Any medication you take can potentially have serious side effects. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare drug-related rashes that can be life-threatening. While more than 100 medications have been reported in association with SJS and TEN, the most responsible culprits are common drugs called non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics and anti-seizure medications called antiepileptics. SJS and TEN are on a continuum within a spectrum of drug eruptions. Read further to find out more about some subtle similarities and differences between the two.
Stevens-Johnson syndrome (pictured here and below)
First observed in 1922 by two U.S. physicians, this rash simulates scalded skin with fever, pain, anxiety, stinging eyes, pain with swallowing, weakness and fatigue. Only 50% of SJS cases are claimed to be caused by a drug, however, this is likely underreported. Over 95% of cases support a strong association with medication ingestion and skin eruption in TEN. In SJS, 30% or less of skin is involved, in TEN, greater than 30% of the skin is involved. SJS and TEN usually occur 7-21 days after the start of the offending drug. The prognosis is unpredictable as progression may occur rapidly.What factors increase the risk in developing this potentially deadly rash?
In individuals with AIDS, the risk of TEN is 1000-fold higher than in the average population.- Risk is highest during the first 2 months of therapy.
- Medications with a long half-life have increased risks to cause a skin reaction and fatal outcome.
Individuals are treated like a burn patient and are monitored for electrolyte imbalances, nutritional support, respiratory care and placed in a warm environment. Exposed skin is protected and measures are taken to prevent secondary infection. A scale is used called SCORTEN to determine the mortality rate for the affected individual. These factors include:
- Age
- Associated malignancy
- Heart rate
- Serum BUN
- Detached or compromised body surface
- Serum bicarbonate
- Serum glucose
Death occurs in 1 out of 3 patients with TEN, typically due to a secondary infection. Lung involvement typically portends a poor outcome. Optimal management includes timely diagnosis and cessation of the offending agent.
Reference:
- Bolognia J, Jorizzo J, Rapini, R. Drug reactions. In: Revuz J, Valeyrie-Allanore L, eds. Dermatology. 2nd ed. Spain: Elsevier. 2012:287-300.
