Stevens-Johnson Syndrome

Stevens-Johnson syndrome (SJS) is a severe, T-cell-mediated hypersensitivity reaction. Activated cytotoxic T cells trigger widespread apoptosis and necrosis of keratinocytes, so the epidermis separates from the underlying tissue and the protective barrier fails. That single mechanism explains several urgent problems at once. Damaged skin loses fluid, electrolytes, protein, and heat. Raw surfaces become painful and vulnerable to infection. Mucosal injury causes erosions in the mouth, eyes, genitals, urinary tract, and sometimes the respiratory tract; swallowing, urination, vision, and breathing can all be affected. SJS is not a pressure injury, an ordinary drug rash, or a superficial wound-care problem. The nurse’s first clinical question is, “Could this be a rapidly evolving medication reaction with mucosal and barrier failure?” A patient who reports that the skin hurts before it looks severely damaged deserves particular attention. Pain and skin tenderness can precede obvious blistering or detachment. An RPN contributes by identifying the pattern, obtaining a precise medication history, trending the patient’s condition, carrying out ordered care, and escalating changes promptly. Assessment and medication actions must remain within provincial scope, local policy, and the...