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Stevens Johnson Syndrome

SJS Or TEN Can Be Caused By An Allergic Reaction To Drugs

SJS is the abbreviation for Stevens Johnson Syndrome , a potentially deadly skin condition frequently caused by a drug reaction. This distinct disease was named after the two who identified its unique appearance in 1922 - Stevens and Johnson. These lesions typically appear on the face and trunk, together with severe conjunctivitis. They are flat and irregular, in contrast to erythema multiforme (EM).

 , a potentially deadly skin condition frequently caused by a drug reaction. This distinct disease was named after the two who identified its unique appearance in 1922 - Stevens and Johnson. These lesions typically appear on the face and trunk, together with severe conjunctivitis. They are flat and irregular, in contrast to (EM).

Recent medical literature describes a controversy of naming related to these two serious disorders. The latter was first described in 1860 - an acute, but self-limited (resolves with time) disorder involving target-shaped, or bulls’ eye shaped, skin lesions appearing on the extremities first. These resolve in a benign manner and were often associated with virus infection, after exposure to Epstein-Barr for example. One variation identified now includes ulcers in the mouth, bullous EM, and further clarifies the nomenclature.

However, in contrast to EM, Stevens Johnson  can be life-threatening. In 1950, medical literature conflated the two as variations of the same disease, calling them “minor” and “major” forms of EM, respectively. Later research into their causes and their different symptoms led to their being disassociated.

One disease which does overlap, in having similar precipitating factors, lesions, and clinical patterns, and is now considered to be the more severe form of the same disorder is: toxic epidermal necrolysis, or TEN . This was first described by Lyell in 1956, so it has sometimes been called Lyell’s disease. A patient is diagnosed with this when these lesions cover more than 30% of the body, and diagnosed with SJS  when it is less than 10%. Allergic reactions and TEN  combine to pose a very serious mortality risk, and often cause extreme pain.

Though these extreme diseases are sometimes linked to viral infection, they are most often linked to an immune response.  A range of drugs have triggered the Stevens-Johnson drug allergy , including Sulfonamides (Sulfa drugs) as the most common trigger, accounting for approximately 30% of cases, followed by anticonvulsants (including Phenytoin), and a wide range including commonly-used pain relievers (analgesics) like acetaminophen, antibiotics (Aminopenicillins and Tetracycline), and Barbiturates. Children’s Motrin has also been linked to the serious disorder.

Allegations that some drug companies know about the risk for drug toxicity and skin affecting conditions have led to lawsuits. Pfizer is reported to have known about the Bextra adverse drug reaction  and the Bextra-Stevens Johnson Syndrome connection. The Food and Drug Administration (FDA) recalled this Cox-2 inhibitor in April 2005.

Doctors understand the drug allergy to be a result of abnormal metabolism. Scientists hypothesize that in some people, the immune system processes drugs in a way that produces excessive toxic metabolites, which are molecules that then bind to the proteins in our epithelial (skin) cells and cause the immune response of cell death (necrolysis). The epidermis seems to disappear, through death of keratinocytes (cells which hold the epidermis and dermis together) and the loss of this protective barrier leads to death in 5% of cases. The mortality risk is directly proportional to the percentage of the skin affected. Sepsis from infection, following the loss of the skin, is the ultimate cause of death.

The elderly are more at risk, by virtue of their increased chance to be prescribed the allergy-causing drugs. Medical evaluations of skin lesions always include questions as to whether one has begun a new drug within two months prior to signs of the illness.

Because these conditions can be fatal, it is crucial to understand information about its symptoms in order to act quickly and seek medical attention. The success of treatment can be affected by reaction time, since the body’s susceptibility to complications increases as the protective barrier dissolves. After consulting with a doctor about possible medication allergies, legal action may help recover compensate the victim, or their loved ones if the reaction resulted in death from the terrible combination of a drug reaction and Stevens Johnson . Contact legal representation to learn more about filing suit - especially from Bextra, or to learn more about the Dilantin side effects lawsuit .

 

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