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STEVENS-JOHNSON SYNDROME

STEVENS-JOHNSON
SYNDROME

 Potentially fatal skin disorder and the most severe form of erythema
multiforme
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STEVENS-JOHNSON SYNDROME

 SJS is triggered by a reaction to medications; Antibiotics, especially

sulfonamides, anti-seizure agents, NSAIDS

INCIDENCE
 Occurs in all ages and both gender
 Higher incidence in older people because of their use of many
medications
 Immunosuppressed people (HIV, AIDS)

CLINICAL MANIFESTATIONS
 Initial: conjunctival itching or burning, cutaneous tenderness, fever, cough,
sore throat, headache, extreme malaise, and myalgias (ie, aches and
pains)

 Followed by a rapid onset of erythema involving much of the skin surface

and mucous membranes (oral mucosa, conjunctiva and genitalia)
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STEVENS-JOHNSON SYNDROME

 Severe cases of mucosal involvement: danger of damage to the larynx,

bronchi, and esophagus from ulcerations
 Large, flaccid bullae

 Large sheets of epidermis are shed, exposing the underlying dermis

 Fingernails, toenails, eyebrows, and eyelashes may be shed along with
the surrounding epidermis
 “Scalded skin syndrome” – loss of skin leaves a weeping surface similar to
that of total body, partial thickness burns
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STEVENS-JOHNSON SYNDROME

COMPLICATIONS
 Sepsis and keratoconjunctivitis – can be life threatening; loss of vision and
conjunctival retraction, scarring and corneal lesion

ASSESSMENT AND DIAGNOSTIC FINDINGS

 Histologic studies of frozen skin cells from a fresh lesion
 Cytdodiagnosis of collections of cellular material from freshly denuded
area (microscopic study of cells)
 History of medication use
 Immunofluorescent studies – to detect atypical epidermal autoantibodies

MEDICAL MANAGEMENT
GOAL: control of fluid and electrolyte balance, prevention of sepsis, prevention of
ophthalmic complications
 Surgical debridement or hydrotherapy in a Hubbard tank (large steel tub) –
performed to remove involved skin
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STEVENS-JOHNSON SYNDROME

 Tissue samples from nasopharynx, eyes, ears, blood, urine, skin, and
unruptured blisters are obtained for culture to identify pathogenic
organisms.
 IV fluids to maintain F & E balance
 IV immunoglobulin – treatment of choice
 Topical antibacterial and anesthetic agents – prevent wound sepsis and
assist with pain management
 Plastic semipermeable dressings (eg. Vigilon) maybe used to reduce pain,
decrease evaporation, prevent secondary infection until the epithelium
regenerates
 Meticulous oropharyngeal and eye care is essential when there is severe
involvement of the mucous membranes and eyes

NURSING DIAGNOSIS
 Impaired Tissue Integrity r/t epidermal shedding
 Deficient Fluid Volume and Electrolyte losses r/t loss of fluids from
denuded skin
 Acute Pain r/t denuded skin, oral lesions
 Anxiety r/t physical appearance of the skin and prognosis
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STEVENS-JOHNSON SYNDROME

NURSING INTERVENTIONS
 Maintaining skin and mucous membrane integrity
 Attaining fluid balance : V/S, UO, changes in sensorium are observed for
signs of hypovolemia
 Relieving pain
 Reducing anxiety : emotional support
 Monitoring and managing potential complications: Sepsis – major cause of
death
 Strict asepsis during routine skin care
 Hand hygiene and wearing sterile gloves
 Eyes – daily inspection for pruritus, burning and dryness
 Applying cool, damp cloth over the eyes may relieve burning
sensations.
 Administering eye lubricant may alleviate dryness