Stevens-Johnson syndrome physical examination

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

Overview

Common physical examination findings of SJS include rash or redness that is seen as red or reddish purple macules that enlarge to form bullae, vesicles and may rupture later to leave denuded skin underneath. Nikolsky sign may be positive which shows sloughing of the skin by gentle lateral pressure on the erythematous skin. In addition to skin, Mucosal involvement is found mostly in oral mucosa in addition to the nasopharynx and ocular involvement-can be seen as edema, erythema, blistering, sloughing, necrosis and ulceration. In addition to these changes: fever, hypotension, and tachycardia can be seen in patients with SJS

Physical Examination

Appearance of the Patient

• Patients with SJS usually appear sick.

Vital Signs

• Fever is frequently seen in patients of SJS
• Hypotension may be seen
• Tachycardia may be seen

Skin

• Skin examination of patients with SJS shows confluent redness that is seen as red or reddish purple macules that enlarge to form bullae, vesicles and may rupture later to leave denuded skin underneath.
• Can occur anywhere on the body but more common on trunk and extremities and may involve palms and soles
• Nikolsky sign may be positive- Sloughing of the skin by gentle lateral pressure on the erythematous skin

HEENT

• Mucosal involvement is found mostly in oral mucosa in addition to the nasopharynx and ocular involvement-can be seen as edema, erythema, blistering, sloughing, necrosis and ulceration
• Slit lamp Eye exam may be abnormal with findings of conjunctival papillae, follicles, keratinization as well as corneal keratinization, ulceration and perforation among other ocular complications
• Conjunctival or eyelid erythema
• Discharge (mucous/membranous)

Neck

• Neck examination of patients with SJS is usually normal.

Lungs

• Pulmonary examination of patients with SJS is usually normal.

Heart

• Cardiovascular examination of patients with SJS is usually normal.

Abdomen

• Abdominal examination of patients with SJS is usually normal.

Back

• Back examination of patients with SJS is usually normal.

Genitourinary

• Genitourinary examination of patients with SJS can show erythema, edema, ulcerations leading to urethritis, urinary retention, vulvovaginitis as a result of mucosal involvement

Neuromuscular

• Neuromuscular exam of Patients with SJS is usually normal

Extremities

• May show sloughing of skin with vesicles and bullae along with desquamation of skin at palms, soles or dorsum of hands