What is the relationship between herpes and Stevens-Johnson syndrome?

M.E.

Stevens-Johnson syndrome is a serious inflammatory disorder primarily involving the skin. It is similar, only far worse in severity, to a skin rash called "erythema multiforme." The classic rash of erythema multiforme looks like a red bull's-eye target. However, a variety of other skin lesions can be present -- hence the name "multiforme" (many forms). Some experts divide erythema multiforme into major and minor types, with the major type also called Stevens-Johnson syndrome. Stevens-Johnson syndrome involves much more of the body, particularly the mouth, as well as the eyes, genitals and in some cases even internal organs. In the severest cases of Stevens-Johnson syndrome, there may be liver damage, kidney damage and severe skin loss leading to infection, fluid loss and even death.

Usually, Stevens-Johnson syndrome is an inflammatory reaction to a drug. Sulfa antibiotics and seizure medications are some of the more common culprits. Occasionally, Stevens-Johnson syndrome follows herpes infections, but that is pretty rare. However, most cases of erythema multiforme minor are related to herpes simplex infections. A person gets oral or genital herpes sores and at the same time develops scattered skin lesions over part or most of the body. There may also be fever, headache and a few sores in the mouth.

Treatment of these two disorders is controversial. Some physicians prescribe steroid anti-inflammatory drugs such as prednisone, especially for severe cases. Most of the studies examining this treatment have not shown much benefit. I do not use steroids unless the patient is quite ill.

There is no way to predict who will get these syndromes after a herpes infection or after taking a new medication. However, some people develop erythema multiforme and rarely Stevens-Johnson syndrome with each recurrence of oral herpes. In these patients, we typically prescribe medication to prevent the recurrences of herpes. Acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex) are taken for this purpose.