From the Guidelines
Stevens-Johnson Syndrome (SJS) typically starts with flu-like symptoms such as fever, sore throat, cough, and fatigue before progressing to skin manifestations, with the initial skin eruptions usually appearing on the face, neck, and upper torso, as well as mucosal involvement, particularly in the eyes, mouth, and genital areas, as noted in the British Association of Dermatologists' guidelines 1. The disease process often begins with a prodrome of systemic symptoms, including fever, malaise, and upper respiratory tract symptoms, which can precede the skin eruption by several days, as described in the U.K. guidelines for the management of SJS/TEN in adults 1. Key features of SJS include:
- A prodrome of fever, malaise, and upper respiratory tract symptoms
- Initial skin eruptions on the face, neck, and upper torso
- Mucosal involvement, particularly in the eyes, mouth, and genital areas
- Painful red or purplish patches that quickly develop into blisters
- Cutaneous pain as a prominent early feature, alerting the physician to incipient epidermal necrolysis, as noted in the study by Revuz et al. 1. The progression from systemic symptoms to mucosal and skin involvement typically occurs rapidly, usually within 1-3 days, making early recognition of these initial symptoms crucial, as SJS is a medical emergency requiring immediate discontinuation of any suspected triggering medications and prompt medical attention to prevent complications, as emphasized in the British Association of Dermatologists' guidelines 1.
From the FDA Drug Label
The most common adverse reactions are gastrointestinal disturbances (nausea, vomiting, anorexia) and allergic skin reactions (such as rash and urticaria) Fatalities and serious adverse reactions, including severe cutaneous adverse reactions (SCARs), including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), acute febrile neutrophilic dermatosis (AFND), acute generalized erythematous pustulosis (AGEP); Allergic Reactions:Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, allergic myocarditis, erythema multiforme, exfoliative dermatitis, angioedema, drug fever, chills, Henoch-Schoenlein purpura, serum sickness-like syndrome, generalized allergic reactions, generalized skin eruptions, photosensitivity, conjunctival and scleral injection, pruritus, urticaria, rash, periarteritis nodosa, systemic lupus erythematosus, drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized erythematous pustulosis (AGEP), and acute febrile neutrophilic dermatosis (AFND)
The FDA drug label does not answer the question.
From the Research
Stevens-Johnson Syndrome (SJS) Onset
- SJS is a mucocutaneous reaction typically brought on by medications or infections 2.
- The diagnosis of SJS is typically made when patients present with a variable appearing rash and involvement of the oral, ocular, or genital mucosa 2.
- Mucous membrane involvement was documented in 61% of patients, with ocular involvement seen in 39% 3.
- The most frequently implicated infectious agent was herpes simplex virus (19.7%), while the drugs most commonly identified as aetiological agents were sulphonamides and penicillins (26% each) 3.
- SJS can be triggered by various factors, including antibiotics, nonprescription medications, and vaccinations 4, 5, 6.
- A real-world pharmacovigilance study found that antibiotics such as amoxicillin, piperacillin, ceftriaxone, and sulfamethoxazole are associated with an increased risk of SJS/TEN 6.