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Early Signs of Stevens-Johnson Syndrome

author image Jen Palombi
Jen Palombi is an optometrist and writer based in Ohio. She has been writing and teaching in the field of health science for more than 15 years, with work featured in numerous consumer and professional publications. Palombi frequently serves as a speaker and industry consultant on health topics nationwide. She is a fellow of the American Academy of Optometry.
Early Signs of Stevens-Johnson Syndrome
Stevens-Johnson Syndrome is a rare and serious skin disorder.

Stevens-Johnson Syndrome is a rare but serious condition in which the skin and mucus membranes -- the moist surfaces in the mouth, nose and eyes -- react severely to a medication or infection. While the later stages of the condition are characterized by painful rash, blisters and shedding of skin, the early signs are often more subtle.

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Fever and Malaise

Fever may be a sign of Stevens-Johnson Syndrome.
Fever may be a sign of Stevens-Johnson Syndrome.

According to a 2011 paper in the "Expert Review of Clinical Immunology," the earliest signs of Stevens-Johnson Syndrome, or SJS, are often fever and malaise, a vague feeling of body discomfort, such as achy joints and generalized soreness. These symptoms are similar to those of the flu and are often overlooked as being the start of the more serious SJS response. In cases involving a reaction to medication, which accounts for 75 percent of SJS cases, these flu-like symptoms usually arise within 4 to 28 days of starting the drug.

Cough and Sore Throat

Cough is often reported by SJS sufferers.
Cough is often reported by SJS sufferers.

The delicate membranes in the respiratory system can be involved in SJS and therefore an early onset cough and sore throat are reported by many SJS sufferers. The cough is typically a dry, nonproductive cough arising from increasingly irritated membranes in the airway and lungs.

Burning Eyes

Burning eyes may occur with SJS.
Burning eyes may occur with SJS.

As the moist membranes of the eyes begin to be affected, patients will notice that the eyes begin to burn; become dry, irritated and red; and may sometimes have a mucus discharge. Later in the disease, the inside of the lids may develop scars and attachments to the eye.


A rash will develop and spread.
A rash will develop and spread.

After the onset of the earliest SJS symptoms, a red or purple skin rash develops and will slowly spread and worsen over the course of hours to days. Rarely does the skin develop blisters in the early stages of SJS skin rash. The rash may also arise in the form of sores around the mouth. Later, the skin may develop blisters and will begin to detach and slough off.

When to Seek Help

If you suspect SJS contact a physician.
If you suspect SJS contact a physician.

Contact a physician immediately if you notice a pattern of symptoms similar to SJS, particularly after beginning a new medication with a known association with Stevens-Johnson Syndrome. The "Expert Review of Clinical Immunology" notes that drugs with the highest known risk for SJS are allopurinol; carbamazapine (Tegretol); trimethoprim/sulfamethoxazole (Bactrim, Septra); lamotrigine (Lamictal); nevirapine (Viramune); phenobarbital (Donnatal); and phenytoin (Dilantin). Men and women are equally likely to develop SJS, and it can affect people of all ages and races.

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