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Stevens-Johnson Syndrome

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  • The eyes getting red and watering
  • Parts of the eye sticking to each other
  • Pain with urination or trouble urinating
  • Trouble breathing, fluid build-up in the lungs, or lung infections

  • What causes SJS? " � SJS is a rare side effect of a medicine, but it can also happen to people who have an infection, such as HIV. There are many medicines that can cause SJS. The chance that one of these medicines will cause SJS is highest during the first 8 to 10 weeks of taking it. Some of the most common examples of medicines that can cause SJS include (table 1): � �
    • Medicines used to treat gout, especially:
      • Allopurinol (brand names: Aloprim, Zyloprim)
    • Certain antibiotics, especially:
      • Trimethoprim-sulfamethoxazole also called cotrimoxazole and other "sulfa " � drugs (sample brand names: Bactrim, Septra, Sulfatrim, TMP-SMX, Pediazole)
    • Medicines used to prevent seizures, pain, or other conditions, called "anti-epileptics, " � including:
      • Carbamazepine (sample brand names: Tegretol, Carbatrol)
      • Phenytoin and fosphenytoin (brand names: Dilantin, Phenytek, Cerebyx)
      • Lamotrigine (brand name: Lamictal)
      • Phenobarbital (brand names: Luminal, Donnatol, Hyonatol)
    • Medicines used to treat pain, including medicines called "non-steroidal anti-inflammatory agents, " � or "NSAIDs, " � especially:
      • Meloxicam (brand name: Mobic)
      • Piroxicam (brand name: Feldene)

    Should I see a doctor or nurse? " � Yes, if you develop symptoms of SJS, go to the emergency room right away or call for an ambulance (in the US and Canada, dial 9-1-1). � �
    Will I need tests? " � Maybe. Your doctor might be able to tell what is wrong by talking to you and doing an exam. Still, he or she might order tests to make sure something else is not causing your symptoms. For instance, the doctor might take a sample of skin (called a biopsy) and send it the lab. He or she might also order a blood test and other tests to check for signs of infection. � �
    How is SJS treated? " � Treatment happens in the hospital and usually lasts 2 to 4 weeks. There you will see a team of different types of doctors, nurses, and other professionals. Some people with SJS are treated in burn centers. � �
    To treat SJS, your treatment team will: � �
    • Stop the medicine that caused SJS (if it was caused by a medicine)
    • Try to keep your skin clean and as healthy as possible " � This might involve scrubbing your skin, keeping it moist, adding dressings, or doing other things.
    • Check you for signs of infection " � This is very important because people SJS can develop serious infections.
    • Give you antibiotics to treat infection
    • Possibly give you medicines to reduce inflammation, such as prednisone or a medicine called IVIG

    What happens after I have had SJS? " � If you have had SJS, you must be very careful to never take the medicine that caused it again or closely related medicines. If you take the same medicine again or one that is closely related, it could kill you. You should wear a medic alert bracelet or necklace at all times that lists the medicine or medicines you must avoid and why. If you cant wear a bracelet or necklace, you should carry a document called an "allergy passport " � at all times. � �
    You should also learn all the names of the medicines you should avoid. Medicines often go by more than one name, so you might have to learn a few. For example, if a "sulfa " � antibiotic caused SJS, you also need to avoid closely related drugs like sulfasalazine (used to treat colitis or arthritis) and some antibiotic creams, lotions, and eye drops (such as sulfacetamide drops and silver sulfadiazine cream). Your doctor or nurse should give you a list of all the names you should know (table 1). � �
    If you had SJS caused by a medicine, your doctor might suggest that your family members take a blood test to find out if they could be at risk of getting SJS with the same medicine. That way they can also be careful not to take medicines that can cause SJS. � �
    All topics are updated as new evidence becomes available and our peer review process is complete. � �
    This topic retrieved from UpToDate on: Nov 04, 2014. � �
    Topic 87114 Version 4.0 � �
    Release: 22.8 - C22.208 � �
    � � 2014 UpToDate, Inc. All rights reserved. � �


    � �
    table 1Medicines that can cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) and closely related medicinesView Largetable 1Medicines that can cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) and closely related medicines

    If you had SJS or TEN with one of these, you must avoid all other medicines that are in the same group and closely related medicines

    Generic name

    US brand names

    GROUP 1: Used to prevent gout attacks

    Allopurinol

    Aloprim, Zyloprim

    There are no known closely related medicines to allopurinol

    GROUP 2: Some anti-epileptic drugs - used to prevent seizures or pain

    Carbamazepine

    Tegretol, Carbatrol, Epitol, Equetro

    Fosphenytoin

    Cerebyx

    Lamotrigine

    Lamictal

    Phenobarbital (phenobarbitone)

    Luminal

    Phenytoin

    Dilantin, Dilantin Infatabs, Phenytek

    Primidone

    Mysoline

    Following are closely related to above anti-epileptic drugs and must also be avoided:

    Eslicarbazepine

    Aptiom

    Felbamate

    Felbatol

    Oxcarbazepine

    Trileptal, Oxtellar XR

    Phenobarbital combinations for stomach problems

    Donnatal, Hyonatol

    Zonisamide

    Zonegran

    GROUP 3: "Sulfa" antibiotics - used for treating infections

    Trimethoprim-sulfamethoxazole (also called cotrimoxazole and TMP-SMX)

    Bactrim, Septra, Sulfatrim

    Sulfadiazine

    No brand (generic only)

    Sulfadoxine and pyrimethamine

    Fansidar

    Following are closely related to above "sulfa" antibiotics and must also be avoided:

    Erythromycin-sulfisoxazole

    Pediazole, ESP

    Silver sulfadiazine cream

    Silvadene, SSD, Thermazene

    Sulfacetamide containing skin products including cleansers, creams, foams, gels, lotions, pads, washes and shampoos

    APOP, AVAR, Klaron, Claris, Ovace, Plexion, Prascion, Rosanil, Seb-Prev, SSS, Sulfacet-R, Sulfacleanse, Sumadan, Sumaxin, Verti-sulf, Zencia, others

    Sulfacetamide containing eye drops, eye ointments and ear drops

    Bleph-10, Blephamide

    Sulfacetamide, sulfanilamide and/or sulfathiazole vaginal products

    AVS, VVS, Triple Sulfa Vaginal

    Sulfasalazine used for treating colitis or rheumatoid arthritis

    Azulfidine, Sulfazine, Salazopyrin

    GROUP 4: Nonsteroidal drugs (also called "NSAIDs") - used to treat pain or inflammation

    Meloxicam

    Mobic

    Piroxicam

    Feldene

    Other NSAIDs should in general be avoided:

    NOTE: Carefully check all medicine labels including pain relievers, cough or cold medicines, shots, ointments, creams, gels, patches, eye drops and nose sprays to be sure they contain no NSAID.

    Ibuprofen

    Advil, Motrin

    Naproxen

    Aleve

    Celecoxib

    Celebrex

    Ketorolac

    Toradol, Sprix, Acular, Acuvail

    Diclofenac

    Voltaren, Flector, Pennsaid

    Indomethacin

    Indocin

    Many others

    Many others

    This is not a complete list of all medicines that can cause SJS/TEN.


    Graphic 97285 Version 1.0 � �

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    This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.The use of UpToDate content is governed by the UpToDate Terms of Use. � �2014 UpToDate, Inc. All rights reserved. � �

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