Stevens Johnson Syndrome; a dreadful condition for all
Stevens Johnson Syndrome; a dreadful condition for all
Assoc. Prof. Dr. Supakorn Rojananin
Faculty of
Stevens Johnson Syndrome (SJS) is a dreadful adverse (drug) condition to everyone and a nightmare for all practitioners who are facing it. It is unpredictable and can occur to any ones even those without any history of drug allergy. Most researchers believe that SJS is an immune complex- mediated hypersensitivity disorder that may be mainly induced by drugs, only a few related to viral infections, autoimmune disease and malignancies. Fortunately, it is a rare condition affecting only 1-1.4 cases per million per year in Europe and 2.6-8.2 cases in
According to Assoc. Prof. Dr. Puan Suthipinittham, Head of the department of Dermatology, Faculty of Medicine, Siriraj Hospital, the incidence of SJS in Bangkok is quite high and needed to be called for an alert, as only at Siriraj hospital, there were about 20 cases admitted and treated per year with a mortality rate of 5% in SJS and 16.7% in TEN. Most died of secondary infection or sepsis and respiratory failure. Of those survivors, the majority of patients with mild form of disease will recover without sequelae within 4-8 weeks, some may develop morbidities such as; scarring of the skin and mucosa, esophageal stricture, vaginal stenosis, penile scarring. Ocular sequelae may include corneal ulceration. Blindness is a rare complication that may develop secondary to severe keratitis or loss of transparency.
Dr. Puan says 86% of SJS and TEN was drug induced. Most of the patients used the drugs for coping their underlying infection, epilepsy and malignancy. The most frequent causative drugs included antibiotics, anti-tuberculous drugs, anticonvulsants (dilantin, carbamazepine), non-steroidal anti-inflammatory drugs, allopurinol, propyl-thiouracil, propanolol, etc. The leading causes of antibiotics group were co-trimoxazol, penicillin, amoxicillin, ofloxacin, chloramphenical, and tetracycline. Surprisingly, in the past 5 years, one-third of the cases were patients with HIV infection who had antibiotics for getting rid of infection, tuberculosis and prophylaxis for Cryptococcus meningitis and Pneumocystis carinii pneumonia.
Early recognition and suspicion of the disease is most important. Since patients with SJS who present early may not yet be critically ill, the clinician may misdiagnose and discharge. The causative drug should be identified and discontinued. Hospitalization with proper monitoring, careful daily inspection and adequate supportive and symptomatic treatment as well as a team approach for specific management is crucial.
Dr. Puan advises that drug allergy is not uncommon and most are self limited. Adverse drug reaction can involve all systems of the body but skin manifestation is the most easily recognized. Once it is suspicious, early withdrawal of the drugs are the most important preliminaries and go back to see your physicians at once. Since no tight regulation has been implemented for drug consumption recently, people can buy it as easily as having a candy. Improper use is also frequent. This may lead to a higher risk to develop drug induced SJS. Lastly, every people have to know the name of the drugs when used and use it when really needed. Remembering that nature can also heal you as well!
