Management of Stevens-Johnson Syndrome
Jezza has just finished studying for tonight and as part of her bedtime rituals, it’s now time to pamper herself. After taking a warm and relaxing half bath, she then proceeds to rubbing lotion around her body.
“To stay young and radiant despite all the stress nursing school brings,” she keeps telling herself. She really is careful when it comes to her skin. She makes sure that she takes a bath daily, religiously follows her beauty regimen, and even takes vitamins to achieve that smooth and soft skin. However, as she was just finishing applying lotion on her legs, a thought comes into her mind. What if someday she acquires a disease concerning the skin? What will she look like? How would she feel when all of her hard work goes to waste?
She erases the negative thought from her mind and heads off to bed.
“That won’t happen,” she tells herself. “I will never let that happen.”
Overview of Stevens-Johnson Syndrome
Stevens-Johnson syndrome is an immune-complex–mediated hypersensitivity complex that typically involves the skin and the mucous membranes. It is rare and is a serious condition and is usually a reaction to a medication or an infection. Also, it is a medical emergency that usually requires hospitalization.
Symptoms of this condition include:
- Facial swelling
- Tongue swelling
- Hives
- Skin pain
- A red or purple skin rash that spreads within hours to days
- Blisters on your skin and the mucous membranes of your mouth, nose, eyes and genitals
- Shedding of your skin
If you have Stevens-Johnson syndrome, several days before the rash develops you may experience:
- Fever
- Sore mouth and throat
- Fatigue
- Cough
- Burning eyes
Physical exam, a review of the patient’s medical history and a skin test are needed to diagnose this syndrome. Stevens-Johnson syndrome may be identified based on the medical history and signs and symptoms found during the physical exam. To confirm the diagnosis, your doctor may remove a sample of skin for laboratory testing (biopsy).
Management
Since S-J syndrome is a medical emergency, those with this case are often admitted at the ICU or the burn unit.
Non-essential medications are to be stopped since the first and most important step in treating Stevens-Johnson syndrome is to discontinue any medications that may be causing it. Fluid replacement and nutrition may also be provided as supportive care because of the skin loss which can also result in significant loss of fluid from your body. Fluids and nutrients may be received via a nasogastric tube (NGT).
Wound care is also important. Here, the healthcare provider may gently remove any dead skin and place a medicated dressing over the affected areas. This may also be done through applying cool, wet compresses that will help soothe blisters while they heal.
Eye care may also be provided and the patient may be referred to an ophthalmologist. Aggressive lubrication of the ocular surface may be done. As inflammation and cicatricial changes ensue, most ophthalmologists use topical steroids, antibiotics, and symblepharon lysis.
As for the medications, these are the most commonly used for Stevens-Johnson syndrome: Pain medication to reduce discomfort, antihistamines (to relieve itching), Antibiotics to control infection, and topical steroids to reduce skin inflammation.
If left untreated, certain complications may arise, such as: Secondary skin infection (cellulitis), Blood infection (sepsis), Eye problems, damage to internal organs, and permanent skin damage.
Sources:
- http://www.mayoclinic.org/diseases-conditions/stevens-johnson-syndrome/basics/complications/con-20029623
- http://emedicine.medscape.com/article/1197450-overview
Liane Clores, RN MAN
Currently an Intensive Care Unit nurse, pursuing a degree in Master of Arts in Nursing Major in Nursing Service Administration. Has been a contributor of Student Nurses Quarterly, Vox Populi, The Hillside Echo and the Voice of Nightingale publications. Other experience include: Medical-Surgical, Pediatric, Obstetric, Emergency and Recovery Room Nursing.
