Stevens-Johnson syndrome is an extremely serious serious disease, which is considered to be a subspecies of allergic effects, as most often it is thanks to them that the disease develops. This anomaly is quite shocking to the body, since as a result of the manifestation of Stevens-Johnson syndrome, a certain, rather large percentage of the skin is affected in patients.
Skin carries in itself important barrier and protective functions, and also participates in maintaining the balance of immunity. When the integrity of the cover is violated and its partial necrotic lesion, the gate opens to enter the body of numerous infections. Thus, the shock status of Stevens-Johnson syndrome is complicated by a massive infectious disease of the body. By the way, it is the infectious complication of Stevens-Johnson syndrome that often causes death of patients with this anomaly.
The Stevens-Johnson Syndrome
Most often Stevens-Johnson syndrome is caused by drugs. The number of such cases is 85% of the total incidence of this syndrome.
The main drugs - causative agents of Stevens-Johnson syndrome are, of course, antibiotics: sulfonamide antibiotics and antibiotics of a number of cephalosporins. Also Stevens-Johnson syndrome causes excessive use of ointments, where diclofenac sodium is contained. In addition, preparations of a number of carbamazepines and antibiotics, ampicillins, have the same action.
Therefore, it is extremely important to prescribe the therapy with the above mentioned drugs to take into account the possible sensitivity to the body and prescribe clearly defined doses, not to abuse their quantity.
In addition to antibiotics, Stevens-Johnson syndrome can cause and special series of antiepileptic drugs. Some sedatives can also be put into a series of drugs - provocateurs of the Stevens-Johnson syndrome.
Interestingly, in some patients, Stevens-Johnson syndrome can occur without taking the above medications. In a very small percentage of patients, this syndrome occurs due to the invasion of bacteria, food allergens, ingestion of pathogenic chemical compounds. Stevens-Johnson syndrome may even develop after vaccination, as a result of an increased allergic response of the body to new and other substances - antibodies.
Allergic cause of occurrence plays a key role, due to which there is Stevens-Johnson syndrome in children. Like most serious illnesses, for a small child this syndrome is extremely painful. Infants with Stevens-Johnson syndrome have the appearance of "scalded with boiling water" - so terrible and scale necrosis of the skin in this syndrome in children.
The main pathogenetic causes of the manifestation of Stevens-Johnson syndrome are unknown until now. It is known only that the body sharply increases allergic activity. T-lymphocytes with cytotoxic abilities are activated: these cells are literally filled with active substances that can destroy foreign cells. But the thing is that with Stevens-Johnson syndrome all aggressive activity is aimed at their own body structures, namely the skin. These toxic lymphocytes attack the components of the skin, the cells - keratocytes. Keratocytes, under the influence of toxic substances for them, are destroyed, and a coronary phenomenon occurs in Stevens-Johnson syndrome: the skin is defended and literally departs from its base.
It should be noted that the Stevens-Johnson syndrome develops very quickly. The rapidity of its manifestation is provided by certain hypersensitivity reactions of the organism, which trigger the appearance of this anomaly.
By the way, in addition to variants of Stevens-Johnson syndrome with established triggering factors, there are also those where the cause of the syndrome can not be established at all. Such forms, usually characterized by a higher rate of their appearance and more severe lesions.
Stevens-Johnson syndrome symptoms
It is interesting that from the time of the action of the triggering cause and to the full development of all the signs of Stevens-Johnson syndrome, it can take as long as 1 day, or several weeks. Everything will depend directly on the level of reactivity of the human immune system: the more "urged" it is, the faster Stevens-Johnson syndrome will appear.
The symptomatology of Stevens-Johnson syndrome has its coronary, basic manifestations and additional signs.
The main manifestations, of course, will be skin lesions. On the skin there are certain localized lesions - bullae or bubbles. Their main feature will be that if you touch them with any object, the skin will immediately begin to exfoliate. But these bubbles do not appear immediately. First, in some areas of the skin there will be an itch and a rash, in which there will be both spots and towering papule elements. Such a rash is also called korepodobnoy, because it is similar to that in the manifestation of measles.
Then this rash gradually turns the blisters with a flaccid, tumble-in lid. The skin near and from these blisters can leave whole layers, as with a severe burn. Under the descended skin, a red surface appears, which can become wet.
The first elements of skin lesions in Stevens-Johnson syndrome appear on the face and limbs. In a few days they spread and merge. But, and this is an important diagnostic feature - almost hairy areas of the head and palms with soles are practically not affected. The strongest manifestations of Stevens-Johnson syndrome will be located precisely on the limbs and trunk.
Skin lesions with Stevens-Johnson syndrome are extremely large. They can imitate the picture, as if the skin is hit by a burn at least a 2nd degree. The most affected are those parts of the skin that are exposed to pressure and friction clothing.
But if the time is right and properly prescribed treatment, then the affected areas are restored. Their complete healing will take about 3 weeks. Again, it should be remembered that areas subject to pressure and areas of integument of natural openings will heal longer.
The second typical lesion in Stevens-Johnson syndrome is mucous. The majority of patients on the lips have multiple painful erosions and redness ( erythema ). The mucous membranes of the external genitalia and the area around the anus also suffer.
It must also be said that the third "crown" sign of Stevens-Johnson syndrome will be pain. Pain syndrome is expressed so much that even at the initial stages of this syndrome patients experience severe pain even with a slight pressure on the unaffected skin bordering on the lesion.
Stevens-Johnson syndrome in its most difficult stages can cause a number of complications. The first is, of course, the attachment of infectious agents. Damaged skin can no longer protect its body, and therefore, it is extremely freely located various microbes.
The second complication of Stevens-Johnson syndrome is severe eye damage. There may be a fusion of the conjunctiva of the eyelid and the eyeball, the corneal vessels may proliferate, or the curvature of the affected eyelid may appear.
The third complication is the appearance of skin complications. On the healing skin, permanent scarring can occur, as well as benign formations. And if the pathological process is localized next to the nails, then they can later lose the ability to grow or even fall out.
Stevens-Johnson Syndrome Diagnosis
The main symptom of Stevens-Johnson syndrome will be Nikolsky's syndrome. It says that if you touch the skin next to the pathological bulla (bladder), then it will easily begin to exfoliate.
In addition, it is important to establish a connection between the acceptance of a certain starting substance by man and the development of the disease. It is also important to take into account the localization of lesions - with Stevens-Johnson syndrome, only the skin of the face and limbs will be affected.
You can make a biopsy of the skin area and see in it the characteristic changes: necrosis of epidermal cells, subcutaneous nucleation of bullae and numerous infiltration of the affected skin area with lymphocytes.
In addition, bacterial pathogens are isolated from the necrotic discharge. Most often this is already done in order to find the sensitivity of bacteria to certain medications and to prescribe the correct antibiotic.
In addition to the above methods, a common blood test for all patients will be a blood test. There will be signs of inflammation, and sometimes an increase in the number of certain cells-leukocytes. It is their increase that will speak of a massive allergic reaction in the body.
A special immune panel can also be prescribed. It can be found increasing the number of individual immune cells. Including those described above, tropic to skin cells, T-lymphocytes.
Stevens-Johnson syndrome treatment
Stevens-Johnson syndrome requires urgent treatment. This is a serious emergency and every minute of delay brings the patient closer to the possible development of severe complications.
Stevens-Johnson syndrome is not treated under the usual conditions or conditions of separation of therapy: patients are transferred to the burn department or intensive care unit and there they perform their treatment.
The first line of therapy for Stevens-Johnson syndrome is corticosteroids. These are substances with extremely powerful effects and it is this effect that can help stop a massive allergic reaction in the body, which is the primary cause of the development of Stevens-Johnson syndrome. It is best to inject injectable versions of these drugs: they can have a faster time action. Most often, the syndrome is treated by such representatives of the group of corticosteroids as Prednisolone and Dexamethasone.
In addition to the immediate and rapid therapy of Stevens-Johnson syndrome with corticosteroids, electrolyte solutions are prescribed. Like corticosteroids, these solutions are better to be prescribed as droppers, where the drug will be injected (with a large amount of the substance in 1 minute).
Since the Stevens-Johnson syndrome affects a certain amount of skin, then there may be bacterial complications. In order to stop their manifestation, antibiotics are prescribed additionally to the main therapy regimen. It is important to know that antibiotics are selected individually for each case of the disease, taking into account the indices of the organism's tolerance to the effect of the drug.
In addition to the general treatment of Stevens-Johnson syndrome, local treatment is performed, which consists in the correct toilet and skin care and the correct gentle removal of the remains of necrotic skin. In this good help will be solutions of antiseptics. Most often these are solutions of hydrogen peroxide and manganese (potassium permanganate).
In addition to the above methods of treatment, there is another important method. This is the identification of the cause that triggered the development of Stevens-Johnson syndrome and its removal from the circle of constant exposure to humans. So, for example, with Stevens-Johnson's drug syndrome, you need to find a drug with a harmful effect and completely eliminate it from human consumption in the treatment regimen.
Patients must necessarily adhere to a strict diet, aimed at reducing the highly-allergenic status of consumed products. It is forbidden to eat citrus, sweets, sweets, any sorts of chocolate and fish.