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Thursday, February 9, 2012
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NetWellness provides the highest quality health information and education services created and evaluated by faculty of our partner universities.
Thursday, February 9, 2012
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Skin Care and Diseases |
Stevens Johnson Syndrome07/30/1999 |
Please provide information of Stevens Johnson Syndrome. What are the symptoms? What causes the disease? What is the cure? Is there a reference where I could find out more? Thank you.
In order to fully understand this syndrome we need to classify the basic process known as erythema multiforme and then discuss its related syndromes. Erythema multiforme is a collection of clinical signs and symptoms and it has been divided as follows: (1) erythema multiforme minor, (2) erythema multiforme major (Stevens Johnson Syndrome), and (3) toxic epidermal necrolysis.Erythema multiforme major -- Stevens Johnson Syndrome is most frequently associated with drug ingestion. Characteristically it involves the mucous membrane of the genitalia, mouth and eyes and may spread to involve all of the skin surface with deep seeded blisters. On the cutaneous surface it characteristically begins as erythematous macules progressing to plaques that may erode in the most severe forms of the disease. If it progresses to the point of having large blister formation with desquamation we usually add the name toxic epidermal necrolysis.
Erythema multiforme simplex is a reactive process following herpes simplex infections. It tends to be minor and recurrent. It has also been associated with a number of other bacterial and viral diseases. Characteristically it has its onset 7-10 days after the onset of the viral process and is for the most part self-limited and rarely involves mucous membranes.
In contrast, the more severe form of erythema multiforme -- Stevens Johnson Syndrome-toxic epidermal necrolysis is most frequently associated with systemic medications. The list is extensive. The drugs that are most frequently associated with this syndrome are sulfonamides such as trimethoprim-sulfamethoxazole combinations, sulfadoxine-pyrimethamine combinations, anticonvulsants, numerous antibiotics such as penicillins, tetracyclines, and many others. If you are interested in the full description of the etiologic agents I would refer you to the textbook by W. Mitchell Sames, Jr. and Peter J. Lynch entitled, "Principles and Practice of Dermatology", chapter 37 (Erythema Multiforme and Related Syndromes by J. Clark Huff), pages 445-455 (published 1990).
If you have cutaneous symptoms associated with medications that you are taking or following a viral infection I would encourage you to see your family dermatologist promptly. Appropriate treatment of the etiologic agent or withdrawal of the medication that is precipitating the process may be lifesaving in the major form of the disorder.
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Charles L Heaton, MD Professor Department of Dermatology College of Medicine University of Cincinnati |
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