Stevens-Johnson Syndrome
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Stevens-Johnson Syndrome
The eyes getting red and wateringParts of the eye sticking to each otherPain with urination or trouble urinatingTrouble breathing, fluid build-up in the lungs, or lung infections What causes SJS? " пїЅ 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): пїЅ пїЅ
Should I see a doctor or nurse? " пїЅ 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). пїЅ пїЅ
Will I need tests? " пїЅ 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. пїЅ пїЅ
How is SJS treated? " пїЅ 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. пїЅ пїЅ
What happens after I have had SJS? " пїЅ 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 " пїЅ at all times. пїЅ пїЅ
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 " пїЅ 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). пїЅ пїЅ
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. пїЅ пїЅ
All topics are updated as new evidence becomes available and our peer review process is complete. пїЅ пїЅ
This topic retrieved from UpToDate on: Nov 04, 2014. пїЅ пїЅ
Topic 87114 Version 4.0 пїЅ пїЅ
Release: 22.8 - C22.208 пїЅ пїЅ
пїЅ пїЅ 2014 UpToDate, Inc. All rights reserved. пїЅ пїЅ
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
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. пїЅ пїЅ2014 UpToDate, Inc. All rights reserved. пїЅ пїЅ
- Medicines used to treat gout, especially:Allopurinol (brand names: Aloprim, Zyloprim)
- Certain antibiotics, especially:Trimethoprim-sulfamethoxazole also called cotrimoxazole and other "sulfa " пїЅ drugs (sample brand names: Bactrim, Septra, Sulfatrim, TMP-SMX, Pediazole)
- Medicines used to prevent seizures, pain, or other conditions, called "anti-epileptics, " пїЅ 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, " пїЅ or "NSAIDs, " пїЅ especially:Meloxicam (brand name: Mobic)Piroxicam (brand name: Feldene)
- Allopurinol (brand names: Aloprim, Zyloprim)
- Trimethoprim-sulfamethoxazole also called cotrimoxazole and other "sulfa " пїЅ drugs (sample brand names: Bactrim, Septra, Sulfatrim, TMP-SMX, Pediazole)
- Carbamazepine (sample brand names: Tegretol, Carbatrol)
- Phenytoin and fosphenytoin (brand names: Dilantin, Phenytek, Cerebyx)
- Lamotrigine (brand name: Lamictal)
- Phenobarbital (brand names: Luminal, Donnatol, Hyonatol)
- Meloxicam (brand name: Mobic)
- Piroxicam (brand name: Feldene)
- Stop the medicine that caused SJS (if it was caused by a medicine)
- Try to keep your skin clean and as healthy as possible " пїЅ This might involve scrubbing your skin, keeping it moist, adding dressings, or doing other things.
- Check you for signs of infection " пїЅ 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
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.