broken causing severe stomatitis accompanied by fake bleeding membranes, increased salivation, mouth ulcers.
  • In the skin, acne, puffiness, skin sliding, hemorrhage on the face and feet. After that, the body lesions appear, accompanied by inflammation in one or all the natural cavities of the body such as the mouth, nose, conjunctiva, urethra, vagina, anus.
  • In the eye appears conjunctivitis on both sides, corneal ulcer. In the nose, there are symptoms of rhinitis, congestion, nose bleeding.
  • There are many affected organs, necrosis and superficially occur in the trachea, bronchial, kidney, intestines, etc.

    • Other symptoms that may appear including bronchitis, skin perforation, respiratory failure, digestive disorders, anxiety, light sensitivity to light , red eyes or dry eyes, visual reduction, ...

    This disease will progress more and more severe, patients are tired, painful, arrhythmia, pericarditis, shortness of breath, coma, blood infection can lead to death Vong.

    People at risk for Stevens-Johnson syndrome's disease

    This is a rare disease, but the disease can occur in anyone. Subjects at high risk include:

  • People with HIV virus will be 100 times higher than that of normal people. 

    • People with weakened immune systems will have a high risk of Stevens Johnson syndrome . The immune system can be affected when transplanting internal transplantation, autoimmune diseases or HIV/AIDS/

    Infection with viral infections: The risk of disease will increase if infected with viruses such as herpes, viral pneumonia, hepatitis, HIV

  • There has been a history of Stevens-Johnson syndrome or a family of people who have had Stenvens-Johnson syndrome . If you have been allergic to a certain drug, when you use that drug, there will be a risk of recurrence. If there is a person who has had a Stevens-Johnson syndrome, there will be a higher risk of disease.

    • If you have the HLA-B 1502 gene, there will be a risk of Stevens-Johnson syndrome more, especially if you are using it often Medications for neuropathy, convulsions.

    Prevention of Stevens-Johnson syndrome's disease

    To limit the risk of Stevens-Johnson syndrome, to note:

  • Must take the drug in accordance with the instructions of the doctor, do not arbitrarily take the drugs that are not prescribed, do not use other people's prescriptions, do not arbitrarily abandon the dose, stop using medicine. Must notice allergies about drugs and food to the physician. In the process of using the drug, if there is any abnormal symptoms, especially high fever, stomatitis, must go to medical facilities for timely examination and treatment.
  • Periodic health examination to control health status.
  • A suitable diet, drink enough water. Wash your hands before eating, when taking care of the damaged skin.

    • Diagnostic measures for Stevens-Johnson syndrome's disease

    To diagnosed Stevens-Johnson syndrome , doctors will rely on the patient's medication history, the extent of skin manifestations and general test results. In addition, the skin biopsy can be used for more accurate diagnosis.

    Stevens-Johnson syndrome's disease treatments

    If the cause of Stevens-Johnson syndrome is due to drug allergies: stop using that drug immediately. The drug patients used within 1 month before the onset of the disease can be the cause of allergies. Consulting patients do not reuse those drugs. There are currently no specific tests to determine allergens. Some tests can be used such as: skin pressure test, lymphocytic shift, measuring concentration of cytokin, interferon produced by lymphocytes due to the effect of the drug. 

    Patients with an area of ​​over 10% should be transferred to the Department of Burns or Positive Resuscitation, with the support of many specialists such as medical, eye, obstetrics, skin, skin Willow, ...

    Local treatment:

    Skin care:

  • Avoid holding, enticing serious patients, using protection when interacting with patients. Use antibiotics if there is evidence of infection, use pain medication if pain is very much damaged. In patients who cannot move or patients with diarrhea, avoid stool, dirt on the damaged skin.
  • Wash the damaged skin with physiological saline, sterile warm water or disinfectant solution. Use moisturizer like vaseline, paraffin all over the skin. Apply antibiotics to the skin scaled, slip. The skin loss of the epidermis should be tied with non -stick gauze. The pieces of the epidermis should be kept to protect the skin.

    • Care of damaged mucosa:

  • Eye mucosa: if not treated promptly, it can leave complications such as corneal ulcer, mi-eyelid stick, eye-catching eye corner and lead to blindness. Therefore, patients should be examined and monitored by the eye specialist.

    • Oral mucosa: Clean with disinfectant solutions, use corticosteroids in the form of solution to rinse mouth, use moist gauze to cover lips and mouth. Using herpes, Candida medications with cases of long -lasting oral mucous membranes.

    Vaginal mucosa, vaginal should be examined regularly, hygienic with disinfectant solutions, topical corticosteroids to reduce inflammation. Systemic treatment:

  • Supplementing water-electrolytes: oral supplements if the patient can drink. Place the transmission line in non -damaged skin areas, monitor the balance of fluid with catheter, monitor the amount of fluid and the amount of fluid (the amount of urine). Calculate the appropriate amount of fluid.
  • There is a good diet: patients Stevens-Johnson syndrome need a higher diet than normal. If the mouth is damaged, cannot be eaten, the stomach should be placed for the patient. The amount of calories to be provided in the acute phase of the disease is 20-25KCal KG-1 per day, during the recovery period is 25-30 KCAL KG-1 per day.
  • Dialysis if there is a blood infection

    • See also:

  • How to have mosquito repellent allergies to prevent dengue fever? and treatment
  • Some common allergies in children

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