Case Definition

Definition:
The Stevens-Johnson Syndrome is a severe form of erythema multiforme characterized by bullae on the oral mucosa, pharynx, anogenital region, and conjunctiva. Typical erythema multiforme lesions may or may not be present elsewhere on the skin. The patient may be unable to eat or close his mouth properly and drools continually. The eyes may become very painful, and conjunctivitis with swelling and pus may make it impossible for the patient to open them. The conjunctival lesions may leave residual corneal scarring. The condition is occasionally fatal.

The skin lesions of erythema multiforme must be distinguished from bullous pemphigoid and dermatitis herpetiformis: the oral lesions, from allergic stomatitis, pemphigus, and herpetic stomatitis.
The Merck Manual 14 Edition

Treatment:
When a cause can be found, it should be treated, eliminated, or avoided. Local treatment depends on the type of lesion. Simple erythema often needs no treatment. Vesicles an bullous or erosive lesions can be treated with intermittent tap water compresses. Cheilitis and stomatitis of erythema multiforme may require special care. Systemic corticosteroids have often been used in severe erythema multiforme, sometimes with apparent benefit. Other patients, especially those with severe mouth and throat lesions, seem to succumb more readily to fatal respiratory infections if treated with systemic corticosteroids. Intensive systemic antibiotics, fluids, and electrolytes may be life-saving in patients with extensive mucous membrane lesions.
The Merck Manual 14 Edition

My Treatment:
Basic Nutrition and Homeopathic Remedies were used. Client was stable within 8 weeks. All the doctors were amazed at his recovery. Fatal respiratory death would of been clients outcome. No antibiotics or steroids were used when under my care. This work was confidential between the family and myself. The Medical staff had no idea why my client was healing so fast. The Body Heals Itself when given the proper energy and stimulation.

Stevens Johnson Syndrome cause by Drugs:

Stevens Johnson Syndrome - Skinassn / caused by drugs

Among the most feared complications of drug therapy are the exfoliative skin disorders--erythema multiforme (EM), Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). Both diseases, Stevens Johnson Syndrome (SJS) and TEN, are primarily, if not solely, caused by drugs among adults, and approximately 50% are drug-related among all ages. The most common drugs associated with Stevens Johnson Syndrome (SJS) and TEN are antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and anti-convulsants.  Prescription NSAIDs, such as Bextra (valdecoxib) and Daypro (oxaprozin), are one of the leading classes of drugs that cause Stevens Johnson Syndrome (SJS) and TEN reactions.   In many countries, increasing rates of skin eruptions are attributed to (NSAIDs).  NSAIDs have played in increasing role in the etiology or cause of TEN, and it has been reported in the medical literature that some NSAIDs that have a long half-life carry a higher risk of Stevens Johnson Syndrome (SJS) or TEN.

History

In 1922, Stevens and Johnson described two children with fever and stomatitis (mouth ulcers), severe disseminated conjunctivitis (eye inflammation) and cutaneous (skin) eruptions.  It soon became evident that severe forms of Stevens Johnson Syndrome (SJS) could lead to toxic epidermal necrolysis (TEN) and that both diseases could be induced by the same drugs. Timing of Stevens Johnson Syndrome (SJS) / TEN reaction The reaction usually develops within 1-4 weeks from the onset of starting drug therapy. However, the prodromal or beginning symptoms can develop within hours or days and include mild rash, or mucosal lesions or fever of an unexplained origin.  Mucosal lesions include lesions of the mouth, eyes, GI and respiratory tract, anus and vagina.  If any of these symptoms occur, the drug should be discontinued immediately and you should seek medical attention. This is because, in some cases, such reactions may develop into severe, sometimes, life-threatening skin and mucous membrane reactions, such as Stevens Johnson Syndrome (SJS) and TEN. Erythema Multiforme / Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Most experts agree that erythema multiforme, a mild blistering skin eruption, is a milder version of Stevens Johnson Syndrome (SJS), which can progress into Stevens Johnson Syndrome (SJS) or TEN.  The most severe skin reactions to drug therapy are Stevens Johnson Syndrome (SJS) and TEN, which are skin diseases that result in eruptions resembling burns and are characterized by epidermal loss.  Stevens Johnson Syndrome (SJS) and TEN are often heralded by fever, sore throat, cough, and burning eyes for 1 to 3 days.   The skin eruption usually begins as a rash that develops into blisters and mucous membrane involvement, including the eyes, mouth, respiratory and GI tract, genitals and anus. Almost 90% of all TEN reactions involve the mucous membrane and 85% have conjunctivitis or eye lesions. Mortality and epidemiology (death rate/incidence rate)

Mortality rates have been reported to be between 25% and 80%.  Age and extent of skin loss are the most significant predictors of mortality. One of the most frequent causes of death is sepsis or a systemic infection caused by losing the protection of your skin. Females appear to be about twice as frequently affected than males with TEN.  However, the incidence rate among women taking certain NSAIDs, such as Daypro/oxaprozin is much higher.  There have been reported annual incidence rates of Stevens Johnson Syndrome (SJS) in the range of 2.6-8.2 per million reported from a study conducted in the U.S.  A higher rate of Erythema Multiforme (EM) has been reported to be between 10.2- 46.5 per million from the same study.