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{{Stevens-Johnson syndrome}}
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==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<ref name="pmid211627212">{{cite journal| author=Harr T, French LE| title=Toxic epidermal necrolysis and Stevens-Johnson syndrome. | journal=Orphanet J Rare Dis | year= 2010 | volume= 5 | issue=  | pages= 39 | pmid=21162721 | doi=10.1186/1750-1172-5-39 | pmc=3018455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21162721 }}</ref>.
 
==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
** [[Fever]]
** [[Sore throat]]
** [[Chills]]
** [[Headache]]
** [[Malaise]]
** [[Cough]]
** [[Arthralgia|Arthralgias]]
* '''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<ref name="pmid15875523">{{cite journal| author=Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS| title=Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. | journal=Ann Allergy Asthma Immunol | year= 2005 | volume= 94 | issue= 4 | pages= 419-36; quiz 436-8, 456 | pmid=15875523 | doi=10.1016/S1081-1206(10)61112-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15875523 }}</ref>
** Involved mucosal surfaces may include<ref name="pmid21162721">{{cite journal| author=Harr T, French LE| title=Toxic epidermal necrolysis and Stevens-Johnson syndrome. | journal=Orphanet J Rare Dis | year= 2010 | volume= 5 | issue=  | pages= 39 | pmid=21162721 | doi=10.1186/1750-1172-5-39 | pmc=3018455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21162721 }}</ref>
*** 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<ref name="pmid19243825">{{cite journal| author=Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z et al.| title=Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. | journal=Ophthalmology | year= 2009 | volume= 116 | issue= 4 | pages= 685-90 | pmid=19243825 | doi=10.1016/j.ophtha.2008.12.048 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19243825  }}</ref>
*** Urogenital : Can cause [[Urethritis]], [[Vulvovaginitis]]
*** Nasopharynx
*** Tracheo-Bronchial and intestinal involvement is uncommon<ref name="pmid9470079">{{cite journal| author=Lebargy F, Wolkenstein P, Gisselbrecht M, Lange F, Fleury-Feith J, Delclaux C et al.| title=Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study. | journal=Intensive Care Med | year= 1997 | volume= 23 | issue= 12 | pages= 1237-44 | pmid=9470079 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9470079 }}</ref>
 
==References==
==References==
{{reflist|2}}
{{Reflist|2}}
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Latest revision as of 15:23, 15 September 2018

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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

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

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

  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.

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