Does your skin suddenly turn red, blister, and peel? Learn about Stevens-Johnson Syndrome

What Is Stevens-Johnson Syndrome (SJS)?

Simply put, Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are two very serious skin conditions. When this happens, red patches and rashes suddenly appear on your skin. Then, blisters form, and the top layer of your skin begins to peel off. This condition also affects your mucous membranes, which are the moist linings inside your eyes, mouth, and private areas. If you develop this condition, you must stay in the hospital to get proper medical treatment.

Some doctors view SJS and TEN as two separate conditions. This others view them as two different severity levels of the same disease. SJS is considered a less severe form than TEN. For example, in SJS, less than 10 percent of the skin across your whole body peels off. However, in TEN, more than 30 percent of your skin can peel away. Even so, you must remember that both of these conditions can threaten your life.

Alternative Names for SJS.

Yes, people use several other names for this condition as well. For example, you might hear:

• Lyell’s Syndrome.
• Stevens-Johnson syndrome/toxic epidermal necrolysis.
• Stevens-Johnson syndrome toxic epidermal necrolysis spectrum.

Sometimes, the name changes based on the root cause. If a medicine causes it, people call it drug-induced Stevens-Johnson syndrome. If an infection like Mycoplasma causes it, they call it mycoplasma-induced Stevens-Johnson syndrome.

Who Is Most Likely to Get SJS?

Most of the time, SJS happens more often in young adults under the age of 30 and in young children. Even so, it can affect people of any age, especially older adults. Females also have a higher chance of getting SJS compared to males.

Think about it: if a young child catches an infection like pneumonia and then develops this kind of skin problem along with it, it could be SJS. Infections like pneumonia are a leading cause of SJS in children. However, medicines are the most common cause of SJS and TEN in adults.

What Risk Factors Cause SJS?

A single cause does not usually trigger this disease. Instead, a combination of factors can play a role. One of the main factors is your genetic makeup. This means your genes might carry a specific vulnerability. Environmental triggers can then activate those genes. One of these genetic factors involves special proteins in your body called Human Leukocyte Antigens (HLAs). People who carry certain versions of these HLAs face a higher risk of developing SJS or TEN than other people.

What Are the Symptoms of SJS?

SJS brings several noticeable symptoms. Knowing about these signs is very important:

• Severe skin pain: Your skin starts to hurt before anything else appears.
• Fever: Your body temperature rises.
• Body aches: You feel sore all over your body.
• Red skin patches or spots: Red spots or patches form across your skin.
• Cough: You may develop a persistent cough.
• Blisters and sores: Blisters and sores form not just on your skin, but also on the mucous membranes inside your mouth, throat, eyes, private areas, and anal area. Think about how mouth sores make it hard to eat or even speak.
• Peeling skin: The skin over the blistered areas peels away.
• Drooling: Mouth sores make it hard to close your mouth, leading to drooling.
• Swelled-shut eyes: Blisters and swelling around your eyes can make them swell completely shut.
• Painful urination: Sores on your mucous membranes make going to the bathroom very painful.

Imagine starting a new medicine, feeling unwell after a few days, getting a fever and body aches, and then suddenly seeing red skin spots and blisters pop up. That is when you should suspect a potential SJS condition.

What Causes SJS?

Several main reasons can trigger SJS:

• Allergic reaction to a medicine: This is the primary cause for most SJS cases and all TEN cases. If your body does not react well to a medicine you take, this condition can happen.
• Infections: Examples include Mycoplasma pneumonia, the herpes virus, or hepatitis A.
• Graft-versus-host disease: This condition can happen after medical procedures like a bone marrow transplant.
• Unknown causes: Sometimes, SJS occurs without any clear reason.

If a medicine causes your SJS, symptoms usually start within one to three weeks after you begin taking that pill. At first, you show normal flu signs like fever, cough, and a headache. Skin rashes and peeling skin start soon after. In TEN cases, some people even lose their hair and nails. In very rare cases, reports show that a recent vaccine can trigger SJS.

Which Medicines Are More Likely to Cause SJS?

Certain types of medicines carry a higher risk of causing SJS. They include:

• Antibacterial sulfa drugs.
• Anti-epileptic drugs, such as Phenytoin (Dilantin), Carbamazepine (Tegretol), Lamotrigine (Lamictal), and Phenobarbital (Luminal).
• Allopurinol (Aloprim, Zyloprim), which doctors prescribe for gout and kidney stones.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as Piroxicam (Feldene), Nevirapine (Viramune), and Diclofenac (Cambia, Flector).
• Other general antibiotics.

Important: This does not mean everyone who takes these medicines will get SJS. Even so, studies show that these specific medicine groups connect to a higher risk of SJS.

Are There Other Factors That Increase SJS Risk?

Yes, other health states can increase your risk of SJS:

• Having a prior bone marrow transplant.
• Having autoimmune diseases like systemic lupus erythematosus (SLE).
• Living with human immunodeficiency virus (HIV) infection.
• Having other chronic diseases of your joints and connective tissue.
• Having cancer.
• Having a weakened immune system.
• Having a family history of SJS.
• Carrying specific gene variations like Human Leukocyte Antigen-B (HLA-B).

How Do Doctors Diagnose SJS?

Doctors diagnose SJS and TEN by reviewing several factors:

• Examining affected skin and mucous membranes: Doctors usually look for damage in at least two mucous membranes.
• Checking your pain levels: They assess how much discomfort you feel.
• Evaluating how fast your skin reactions spread: They look at how quickly your skin symptoms develop.
• Measuring the affected body surface area: They calculate how much of your skin suffers damage.
• Skin biopsy: Sometimes, doctors take a tiny sample of your skin and examine it under a microscope to confirm the diagnosis with certainty.

How Do Doctors Treat SJS?

SJS requires immediate hospital care. Trying to treat this at home can make your condition much worse. Hospital treatments include:

• Stopping the trigger medicine right away: This is the very first step doctors take.
• Giving intravenous (IV) fluids and electrolytes: Because your skin peels off, your body loses a lot of fluids. IV fluids help manage this loss.
• Applying non-adhesive dressings: Doctors cover damaged skin with special bandages that do not stick.
• Providing high-calorie meals: Good nutrition speeds up healing. Sometimes, doctors use tube feeding.
• Giving antibiotics: Doctors use antibiotics when needed to prevent or treat bacterial infections.
• Providing pain medicines: medicines keep you comfortable while you heal.
• Hospital care units: You may stay in an intensive care unit (ICU) or a burn unit.
• Specialist care teams: Dermatology and ophthalmology experts help manage skin and eye issues.
• Advanced therapies: In some cases, doctors use IV immunoglobulin, cyclosporine, IV steroids, or amniotic membrane grafts for your eyes.

What Complications Can SJS Cause?

Because SJS and TEN are severe conditions, their complications can also turn dangerous.

• Death: This is the most frightening complication. About 10 percent of SJS patients and up to 50 percent of TEN patients can pass away.
• Pneumonia: Lung infections can develop.
• Sepsis: This is a severe, life-threatening blood infection.
• Shock: Your blood pressure can drop to dangerous levels.
• Multiple organ failure: Several vital organs can stop working properly.

These severe complications explain why SJS and TEN demand rapid hospital care.

Can You Prevent SJS?

To be honest, you cannot prevent SJS in most cases. This happens because it usually stems from an unexpected reaction to a medicine. Therefore, no reliable way exists to predict this before you take a pill.

Even so, if doctors find that a specific medicine caused this reaction for you, the most important rule is never to use that medicine or similar drug groups ever again. Tell your doctor about this allergy, and make sure to record it in your medical files.

What Is the Long-Term Outlook for Someone Who Had SJS?

Every person recovers from SJS differently. Some people grow new skin within a few weeks. However, if your symptoms are severe, complete recovery can take many months. Some people suffer long-term effects, such as:

• Skin issues: Dry skin, itching, and skin color changes.
• Eye problems: Frequent swelling, dry eyes, burning eyes, vision trouble, and light sensitivity (photophobia).
• Excessive sweating: Increased sweating across the body.
• Lung damage: Conditions like chronic obstructive pulmonary disease (COPD) or asthma.
• Nail changes: Peeling or deformed nails.
• Hair loss: Alopecia or hair thinning.
• Dry mucous membranes: This can cause problems with urination.
• Chronic fatigue syndrome: Ongoing tiredness.
• Taste changes: Altered sense of taste.

Most importantly, if you take the medicine that originally caused your SJS again, the disease can return. If that happens, symptoms during the second time are usually much worse than the first time.

About 10 percent of SJS patients and 30 percent of TEN patients pass away, mainly due to sepsis, acute respiratory distress syndrome (ARDS), and multiple organ failure.

Key Takeaways to Remember.

We have covered many details about this dangerous SJS condition. Here are the core points you should keep in mind:

• Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are serious, life-threatening skin conditions.
• If you start a new medicine and notice skin pain, red spots, blisters, peeling skin, or mouth and eye sores within a week or two, seek medical advice right away. This could be SJS.
• If you have a known allergy or severe reaction to a medicine, always tell your doctor.
• Never use a medicine or similar drug group that caused an SJS reaction in the past.
• If you suspect SJS, do not stay at home. Go to a hospital quickly. Fast medical treatment can save your life.

We hope you found this information useful. Stay healthy!

Comparison of SJS and TEN.