Stevens-Johnson Syndrome (SJS): Effectiveness of Corticosteroids in Management and Recurrent SJS

Abstract

To confirm that corticosteroids are beneficial in the treatment of Stevens-Johnson syndrome (SJS), 15 patients with the syndrome were evaluated by the same group of physicians over 2 years. All pat ients had cutaneous and most had mucosal lesions. Patients were treated with corticosteroids rangingfrom prednisone 40 mg daily to methylprednisolone 750 mg daily. The same group of physicians participated in the management of these patients until recovery. No deaths occurred among the 15 patients. Recovery was complete in all cases, and there was no residual skin, mucosal, or visceral damage except for minimal scarring in one patient. In some cases, reversal of disease after onset of corticosteroid therapy was sufficiently dramatic to demonstrate a benefit. The use of corticosteroids in the treatment of SJS remains controversial. We conclude that corticosteroids are beneficial in treatment of the syndrome. They may be lifesaving in some patients and should be the standard of therapy. SJS should be considered to be erythema multiforme with either bullous lesions or visceral involvement or both. (AllergyProc. 13, 2:89-95, 1992)

Nimesulide induced Stevens Johnson Syndrome: a case report

“…Treatment consists of prompt withdrawal of suspended drug, appropriate symptomatic medication, fluid replacement and wound care. 9 At present, there is no uniform strategy for management of SJS and administration of corticosteroids is controversial. 10 The popular belief is that corticosteroids suppress the intensity of reaction, control the extension of necrolytic process and prevent damage to internal organs when given at an early stage.…”

“…10 The popular belief is that corticosteroids suppress the intensity of reaction, control the extension of necrolytic process and prevent damage to internal organs when given at an early stage. 9 Antiseptic/antibiotic eye drops should be liberally used on ocular lesion. Topical antiseptic like 0.5% silver nitrate/ 0.05% chlorhexidine are used for skin lesions to prevent secondary infection.…”

Recent advances in the genetics and immunology of Stevens-Johnson syndrome and toxic epidermal necrosis

“…Dexamethasone pulse therapys has been reported for reducing the mortality rate in SJS/TEN without increasing healing time when given at the early stage of disease onset [66]. Systemic corticosteroids with a high dose are considered to be able to suppress the intensity of immune reaction, control the extension of the necrolytic process, decrease the injury area, reduce fever and discomfort, and prevent damage to internal organs in SJS/TEN patients at the early stage [67]. Yet, its immunosuppressive functions may cause deleterious effects on the outcome, decreased host resistance, increased morbidity and complications, such as sepsis, leucopenia, gastrointestinal ulcerations, and prolonged recovery for skin healing.…”

Controversy in the Use of High-Dose Systemic Steroids in the Acute Care of Patients With Stevens-Johnson Syndrome

“…Could methylprednisolone work better than prednisone, which we saw earlier in some case reports? 44 n Discussion…”