Medications are most often the cause of Stevens-Johnson Syndrome -- a rare, serious skin condition, that can sometimes be fatal.
Often, signs of Stevens-Johnson Syndrome begin with flu-like symptoms, followed by a painful red or purplish rash that spreads or blisters, eventually causing the top layer of your skin to die and shed.
Drugs commonly associated with Steven’s-Johnson Syndrome include:
Anticonvulsants -- Phenobarbital, Dilantin, Lamotrigine, Tegretol, Phenytoin , Carbamazepine, and Valproic acid
Antifungals, Antivirals and Anti-gout medications (Allopurinol)
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) -- Naproxen, Ibuprofen
Sulfa antibiotics and Penicillins, used to treat infections
Barbiturates and Cocaine, not surprisingly, are also on the list.
And SJS has also been consistently reported as an uncommon side effect of herbal supplements containing Ginseng!
In short, just about any drug is a potential cause.
If you have any of the symptoms listed above or any history of Steven’s-Johnson Syndrome, get a full list of meds to be avoided from your doctor, dermatologist, neurologist or pharmacist.
References:
http://www.mayoclinic.com/health/ste...SECTION=causes
http://www.skinassn.org/
http://en.wikipedia.org/wiki/Stevens...hnson_syndrome
http://www.merck.com/mmhe/sec18/ch203/ch203e.html
http://dermnetnz.org/reactions/sjs-ten.html
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Comments
Husband has SJS
My husband has a large tumor in his left temporal lobe. He's only had 1 grand mal seizure in the past 2 years, but he has many auras. When they put him on anti-convulsant drugs we found he had SJS - he had welts and a rash all over his body and so many ulcers in his mouth - it was very painful for him.
Our GP prescribed Ativan to help him with his seizures/ auras which isn't an anti-convulsant, but a "relaxant". It has been a good alternative, but can be quite addictive and make one tired. Our epileptologist has since prescribed Urbanol which seems to not have a bad effect on him and sub-lingual ativan to use in emergencies.
My husband is going for his brain op next week. Does anyone know if any of the anesthetic or drugs they'll give him will trigger SJS? I know it takes some time for symptoms to show for SJS, but he has to be in observation for a while. I'm just worried the doctor's aren't used to the SJS condition and so they may give him something that might make him extremely weak - many of them don't even know what it is!
Re: Husband has SJS
Lauren,
Both Ruth and I had extensive talks with the head anesthesiast when we had surgeries. Bring a full list of your husband's meds, and explain his history of SJS.
The guys in charge know their stuff and I have never had a problem (except that sometimes they don't give me enough!)
Good luck. Hope the surgery works out well! Phylis Feiner Johnson www.epilepsytalk.com
Re: Drugs that can trigger Steven's-Johnson Syndrome
Causes
By Mayo Clinic staff
The exact cause of Stevens-Johnson syndrome can't always be identified. Usually, the condition is an allergic reaction in response to medication, infection or illness.
There is an excellent article on WebMd that the spam trap won't let through. I have no idea why.
emedicine.medscape.com/article/756523-overview
Here's some of the text:
Pathophysiology
Stevens-Johnson syndrome is an immune-complex–mediated hypersensitivity disorder that may be caused by many drugs, viral infections, and malignancies. Cocaine recently has been added to the list of drugs capable of producing the syndrome. Additionally, the antidepressant mirtazapine and tumor necrosis factor (TNF) – alpha antagonists infliximab, etanercept, and adalimumab have been reported as causes. In up to half of cases, no specific etiology has been identified.
Although not currently relevant to the practice of emergency medicine, research into the pathophysiology of SJS/TEN may soon allow for the development of tests to aid in the diagnosis as well as to identify those at risk.
Pathologically, cell death results causing separation of the epidermis from the dermis. The death receptor, Fas, and its ligand, FasL, have been linked to the process, as has TNF-alpha. Researchers have found increased soluble FasL levels in the sera of patients with SJS/TEN before skin detachment or inset of mucosal lesions.2
Others have also linked inflammatory cytokines to the pathogenesis.
A "killer effector molecule" has been identified that may play a role in the activation of cytotoxic lymphocytes.3
There is also strong evidence for a genetic predisposition to severe cutaneous adverse drug reactions such as SJS. The US FDA and Health Canada advise screening for a human leukocyte antigen, HLA-B*1502, in patients of southeastern Asian ethnicity before starting treatment with carbamazepine. (The risk is much lower in other ethnic populations, making screening impractical in them). Another HLA antigen, HLA-B*5801, confers a risk of allopurinol-related reactions. Pretreatment screening is not readily available.4
The people who say that it is primarily due to drug reactions are assuming. In WIKI they qualify it with the word "appears" yet give no citations. As more and more toxic medications are developed, this may increasingly become the case. Let us pray not.
SJS is an important topic. I wish you would broach it in more precise fashion. You need to be careful as you are setting yourself in a position of authority and trust.
You do not come on this site as a peer. You say you are "one of us," yet you are in a suit in your profile pic and have a slick web site with advertising. You can't have it both ways.
I don't pretend to be a doctor. I am not in a position of authority. I don't pretend I am. I sometimes make mistakes and when I to, I 'fess up and if I hurt someone I apologise.
I do not mean to hurt you, but I don't like the way you have come onto this site and set yourself up as some sort of expert authority when you clearly are not. I keep asking you to please be careful. Please take that advice.
Baruch Hashem. Hoshia na.
Devorah Zealot Soodak http://psychout.typepad.com/ the zealot needs help!
P.S. Please read my blog. Thanks.
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