Stevens-Johnson Syndrome: Diagnosis and Medications (Nursing)

00:01 Ugh, this next one I hate to even talk about.

00:04 It’s Stevens-Johnson syndrome.

00:07 Now, later on, we’ll talk about what toxic epidermal necrolysis is.

00:10 They kind of go together, but let’s just start with Stevens-Johnson syndrome.

00:16 It’s rare, but if it happens, it is a huge deal.

00:19 It’s a very serious disorder of the skin and mucous membranes that can become life threatening, and that’s because it almost acts like if it progresses and it really gets bad, it just starts like flu-like symptoms and you have these painful red and purplish rashes kind of blisters that pop up and then they peel and they form these erosions.

00:40 So, when we say erosions, that’s because when a blister breaks, you have that really sensitive skin underneath it, but it’s much worse than that.

00:48 So, they start with these kind of like flu, all over achy symptoms, then they have this really painful red or purplish rash and the skin starts to break away and the erosions are almost like a burn.

01:00 So, think about how painful it would be if you dipped your hand into boiling water and pulled it back out.

01:05 That’s what it feels like when Stevens–Johnson syndrome progresses.

01:09 It’s similar to feeling the same kind of damage from a really severe hot water burn.

01:14 It usually starts on the face and chest, but it can spread throughout the whole body.

01:19 Now, just stop and think about that for a minute.

01:22 Can you imagine seeing someone have to go through this where they first start to not feel very good, then they have these really painful sores break out, and then it just feels like they’ve been dipped in hot boiling water? It’s horrible.

01:36 And, they can also have mucous membrane damage in the throat—their airway, and swallowing and breathing becomes really, really difficult for them to do.

01:45 So, Stevens-Johnson syndrome starts with just kind of not feeling good, progresses to these horrible sores and erosions, and then they lose that protective skin covering.

01:57 And recovery can be a very, very long time.

02:01 These two syndromes, SJS and TEN (Toxic Epidermal Necrolysis) used to be considered separate conditions but now they pretty much determined that TEN is seen as like a continuum of SJS, so as Stevens-Johnson syndrome becomes more severe, it becomes Toxic Epidermal Necrolysis.

02:20 So, think about that—toxic skin death— is essentially what toxic epidermal necrolysis looks like.

02:27 So, they just end up losing all their skin.

02:30 Now, that is horrible, but I also want you to take it one step further.

02:34 My skin does a lot of things.

02:36 My skin protects me from infection.

02:39 So, if I walk through this, If I end up having this, now I am so likely to become infected, and septic, and really, really sick.

02:48 My skin helps keep everything that should be kind of moist on the inside.

02:53 You’re going to have real problems with fluid shifting if someone loses their skin.

02:57 So, it’s just as serious and life threatening as if someone had a severe burn and all of their skin was also damaged.

03:05 So, let’s talk about how this horrible thing happens.

03:09 It’s most often triggered by medications.

03:12 Now, you can also have a genetic predisposition to develop this like you’re maybe somebody’s who’s more at risk of developing it, but I’m going to show you a list of drugs that are most often associated, and let me underscore this is rare, but man, if you’re that one person it happens to, it’s a life-altering event.

03:30 So some seizure medications such as carbamazepine, lamotrigine, and phenytoin, you’ve got those listed there.

03:36 Some of those medications have been known to cause this syndrome.

03:39 Allopurinol, something that we use to treat gout or kidney stones— that’s another group of medications that have been known to cause this.

03:46 Sulfonamides—there they are again— antibiotics are both lifesaving and problematic as you can see.

03:54 Now, look at that next one, we use that to treat HIV infection and the last one is a type of NSAID medication that we use.

04:01 So, that’s a pretty varied list.

04:03 That’s a little harder for you to keep track of.

04:06 Predominately, if I really want you to narrow in on one sulfonamide antibiotics is usually the one that we see most often that causes this.

04:14 The good news is, we don’t give a lot of sulfonamides anymore because bugs have become very resistant to that type of antibiotic.