Dr. David Wetter, Mayo Clinic dermatologist, discusses various features of Stevens-Johnson syndrome based on an article published in the February 2010 issue of Mayo Clinic Proceedings.
Video Summary
We studied 27 patients with Stevens Johnson Syndrome (SJS) 20 of whom had the syndrome in response to drugs. Six of the patients had SJS due to infection of microplasma pneumonia. The most common drugs implicated in SJS were antibiotics and anti-convulsants. All patients had involvement of the oral mucous membranes, while 81% of the patients had involvement of at least two mucous membranes. 70% of patients also had involvement of the ocular mucous membranes. Microplasma pneumonia induced cases manifested less severely than their drug induced counterparts as evidenced by decreased days in the hospital, no internal organ involvement & no treatment in the ICU.
We also looked at biopsy results, but due to the limited number of samples of microplasma pneumonia induced SJS, we were unable to make any conclusions based on the biopsy results. Our findings can help providers recognize the typical features of SJS, both in terms of the typical skin findings as well as the typical mucous membrane findings. Our findings also illustrate the most commons causes of SJS both in terms of medications and microplasma pneumonia. Our findings also illustrate for providers important principles on how to manage patients with SJS, including the paramount importance of supportive care measures. Finally, our study highlights the importance of performing biopsy to confirm the diagnosis of SJS and to rule out mimicking diseases.
There are several important points for patients based upon our study findings. First of all, our study highlights common causes of SJS- in particular medications. It is important for patients to be aware of the severe cutaneous reaction that can occur as a result of several different kinds of medications they may be taking. It is also important for patients to realize that typically, reactions will start within one month of starting the medications. Moreover it is important for patients to realize that if they do develop SJS, and a causative agent is found, the most important treatment is supportive care. Finally, it is important for patients to remember that chronic effects can take hold and affect eyesight- as a result follow-up treatment is paramount.
Future research on the subject of SJS can build upon our study in two ways; first, future studies can look at the role of systemic treatments such as steroids in the role of survival benefits for patients, in addition to the role of supportive care measures alone. Furthermore, further studies can aim to looks at the hysto-pathological features of patients with SJS to see if certain biopsy features can be more predictive of certain causes of SJS.
The take away message for our paper is that SJS is a severe cutaneous reaction that is typically due to medications, but is also often time due to infection with microplasma pneumonia. Cases that are due to infection with microplasma pneumonia typically manifest less severely than their drug induced counterparts. The most important treatment measures for patients with SJS are supportive care measures. Finally, close follow-up, particularly with respect to eye-care complications, is paramount for these patients.