From the Guidelines
Yes, doxycycline can cause Stevens-Johnson Syndrome (SJS), though it is a rare adverse reaction. SJS is a serious, potentially life-threatening skin reaction characterized by fever, skin pain, and widespread blistering of the skin and mucous membranes. Doxycycline belongs to the tetracycline class of antibiotics, which have been associated with severe cutaneous adverse reactions including SJS, as noted in the British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) 1. If you're taking doxycycline and develop symptoms such as unexplained skin rash, fever, flu-like symptoms, blistering or peeling skin, painful sores in the mouth, eyes, or genital area, you should seek immediate medical attention and discontinue the medication.
The mechanism behind doxycycline-induced SJS involves an immune-mediated hypersensitivity reaction where the drug triggers an abnormal immune response targeting skin cells and mucous membranes. Patients with a history of allergic reactions to tetracyclines or other medications should inform their healthcare provider before starting doxycycline therapy. Alternative antibiotics may be considered for patients with previous SJS reactions to any medication. The U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016 provide recommendations for the management of SJS/TEN, including the immediate discontinuation of the culprit drug and supportive care 1.
Key points to consider include:
- SJS is a rare but potentially life-threatening condition
- Doxycycline can cause SJS as a rare adverse reaction
- Immediate discontinuation of the medication and medical attention are necessary if symptoms occur
- Patients with a history of allergic reactions should inform their healthcare provider before starting doxycycline therapy
- Alternative antibiotics may be considered for patients with previous SJS reactions.
From the FDA Drug Label
Skin: toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, maculopapular and erythematous rashes. Doxycycline can cause Stevens-Johnson syndrome, as stated in the drug label 2. This is a serious and potentially life-threatening adverse reaction.
From the Research
Doxycycline and Stevens-Johnson Syndrome
- Doxycycline has been reported to cause Stevens-Johnson syndrome (SJS) in rare cases, as seen in a case study published in 2007 3 and another in 2011 4.
- SJS is a severe cutaneous adverse reaction that can be triggered by medications, including antibiotics like doxycycline.
- The exact mechanism of doxycycline-induced SJS is not fully understood, but it is thought to be an immune-mediated reaction.
Treatment of Stevens-Johnson Syndrome
- The treatment of SJS typically involves supportive care and the use of systemic corticosteroids, as reported in studies published in 1992 5 and 1994 6.
- Other treatments, such as intravenous immunoglobulins (IVIG) and cyclosporin, have also been used, but their effectiveness is not well established, as noted in a review published in 2022 7.
- The use of corticosteroids in the treatment of SJS remains controversial, but some studies suggest that they may be beneficial in reducing mortality and improving outcomes.
Key Findings
- Doxycycline can cause SJS in rare cases, highlighting the importance of monitoring patients for signs of this condition.
- The treatment of SJS typically involves supportive care and the use of systemic corticosteroids, but other treatments may also be effective.
- Further research is needed to fully understand the causes and treatment of SJS, as well as the role of doxycycline in triggering this condition.