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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Diagnosed With Stevens Johnsons Syndrome. On Medication. What To Do?

my brother has been diagnosed with stefans jhonsons syndrome ,he was on an antiepilyptic drug epsolin after a vein bleed in the left temporal region,currently hes admitted in fortis hospital noida current line of treatment is ivig 30gms a day, saline water and has shown considerable improvement any advice and dos and donts???
Fri, 21 Dec 2012
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General & Family Physician,  's  Response
Hello
Thanks for your query.

Stevens Johnson Syndrome sometimes occurs in Phenytoin [Epsolin] therapy , more commonly in patients with a particular HLA-B allele, HLA-B 1502.It is thought to be a hypersensitivity reaction affecting skin and mucous membranes.Severe epidermal necrosis occurs.It is a dermatological emergency. The causative drug has to be discontinued [ Epsolin in this case]. Intravenous immunoglobulin [ IVIG] reduce the hypersensitivity reaction and improve the condition.Supportive care in form of iv fluid,pulmonary care,parenteral feeding,maintaining warm environment and symptomatic treatment in form of analgesics,topical antiseptics are the main stay.Blood electrolytes should be monitored.Patient should also be under supervision of an ophthalmologist because eye is also involved.For oral lesions antiseptic mouthwash is indicated.
Care should be taken that superinfection and sepsis does not occur.Culture of blood, urine & skin is indicated if infection is suspected which is a leading cause of morbidity in such patients.
Regular monitoring of patient's condition is needed.

I wish your brother gets well soon.
Take care.
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Diagnosed With Stevens Johnsons Syndrome. On Medication. What To Do?

Hello Thanks for your query. Stevens Johnson Syndrome sometimes occurs in Phenytoin [Epsolin] therapy , more commonly in patients with a particular HLA-B allele, HLA-B 1502.It is thought to be a hypersensitivity reaction affecting skin and mucous membranes.Severe epidermal necrosis occurs.It is a dermatological emergency. The causative drug has to be discontinued [ Epsolin in this case]. Intravenous immunoglobulin [ IVIG] reduce the hypersensitivity reaction and improve the condition.Supportive care in form of iv fluid,pulmonary care,parenteral feeding,maintaining warm environment and symptomatic treatment in form of analgesics,topical antiseptics are the main stay.Blood electrolytes should be monitored.Patient should also be under supervision of an ophthalmologist because eye is also involved.For oral lesions antiseptic mouthwash is indicated. Care should be taken that superinfection and sepsis does not occur.Culture of blood, urine & skin is indicated if infection is suspected which is a leading cause of morbidity in such patients. Regular monitoring of patient s condition is needed. I wish your brother gets well soon. Take care.