Stevens Johnson Syndrome

Stevens-Johnson syndrome

Acute toxic-allergic disease, accompanied by generalized rashes on the skin and mucous membranes; malignant variant of exudative erythema.

Symptoms, course. Body temperature suddenly rises, malaise and headache are noted. Sharply limited large pinkish or bright red spots appear symmetrically on the skin, less often - flattened edematous papules, often with a cyanotic periphery; blisters form in the center of some. Blisters appear on the mucous membranes of the mouth, nose, eyes, larynx, genitals, and in the anus, which open within 2-4 days; a bleeding erosion is formed with fragments of the blisters along the edge. The lips are swollen and covered with bloody crusts.

The process may be complicated by hemorrhagic rashes, nosebleeds, purulent conjunctivitis, and corneal ulceration. The resulting toxicosis can cause cardiovascular and pulmonary failure, nephritis, etc.

The diagnosis is based on a characteristic onset, a severe general condition, the presence on the skin of at least single rashes typical of exudative erythema, the absence of acantholytic cells in the imprint smears, and a negative Nikolsky sign.

Treatment. Corticosteroids, starting with 60 mg of prednisolone or 9 mg of dexamethasone daily, plasmapheresis, hemodesis 100-150 ml every other day or the introduction of a 30% solution of sodium thiosulfate 10-15 ml, calcium preparations. In case of the infectious-allergic nature of the disease, it is advisable to add broad-spectrum antibiotics and salicylates; in the presence of hemorrhagic syndrome - vitamins P, K, ascorbic acid, calcium supplements.

Apply 5% dermatol ointment externally; rinsing with a 2% solution of boric acid, a solution of furatsilin (1:5000), in the presence of conjunctivitis, use drops containing 1% hydrocortisone, sulfacyl sodium, etc. As the process improves, the daily dose of corticosteroids is gradually reduced, treatment is stopped after clinical recovery.

The prognosis is good: the disease lasts 2-3 months, no relapses are observed.