What happens to the skin and how the forms differ
It is based on an immune reaction in which T-lymphocytes attack the cells of the upper layer of the skin. The epidermis dies and separates from the underlying tissues, forming blisters and extensive wound surfaces. At the same time, the mucous membranes of the mouth, eyes, respiratory tract and genitals are affected. Through damaged skin, fluid and protein are lost, infection easily attaches - this is what determines the severity of the condition. Both forms are considered variants of the same process and differ only in prevalence.
- Stevens-Johnson syndrome: detachment of up to ten percent of the body surface
- Transitional form: from ten to thirty percent
- Lyell's syndrome (toxic epidermal necrolysis): more than thirty percent
- Involvement of at least two mucous membranes is a typical sign
- The larger the area, the higher the risk to life
What triggers the reaction
The vast majority of cases are drug-related, with reactions usually occurring in the first weeks of taking a new drug rather than after years of use. The danger does not depend on the dose: it is not an overdose, but an individual immune reaction. In children and young people, the provoking factor is often an infection. It is important that repeated use of the same drug can cause an even more severe episode, so the name of the culprit drug should be written down on the statement.
- Anticonvulsants
- Sulfonamides and some antibiotics
- Drugs to lower uric acid levels in gout
- Nonsteroidal anti-inflammatory drugs
- Infections: mycoplasma pneumonia, herpes simplex virus
- Sometimes the cause cannot be determined
Symptoms: how to recognize in time
One to three days before the rash, signs similar to a cold appear: fever, weakness, sore throat, burning eyes. Then painful red or purple spots appear on the face and torso, often with a dark center. The spots merge, flaccid blisters form on them, which quickly open. The mucous membranes are almost always affected: the lips become covered with bloody crusts, eating and drinking becomes very painful. Any combination of rashes and mouth ulcers associated with a new medication is a reason to immediately seek help.
- Fever and malaise before the rash
- Burning and redness of the eyes, photophobia
- Painful spots and blisters on the skin
- Bloody crusts on the lips, mouth ulcers
- Pain when urinating due to erosions
- Skin peeling when touched
Diagnosis and severity assessment
The diagnosis is made primarily by the clinical picture and in connection with the medication, so treatment is started without waiting for test results. In the hospital, a list of all medications for the last two months, including over-the-counter ones, is restored in detail. The affected area is assessed in the same way as for burns. Tests are needed not to confirm the diagnosis, but to monitor the severity: fluid loss, kidney function, signs of infection. In doubtful cases, a skin biopsy is performed.
- Detailed drug history over the past weeks
- Assessment of the area of epidermal detachment
- Complete blood count, electrolytes, creatinine, urea
- C-reactive protein and cultures if infection is suspected
- Examination by an ophthalmologist on the first day
- Skin biopsy if the picture is unclear
Treatment and recovery
The first and most important action is to stop all suspected medications. Further treatment is carried out in the intensive care unit or burn department: fluid loss is replenished, pain relief is provided, body temperature is maintained, and wound surfaces are treated with non-adhesive bandages. Antibiotics are not usually prescribed prophylactically, but they are used if there are signs of infection. The question of systemic immunosuppressive drugs is decided by the doctor individually. Eyes require special care, otherwise permanent scars and dryness are possible. After recovery, the patient receives a document with the name of the prohibited drug.
- Immediate discontinuation of the offending medication
- Treatment in the intensive care unit or burn department
- Infusion therapy and pain management
- Skin care with non-stick dressings
- Daily eye care
- Lifetime ban on the drug and its analogues