What is Stevens Johnson Syndrome?

The disease was first reported by Stevens-Johnson in 1922. It was included as erythema erythematosus as severe erythema erythematosus, with blistering on the skin, typical or atypical target damage and extensive mucosal damage, accompanied by fever, visceral damage and other system symptom. Occurs in early spring and winter, most people aged 20 to 40.

Basic Information

English name: Stevens-Johnson syndrome
Visiting department: dermatology
Multiple groups: 20 to 40 years old

Common symptoms: Fever, sore throat, chills, headache, joint pain, vomiting, diarrhea, and weakness. Skin and mucous membrane damage suddenly appears, with erythema, pimples, wind mass, etc.

Causes of Stevens-Johnson Syndrome

The etiology is unknown and is thought to be related to cell-mediated immune responses. Related to drugs, infections and visceral diseases, the etiology is unknown in 25% to 50% of cases. Drug factors are important causes, especially carbamazepine, allopurinol and other drugs have a high incidence and serious illness.

Clinical manifestations of Stevens-Johnson syndrome

Prodromal symptoms are non-specific upper respiratory tract infections with fever, sore throat, chills, headache, joint pain, vomiting, diarrhea, and weakness. Skin and mucous membrane damage suddenly appeared, and the rash was polymorphic, with erythema, pimples, wind masses, blisters, bullae, and purpura. Skin lesions are distributed on any part of the body, except for the palms, buttocks, the back of the hands, and the extension of the extremities, often involving the trunk and face.

Mucosal damage is extensive and serious. In addition to the oral cavity, eyes, perianal area, and vulva, it can also affect the mucous membranes of the nose, throat, and respiratory, digestive, and urogenital mucosa.

The disease is a systemic disease that can affect the internal organs and cause corresponding symptoms. Renal damage may include hematuria and proteinuria. Renal tubular necrosis and renal failure may occur in severe cases. Aminotransferases may increase in patients with liver damage. Lymph nodes may increase, tachycardia, hypotension, seizures, and disturbance of consciousness.

Stevens-Johnson syndrome test

Laboratory tests: Lymphopenia, neutropenia, thrombocytopenia, anemia, increased erythrocyte sedimentation, elevated aminotransferase, and elevated non-protein nitrogen may occur.

Stevens-Johnson syndrome diagnosis

The disease has a polymorphous rash and typical or atypical target lesions, extensive and severe mucosal damage, and systemic symptoms such as fever and visceral damage. Diagnosis is generally not difficult.

Stevens-Johnson syndrome treatment

General processing

Treatment was performed immediately after diagnosis, and the room temperature was kept constant.

2. Etiology treatment

Timely treatment for the cause, if the drug is allergic, the suspected allergenic drug should be stopped immediately.

3. Supportive Therapy

It is very important to supplement water, nutrition and multivitamins in time, supplement enough calories and protein, maintain water and electrolyte balance, maintain hemodynamic stability and airway patency.

4. Immunoglobulin therapy

In severe cases, intravenous immunoglobulin therapy can achieve good results.

5. Systematic application of glucocorticoid therapy

Controversial. Advocates believe that early and timely application of hormones can control the development of the disease and relieve symptoms. Once the disease is under control, hormones can be withdrawn and short-term treatment is recommended. Opponents believe that the systematic application of hormones can increase the chance of secondary infection, delay epidermal healing, and may cause side effects such as hypertension and diabetes, so it is considered harmful.

6. Anti-infective treatment

Patients with secondary infections should choose sensitive antibiotics for treatment according to their susceptibility.

7. Other treatments

Application of cyclosporine, cyclophosphamide, thalidomide and other treatments and plasma exchange.

8. Local treatment

(1) Local application of protective agents and alleviating anti-inflammatory agents for skin lesions, such as calamine lotion, zinc oxide oil, silicone oil cream, glucocorticoid ointment, etc., swelling, erosion, exudate, cold and wet compress with saline.

(2) Mouthwash with mouthwash containing oral mucosa. If erosion or ulcer pain prevents eating, apply a mucosal anesthetic to relieve pain. For eye damage, please consult an ophthalmologist in time to take measures to prevent eye sequelae. Anal and external genital lesions should be kept locally clean, and external 0.05% chlorhexidine solution can be used for external cleansing, and antibiotics should be used in time when secondary infections occur. For pharyngeal, larynx, respiratory tract mucosal lesions and digestive tract mucosal lesions, please consult the relevant departments in time for joint treatment.

Stevens-Johnson syndrome prevention

Patients with mild symptoms are cured in 2 to 3 weeks and generally have no sequelae, but those with severe ocular symptoms may have sequelae or even become blind. Severe mucosal damage leaves scars after healing, which can cause stenosis. If severe cases have serious complications, such as respiratory failure, renal failure, and sepsis, the prognosis is poor.

Stevens-Johnson syndrome prevention

Various inducing factors should be avoided, such as inadvertent taking of drugs, especially those with allergies to similar drugs, should avoid re-use. Prevention and treatment of various infections.