Ayurvedic Treatment of Stevens-Johnson Syndrome

Introduction

Stevens-Johnson syndrome is a severe skin reaction most often triggered by certain medication. Most commonly it occurs due to severe reaction of any medicine you have taken. Stevens-Johnson syndrome is a less severe condition than toxic epidermal necrolysis. Few years ago they were thought to be different conditions but now come under same disorder. SJS most commonly involve skin and mucus membrane. SJS starts with fever and flu like symptoms. After few days there is blister formation which leads to peeling of skin. This blister later on converts into very painful erosions which feel like hot-water burn. SJS is a life threatening disease because skin normally acts as protective barrier and extensive skin damage leads to loss of fluid and allow infections to develop.

Stevens-Johnson Syndrome in Ayurveda

In ayurveda SJS comes under autoimmune disease. There is wrong reaction of our body’s immune system against our body. Our immune system keeps us disease free. It identifies all foreign bodies which come in contact with our body and block or destroy them. Ayurveda suggests that our immune system attacks body’s own cell not accidentally but it is a body’s reaction against harmful metabolites (ama). According to ayurveda digestive system plays a major role, weak digestion leads to accumulation of incompletely processed metabolites. Accumulations of ama in body leads to autoimmune diseases depending on the part of body involved. In SJS skin and mucus membrane is involved.

Who Are More Prone To Sjs?

SJS is a rare disease affecting 1 to 2 million people per year. SJS is more common than toxic epidermal necrolysis. People who are HIV positive and those who are suffering from chronic inflammatory disease called systematic lupus erythematosus are more likely to develop SJS than general population. The exact reason behind this disease is still unknown, but immune system factors and certain medicines may play a vital role in development of SJS.

Causes

Genetic changes are mainly associated with SJS. There are antigen (HLA) complex. This gene helps to distinguish body’s own protein than protein’s made by invading body (such as bacteria and viruses). This gene basically helps in allowing each person’s immune system to react to a wide range of high proteins. These variations of genes occur more often in people with SJS. Hence HLA-B gene reacts abnormally to certain medications which lead to SJS. Due to immune systems abnormal response, T cells and natural killer cells produces a substance called granulysin which destroy skin cells and mucous membrane. The death of these cells causes blistering and peeling of skin which are main characteristics of SJS. Most people with genetic variations that increase risk of SJS never develop the disease, even if they are exposed to drugs that can trigger it. There are rare genetic factors and non genetic factors most of which are not known yet are responsible for development this disease. The drugs more often associated with SJS include several medications which are used to treat various conditions. In adults Steven- Johnson syndrome is caused by an adverse reaction to medicines. The medicines that most commonly cause Steven- Johnson syndrome are:

1. To treat seizures (particularly carbamazepine, lamotrigine, and phenytoin) allopurinol this is used to treat kidney stones and gout
2. A group of antibiotics sulfonamides
3. Nevirapine which is used to treat HIV infections
4. NSAIDS (non steroidal anti inflammatory drugs) oxicams.
5. Phenobarbital
6. Steraline
7. Sulfasalazine
8. Pain killers such as acetaminophen, ibuprofen and naproxen sodium.

Associated Diseases which Leads to SJS

1. Flu
2. Mumps
3. Coxsackie virus which causes Bornholm disease
4. Epstein- Barr virus, which causes glandular fever

Less commonly bacterial infections can also trigger SJ.

Symptoms

Skin pain is most common symptom of Stevens – Johnson syndrome. Flu like symptoms is present during initial stages, and may develop:

1. Sore throat and mouth
2. Lack of energy
3. Cough
4. Joint pain
5. Headache
6. High grade fever
7. Facial swelling
8. Swollen lips
9. Burning eyes
10. Blister formation on skin
11. Shedding of skin after blister formation

After few days there is development of a rash which is darker in the middle and lighter on the outside. Rash is not itchy usually and it takes hours and days to spread over body.
Later on this rash is converted into large blisters which leave painful sores after bursting. The membrane inside mouth, throat, eyes and genital tract may also become blistered and ulcerated. This leads to painful swallowing and dehydration and weight loss. The surface of eyes is also affected which leads to corneal ulcers and vision problems, if not treated quickly.

Risk Factors

Risk factors of in Stevens- Johnson syndrome include:

1. Viral Infections– Viral infections such as herpes, hepatitis, viral pneumonia or HIV
2. A Weekend Immune System – as a result of autoimmune diseases, HIV, AIDS, lupus or certain treatment such as chemotherapy and organ transplants.
3. A Previous History of Stevens– Johnson syndrome- If syndrome was previously caused by medication. You are at a high risk of it reoccurring if you take the same medicine again.
4. A Family History – If you have family history of this disease, you are at high risk of getting this disease.
5. Specific genes have also been identified that increase the risk of Stevens- Johnson syndrome among certain group of people.

If you have HLA B1502 gene, you have an increase risk of developing Stevens- Johnson syndrome. Chinese people, South east Asian or Indian descent are more likely to carry this gene.

Complications

Stevens- Johnson syndrome complications include:

• Secondary Skin Infections –cellulites can leads to life threatening conditions such as sepsis.
• Blood Infection –sepsis occurs when infected bacteria enters into blood stream and spreads throughout our body. Blood infections leads to life threatening condition such as shock and organ failure.
• Lungs Involvement– It can lead to acute respiratory distress.
• Vision Problems– If effected eyes left untreated , it may leads to scarring  and loss of vision
• Permanent skin damage

Diagnosis

A diagnosis is made on the basis of combination of:

1. Symptoms
2.  Physical examination
3. Medical history ( including medicines you have taken recently )
4. Skin biopsy

Prevention

• Consider genetic testing before taking any medicines
• If you have this condition try to avoid medication that triggered it

Treatment

Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications as your skin regrow.

Herbal Remedies

Planet Ayurveda offers best combination of effective herbal remedies for ayurvedic treatment of stevens-johnson syndrome.

1. Neem Capsules – 1 capsule twice daily after meals
2. Curcumin Capsules-1 capsule  twice daily after meals
3. Navkarshik Churan– 1 tablespoon twice daily after meals
4. Gandhak Rasayan – 2 tablets twice daily  with plain water after meals
5. Giloy Capsules-1 capsule twice daily after meals
6. Cap. Phyllanthus  Niruri -1 capsule twice daily after meals