What is Stevens-Johnson Syndrome?
Stevens-Johnson Syndrome (SJS) is typically an allergic reaction to a prescription medication causing ulceration and conjunctivis of the mucous membranes (eyes, ears, nose, genitals) and epidermal necrosis. Plainly put, ulcers form in your mucous membranes and blisters cover your entire body, causing your skin to start sloughing off. SJS can be minor, affecting less than 10% of your body, or it can be severe, affecting both your skin and your internal organs.
How do I know I have SJS?
1. Red, itchy eyes
2. Blisters or ulcers in the mouth or other mucous membranes, as shown to the right
3. Blisters on the skin, often fluid-filled or itchy
These are some of the first visible symptoms of SJS. If they persist, it is important to have them looked at immediately.
What can I do to limit my susceptibility to SJS?
I cannot stress enough the importance of READING YOUR PRESCRIPTION PAMPHLETS. Know what possible side effects to look for with all of your medications. I learned the hard way that “contact your doctor if you experience a rash” was far more serious than a simple rash. Never be afraid to speak up and ask questions of your doctors and pharmacists. Susceptibility to SJS is genetic, so if a close relative has experienced SJS, be extra careful about what you put into your body.
The Mayo Clinic has put together a good list of Causes of Stevens-Johnson Syndrome. Ibuprofen is often a cause in young children, and other anti-inflammatory medications (like the anti-rheumatic Arava that caused mine) can be the trigger in older individuals.
What steps should I take once I believe I have SJS?
GO TO THE EMERGENCY ROOM! They will need to admit you to the hospital and take biopsies to verify you have SJS.
In my case, the doctors at Miami Valley Hospital tried a few things to help ease the pain, to keep infections from taking root, and to stop the SJS from being worse than it could have been.
1. They flushed my system. Twice a day for that first week, I drank this vile cinnamon-flavored drink that helped flush the offending medication out of my body. Because of the blisters and ulcers in my mouth it burned horribly, but was likely a factor in keeping the SJS from taking my life.
2. They treated me like a burn victim. When my skin began to slough off, they used a process of debridement to remove it themselves. For more than a week, they did this daily, peeling the dead epidermis away from the new, growing dermis. They kept the new skin clean, and they covered it in pig skin grafts for support. I still have small, mesh-like scars all over my body from the impressions the grafts left, but they aren’t noticeable to the naked eye. What’s more, they did not have to do any skin grafts, placing skin from one part of my body onto another. My own skin was allowed to heal naturally.
3. They kept my eyes shut. Now that I know more about the effects of SJS, I know that amniotic membrane grafts might have saved my sight entirely. These are HIGHLY recommended. I now visit Dr. Scheffer Tseng, the ocular surface innovator who created the amniotic membrane graft and other surgeries, for my eye condition. These grafts help SJS patients around the world keep their vision. However, this information had not yet made it to the hospital where I was being treated. The hospital brought in an eye specialist, and he kept a steady routine of eye drops and salves, along with keeping my eyes closed for the first two weeks. These practices helped to save my corneas. The epithelium (eye skin) was scratched off, but I still have perfect corneas. Keeping the eyes maintained and free from scarring is key to living a full life after SJS!
4. They tried EVERYTHING. As a broke college student, one of my main morphine-assisted concerns in the hospital was that everything would be costly. And let me tell you, it was. Very costly. However, every dime was well spent. I was fortunate to have my family at my side. They insisted on on the doctors ignoring my frets over money and instead ushered in all forms of possible cure. One experimental drug cost $15,000 per IV bag. I got two! At the time, I was mortified to know that a medication could have instead bought me a car (or ten), but afterward I recognized that it probably stopped the SJS from being worse than it was. I highly advocate doing thorough research on what the doctors want to try, but I also suggest being open to things that might not yet be totally proven. Medicine is an ever-growing, ever-innovating field.
5. They kept my toes from growing together! When the epidermis is removed and the dermis is growing back, it can have a tendency to grow together, causing abnormalities like webbed feet and hands or even fused labia. Be aware of the new skin growing in ways it shouldn’t. Checking daily on areas where the skin folds or sits closely to another limb is vital. Only surgery can correct this once it has occurred.
6. They made sure my legs were moving. While this could not always be done, due to the immense pain friction caused to my open wounds, the nurses kept vibrating pads on my legs to keep the circulation flowing. As soon as I was able to sit up, they sent in a physical therapist to begin working with me, and in a few days I’d mastered climbing stairs again. Unfortunately, my time in the bed did lead to a blood clot, but I trust that the hospital did all they could to avoid it. Any type of movement is excruciating when your skin has sloughed off, but sitting still for too long can have dire consequences. In addition to the clot, I formed bed ulcers on my heels from where they rested on the bed. An orthopedist made me two sets of special shoes: one for lying in bed and one for walking. Again, keeping some movement is vital.
7. They brushed my hair. It might seem silly, but after the first week in the hospital, my beautiful long hair was impossibly knotted. I had very minimal human contact in the first two weeks, but after it was safe to touch me, my grandfather and the nurses took turns trying to untangle my hair. It was terribly sweet and kept me from having to chop it all off!
Below are some websites that might offer some more insight into treatments:
Stevens Johnson Syndrome Foundation – Bringing light to the abyss of ignorance.
Ocular Surface Center – Dr. Scheffer Tseng’s website & research
What can I do to help my recovery?
First and foremost, you must allow your skin to recuperate. I had to stay out of direct sunlight for six months. Between the floppy hats and gloves, I’m pretty sure I looked like the fashion child of Michael Jackson and Elizabeth Taylor. But my skin is beautiful now, especially the skin on my face. The one place I don’t have a single scar is my face. This is probably because we kept it thoroughly oiled, medicated, and ointmented for months after my release from the hospital. I had to fight a nasty battle with acne once all that was done, but I won the battle easily and have a gorgeous glow to my cheeks to show for it. I would NOT, however, recommend SJS in the place of a well-timed chemical peel.
Second, eye care is essential. I pretty much lived in sunglasses for two years after SJS. Immediately seek out an ocular surface and corneal specialist. Many people are left blind or near blind after SJS. Seek out the best. Your sight and your future depend on it. In addition to amniotic membrane grafts, I have also already undergone surgeries to resurface one of my eyelids and to replace the epitheleum on my right eye. During my SJS, the stem cells that create clear epitheleum on my right eye were destroyed, so my eye surgeon used membrane from my cheek to replace the lost epitheleum. For a brief time I had sight again in both eyes, but complications from my RA soon caused inflammation and scarring to cover my sight again. Beyond Dr. Tseng’s brilliant surgical solutions, the Boston Foundation has done amazing work for SJS patients. I have personally been considering a consultation for a scleral lens to help with dryness and continued friction from eyelid scarring.
Next, do some research to discover if you can be compensated for your losses. SJS does not appear on many medication labels. And often, doctors will not inform you of this potential side effect. SJS is becoming less and less rare, meaning that more lawyers are trying to fight the pharmaceutical companies that release their drugs without properly testing them first. Keep your original medication bottle. Keep the original pamphlet that came with the medication. Make sure you have the hospital records that clearly state that medication as the cause of your SJS. Fight!
Possibly the most important thing you can do after returning home from the hospital, though, is finding support. The grief of losing the life and the face you had before SJS can be overwhelming. I would not be the strong, independent woman I am today without the love and emotional support of my family and friends. I reached out to my community and found willing souls to share my story with, people who would accept me–scars and all. One year after SJS I was able to return first to work, and then to school. And five years following the incident, I now lead what I consider to be a normal life. My support system helped me to get here. There will be times when you feel like giving up, and there will be times when you feel like a burden, but your family and friends are the ones who will see you through to the good days again. Keep your chin up! You’ve already lived through one of the worst pains life can offer.
Again, here are some ideas that might help your recovery process:
Boston Foundation for Sight – Restoring sight | Reclaiming lives
Google – Try typing in your city, then “Stevens Johnson support group” or “Stevens Johnson lawyers”