STEVENS – JOHNSON SYNDROME

Stevens – Johnson syndrome (SJS) is an infr-

equent severe mucocutaneous eruption tri-
ggerd most frequently by drugs.
Stevens-Johnson syndrome (SJS) and Toxic
Epidermal Necrolysis (TEN) are terms that
most believe describe the same drug induced
disorder.
SJS describes pts with < 10% BSA involvement,
SJS – TEN complex describe pts 10 to 30% BSA
involvement, and
TEN describes pts with > 30% BSA involvement.
ETIOLOGY
Drug induced epidermal apoptosis:
- Anticonvulsants
- Chemotherapeutic agents
- NSAID, etc.
Infections:
- Bacteria – Mycoplasma pneumonia
- Viral -- Hepatitis A virus
- Fungal – Histoplasmosis

Others eg, - SLE,

- Graft vs host reaction
- Lymphoreticular malignancy
- Idiopathic
Clinical features:
- Sudden onset usually
- Appears as painful, diffuse erythema
with crinkled surface

- Initially may be target lesion-like or not,

but rapidly coalesce into large sheets of
dusky erythema.
 - Some form flaccid blisters, sometimes
haemorrhagic blisters.

- Eventually, large areas of skin get denuded,

exposing red oozing dermis, resembling
second degree burns.
- Mucosal involvement is invariable and often
severe: - oral mucosa - 100%
- Eye - 90%
- Genital and anal mucosa – 50%

- GIT and Respiratory truct involvement

connotes grave prognosis.
Stevens – Johnson syndrome
STENENS – JOHNSON SYNDROM
Toxic epidermal necrolysis
 COMPLICATIPONS
- Electrolyte and fluid inbalance
- Infections
- Temperature dysregulation
- Protein loss
 MANAGEMENT
1. Early diagnosis and immediate discontinuat-
ion of any suspected drug or other etiology.

2. Short cource, high dose systemic steroid in

the acute phase, usually relieves the const-
itutional symptoms.
3. Supportive treatment usually in burns or
intensive care unit.
- Correction of fluid and electrolyte
imbalance.
- Broadspectrum antibiotics against
secondary skin infections.

- Protect from hypothermia.

- Adequate nutrition.