Stevens-Johnson Syndrome is an immune disorder that affects the skin and mucous membranes and may cause serious and potentially life-threatening complications that include a burning rash and the subsequent development of lesions, coughing with sputum, and the risk of formation of secondary infections (Foster, 2016). The disease may pose additional complications for patients which influence their quality of life and their ability to fight any primary and secondary infections which may transpire (Foster, 2016). The disease may contribute to a high degree of mortality in patients and requires further analysis and evaluation to determine its causes, any underlying risk factors in patients, any populations which are prominently affected by the disease, and other issues associated with its prevalence in patients. Most importantly, there must be a greater emphasis on understanding the urgent nature of diagnosis and treatment to prevent serious complications and/or loss of life.
Etiology
For patients with Stevens-Johnson Syndrome, a variety of causes must be considered, including prior infection, idiopathic complications, malignancies, and the onset of the disease caused by the use of different pharmacological therapies (Foster, 2016). The disease, although very rare, has been identified in children and adults, and the former tend to contract the disease through infectious means; in addition, some cases in children are recurring and may pose serious health risks to patients (Olson et.al, 2014). Furthermore, it affects some population groups more than others, particularly those who face different types of disparities that impact their health (Olson et.al, 2014). The disease creates difficult challenges for those who are at the greatest risk and must be recognized for its ability to cause serious complications for patients, along with a much greater risk of mortality if the condition is not treated rapidly so that patients will experience relief without experiencing any additional complications.
Pathophysiological Processes
From a pathophysiological perspective, Stevens-Johnson Syndrome poses critical challenges for its patients because it is manifested in different ways which may contribute to high mortality rates (Olson et.al, 2014). In these cases, patients experience significant detachment and necrosis within the epidermis layer of the skin and other severe reactions; therefore, patients experience dermatological deterioration in a brief period of time (Sekula et.al, 2013). Patients often experience severe drug-based adverse events, including complications from cefixime hydrochloride and others (Dhali, Halder, Santra, & Biswas, 2016). For patients, the use of specific drugs to treat a variety of conditions may cause a negative immune response which contribute to skin rashes and other complications that are the most common characteristics of the disease (Dhali et.al, 2016).
Clinical Manifestations & Complications
For patients with Stevens-Johnson Syndrome, the most common clinical manifestations include flulike symptoms such as fever, headache and general fatigue; however, many patients experience a rash that may develop after taking a specific pharmacologic for several days (Dhali et.al, 2016). The rash may begin in isolated areas such as the forehead, but may spread to other parts of the face, neck and hands rather quickly, accompanied by a rash on the eyelids; in addition, ulcers in the mouth may also be prevalent in some patients (Dhali et.al, 2016). In these cases, it is necessary to identify the most common symptoms and complications to determine if the cause of the condition is drug-induced or is exacerbated by other conditions that may include prior infections (Dhali et.al, 2016). Each of these symptoms and complications require proper diagnosis and treatment to ensure that patients experience relief and can recover from the disease as best as possible.
Diagnostics
The disease is generally diagnosed by a dermatologist with the use of Bastuji Garin parameters; however, one of the most common reasons for high mortality rates is the lack of therapeutic interventions conducted with patients that address the specific disease in a timely manner (Dhali et.al, 2016). These risks demonstrate the importance of proper diagnostic tools and the appropriate interventions, including intravenous immunoglobulin, as viable alternatives (Dhali et.al, 2016). It is necessary to examine the patient’s overall history, including the use of pharmacological therapies, many of which may contribute to disease development; these drugs include penicillin, antiretrovirals, NSAIDs, and sulphonamides, among others (Dhali et.al, 2016). Once a definitive diagnosis is made, it is necessary to establish a course of action including a comprehensive treatment plan, depending upon the patient’s specific symptoms. This includes the immediate stoppage of the medication which caused the adverse event and a round of therapies to treat specific symptoms, such as eye drops for those with specific eye rashes and/or lesions (Dhali et.al, 2016).
Conclusion
Stevens-Johnson Syndrome poses significant risks to patients and represents a very high risk of mortality in some patients. Therefore, it is necessary to address the challenges associated with diagnosis and the urgency of treatment to prevent further destruction of the skin and associated symptoms. However, the disease is rare and research remains limited in some areas. Nonetheless, it is necessary to expand research and knowledge of the disease, including its pathophysiological processes, to ensure that patients who are diagnosed receive immediate medical treatment with the intent to reduce complications and mortality rates. Researchers and physicians must demonstrate their knowledge and understanding of the disease to ensure that patients are properly diagnosed and receive treatment in a timely manner. It is necessary to continue to focus on drug-induced cases of the disease, many of which may cause serious harm and high mortality rates if a proper diagnosis and adequate treatment strategy are not achieved.
- Dhali, D., Halder, U., Santra, R., & Biswas, M. C. (2016). Cefixime Induced Stevens-Johnson Syndrome: A case report and Review of literature. Journal of Contemporary Medical Research, 3(5), 1426-1427.
- Foster, C.S. (2016). Stevens-Johnson Syndrome. Retrieved from http://emedicine.medscape.com/article/1197450-overview
- Olson, D., Watkins, L. F., Demirjian, A., Lin, X., Robinson, C. C., Glode, M., … & Dominguez, S. R. (2014, December). 962Recurrent Episodes of Stevens Johnson Syndrome (SJS): Clinical and Epidemiologic Characteristics. In Open Forum Infectious Diseases (Vol. 1, No. suppl 1, pp. S280-S280). Oxford University Press.
- Sekula, P., Dunant, A., Mockenhaupt, M., Naldi, L., Bavinck, J. N. B., Halevy, S., … & Roujeau, J. C. (2013). Comprehensive survival analysis of a cohort of patients with Stevens–Johnson syndrome and toxic epidermal necrolysis. Journal of Investigative Dermatology, 133(5), 1197-1204.
