Can ibuprofen cause Stevens-Johnson syndrome?

October 12, 2025 •

4 min read

The annual incidence of Stevens-Johnson syndrome (SJS) is estimated to be between 1.2 to 6 cases per million people [1.5.3]. While rare, a crucial question for many is, can ibuprofen cause Stevens-Johnson syndrome? The answer is yes; it is a known, though uncommon, trigger [1.3.1, 1.2.2].

Quick Summary

Ibuprofen, a common pain reliever, is a recognized but rare trigger for Stevens-Johnson syndrome (SJS), a severe medical emergency affecting the skin and mucous membranes. Recognizing early flu-like symptoms is critical for immediate medical intervention.

Key Points

Known But Rare Trigger: Ibuprofen can cause Stevens-Johnson syndrome (SJS), but it is a very rare adverse reaction [1.2.2, 1.3.1].
Medical Emergency: SJS is a serious medical emergency that starts with flu-like symptoms and progresses to a painful, blistering rash, requiring immediate hospitalization [1.3.1, 1.6.2].
SJS vs. TEN: The severity is classified by skin detachment: SJS involves <10% of the body, while Toxic Epidermal Necrolysis (TEN) involves >30% [1.7.3].
Highest NSAID Association: Among five common NSAIDs, ibuprofen had the highest number of associated SJS reports in an FDA database analysis, though it also had the lowest fatality rate [1.9.1].
Immediate Action Required: If SJS is suspected after taking ibuprofen or any new medication, it is crucial to stop the drug and seek emergency medical care immediately [1.6.5].
Other High-Risk Drugs: Anticonvulsants, the gout medication allopurinol, and sulfa antibiotics are more commonly associated with SJS than ibuprofen [1.4.4].
Supportive Hospital Care: Treatment involves stopping the drug, wound care, fluid replacement, pain management, and specialized eye care, often in an ICU or burn unit [1.6.4, 1.6.5].

What is Stevens-Johnson Syndrome (SJS)?

Stevens-Johnson syndrome (SJS) is a rare but severe and potentially life-threatening disorder affecting the skin and mucous membranes [1.3.1]. It is considered a medical emergency requiring hospitalization [1.6.2]. The condition typically begins with flu-like symptoms, such as fever, sore throat, and fatigue, which are then followed by a painful, spreading red or purplish rash that blisters [1.3.1]. The top layer of the affected skin eventually dies and sheds [1.3.1].

SJS is part of a spectrum of severe cutaneous adverse reactions (SCARs). The classification depends on the percentage of the body surface area (BSA) affected by skin detachment:

Stevens-Johnson syndrome (SJS): Affects less than 10% of the BSA [1.7.3].
SJS/TEN Overlap: Involves between 10% and 30% of the BSA [1.7.3].
Toxic Epidermal Necrolysis (TEN): The most severe form, affecting more than 30% of the BSA [1.7.3]. The mortality rate for TEN is significantly higher, ranging from 25-35% [1.2.3].

Medications are the most common trigger, responsible for over 80% of cases [1.3.2]. The reaction can occur while actively taking a drug or up to two weeks after discontinuing it [1.3.1].

The Direct Link: Can Ibuprofen Cause Stevens-Johnson Syndrome?

Yes, ibuprofen is a documented cause of Stevens-Johnson syndrome [1.3.1, 1.4.2]. Although ibuprofen is a widely used and generally safe nonsteroidal anti-inflammatory drug (NSAID), it is associated with a risk of inducing SJS, even after a single dose [1.2.2]. A 2022 analysis of the FDA's Adverse Event Reporting System (FAERS) from 2004 to 2021 identified ibuprofen as having the highest association with SJS among five major NSAIDs studied, based on statistical measures like the reporting odds ratio [1.9.1]. In a 55-year retrospective analysis, ibuprofen accounted for 4.13% of all drug-associated SJS/TEN cases reported to the FAERS database [1.5.1].

However, it's crucial to contextualize this risk. SJS is an extremely rare event for any individual drug user [1.4.1]. The onset of symptoms after taking ibuprofen can range from the same day to approximately 15 days later [1.2.1].

Recognizing the Symptoms

Prompt recognition of SJS is critical for improving patient outcomes. The condition often starts with nonspecific symptoms before the characteristic rash appears [1.3.1].

Early (Prodromal) Symptoms:

Fever and malaise [1.3.2]
Sore throat and mouth [1.3.1]
Cough [1.3.2]
Burning eyes [1.3.1]
Fatigue [1.3.1]

Later Cutaneous and Mucosal Symptoms:

A widespread, painful red or purplish rash that spreads [1.3.1]. The rash may have target-like lesions [1.3.6].
Blisters on the skin and mucous membranes, including the mouth, nose, eyes, and genitals [1.3.1].
Shedding and peeling of the skin within days after blisters form [1.3.1].

Other High-Risk Medications

While ibuprofen is a known trigger, it is not considered one of the highest-risk drugs overall. Other medications are more frequently associated with SJS/TEN. These include:

Anticonvulsants: Such as carbamazepine, lamotrigine, and phenytoin [1.4.4, 1.4.5].
Allopurinol: A medication used to treat gout [1.4.2, 1.4.4].
Sulfa Antibiotics: Including sulfamethoxazole and sulfasalazine [1.4.2, 1.4.4].
Other NSAIDs: The oxicam class of NSAIDs (e.g., piroxicam) is also strongly associated with SJS [1.4.1].
Nevirapine: An anti-HIV drug [1.4.2].

Ibuprofen and Other NSAIDs: A Risk Comparison

A 2022 study analyzing the FAERS database provided insights into the relative risks and outcomes for SJS associated with different NSAIDs [1.9.2].


Medication	Association with SJS (Reporting Odds Ratio)	Fatality Rate in SJS Cases	Key Findings
Ibuprofen	7.06 (Highest among those studied) [1.9.2]	6.87% (Lowest) [1.9.2]	Highest number of SJS reports and highest hospitalization rate (79.27%), but lowest mortality [1.9.2].
Diclofenac	Statistically significant [1.9.2]	25.00% (Highest) [1.9.2]	Associated with the highest risk of death among the NSAIDs in this study [1.9.2].
Aspirin	Statistically significant [1.9.2]	19.65% [1.9.2]	Had a significantly higher mortality rate than ibuprofen-related cases [1.9.2].
Acetaminophen	Statistically significant [1.9.2]	N/A in direct comparison	Also a known trigger, with 1,958 cases reported in a 55-year period [1.5.1].
Celecoxib	Lowest association among those studied [1.9.2]	N/A in direct comparison	Had the latest average time to onset of SJS symptoms [1.9.2].

What To Do If You Suspect SJS

Stevens-Johnson syndrome is a medical emergency. If you or someone else develops symptoms like a rapidly spreading rash, blisters, and fever, especially after starting a new medication, seek immediate medical attention at an emergency room [1.6.5]. The first and most crucial step in treatment is to identify and discontinue the medication causing the reaction [1.6.5].

Diagnosis and Treatment

Diagnosis is typically made based on a physical exam and a review of the patient's medication history [1.6.5]. A skin biopsy may be performed to confirm the diagnosis by showing full-thickness necrosis of the epidermis [1.2.2, 1.6.5].

Treatment is supportive and focuses on managing symptoms and preventing complications. It often occurs in an intensive care unit (ICU) or a hospital burn unit [1.6.4]. Key elements of care include:

Wound Care: Dead skin is gently removed, and affected areas are covered with special, non-adhesive dressings [1.6.4, 1.6.5].
Fluid and Nutrition Support: Intravenous (IV) fluids are given to prevent dehydration, and nutrition is often supplied via a nasogastric tube [1.6.5].
Pain Management: Medications are used to control the significant pain associated with the condition [1.6.6].
Eye Care: An ophthalmologist is consulted to manage eye involvement with lubricants and topical steroids to prevent long-term damage like blindness [1.6.3, 1.3.2].
Medications: Depending on the severity, treatments may include corticosteroids, intravenous immunoglobulin (IVIG), or other immunosuppressive drugs like cyclosporine [1.6.1, 1.6.6].

Conclusion

While the question 'Can ibuprofen cause Stevens-Johnson syndrome?' is answered with a 'yes,' the event remains extremely rare [1.2.2, 1.5.5]. Ibuprofen is a widely used and effective medication for pain and inflammation. However, its potential to trigger this severe reaction underscores the importance of medication safety and awareness. The key is vigilance. Understanding the early flu-like symptoms that precede the rash is critical. If SJS is suspected, discontinuing the potential offending drug and seeking immediate emergency medical care is paramount to minimizing complications and improving the chances of a full recovery. Anyone who survives SJS must permanently avoid the causative drug and related medications [1.6.2].

For more information from a trusted source, you can visit the Mayo Clinic's page on Stevens-Johnson syndrome.

Frequently Asked Questions

The very first signs of SJS are often flu-like symptoms, including fever, a sore mouth and throat, fatigue, and burning eyes. These symptoms typically appear one to three days before the characteristic rash develops [1.3.1].

The onset of SJS after taking ibuprofen can vary, ranging from within hours of a single dose to approximately 15 days after starting the medication [1.2.1, 1.2.2].

SJS and TEN are part of the same disease spectrum. The main difference is the extent of skin detachment. SJS involves less than 10% of the body surface, SJS/TEN overlap is 10-30%, and TEN involves more than 30% [1.7.3].

SJS can affect anyone of any age, including children who have taken a children's dosage of ibuprofen [1.2.4]. Overall, the most impacted age group for drug-induced SJS/TEN is adults aged 18-64 [1.5.1].

The drugs most commonly associated with SJS are certain anticonvulsants (like carbamazepine and lamotrigine), the gout medication allopurinol, and antibacterial sulfonamides [1.4.4, 1.4.2].

If you develop a rash, especially if it's painful, spreading, blistering, or accompanied by fever and feeling unwell, you should stop taking the medication and seek immediate medical attention at an emergency room to rule out SJS [1.6.5].

There is no specific cure for SJS. Treatment is focused on supportive care, which includes removing the causative drug, managing wounds, controlling pain, preventing infection, and maintaining hydration to help the skin regrow [1.6.2, 1.6.4].