What is Stevens-Johnson Syndrome (SJS)?
Stevens-Johnson syndrome (SJS) is a rare but serious and potentially fatal medical emergency that affects the skin and mucous membranes [1.5.1, 1.5.3]. It is considered a hypersensitivity reaction, most often triggered by medications [1.4.1, 1.5.1]. The condition typically begins with flu-like symptoms, such as fever, sore throat, and fatigue, which are then followed by a painful, spreading rash that blisters [1.5.1, 1.5.6]. The top layer of the affected skin dies and sheds [1.5.2].
When skin detachment covers less than 10% of the body's surface, it is classified as SJS [1.5.1, 1.8.3]. If it covers more than 30%, it is known as toxic epidermal necrolysis (TEN) [1.5.1, 1.8.3]. The range between 10% and 30% is considered SJS/TEN overlap [1.5.2]. Treatment requires hospitalization, often in a burn unit or intensive care unit, to manage symptoms, prevent infection, and support healing [1.5.1, 1.5.3].
Early Signs and Symptoms of SJS
- Fever and body aches [1.5.2]
- Sore throat and cough [1.5.1]
- Burning eyes [1.5.1]
- A red or purplish rash that spreads and blisters [1.5.2]
- Sores on mucous membranes, including the mouth, eyes, and genitals [1.3.3, 1.5.2]
The Link Between Tylenol (Acetaminophen) and SJS
Tylenol is the brand name for acetaminophen, one of the most widely used over-the-counter medications for pain and fever in the United States [1.2.1]. The U.S. Food and Drug Administration (FDA) has confirmed a link between acetaminophen and rare cases of SJS, TEN, and a related condition called acute generalized exanthematous pustulosis (AGEP) [1.6.2].
In 2013, the FDA issued a Drug Safety Communication warning that acetaminophen can, in rare instances, cause these severe skin reactions [1.6.2]. This warning was based on a review of medical literature and the FDA's Adverse Event Reporting System (FAERS), which found dozens of cases linked to the drug, including some resulting in hospitalization and death [1.3.5, 1.6.2]. As a result, the FDA mandated that a warning about this risk be added to the labels of both prescription and over-the-counter acetaminophen products [1.6.2, 1.6.6].
It's important to note that this reaction is rare and can occur at any time, even if someone has used acetaminophen in the past without issue [1.2.1]. There is no way to predict who might be at higher risk [1.2.1]. A key challenge in confirming causality is "protopathic bias," where acetaminophen is taken for the early flu-like symptoms of SJS, making it difficult to distinguish it as the cause versus a treatment for the initial symptoms [1.3.1, 1.6.2]. However, some studies that controlled for this bias still found a significant association [1.2.2, 1.3.1].
Other Medications That Cause SJS
While acetaminophen is a known trigger, it is not the most common one. SJS is more frequently associated with other classes of drugs [1.4.2, 1.5.1]. Anyone who develops a rash while taking a new medication should seek medical attention immediately [1.2.1].
Common high-risk medications include:
- Anti-gout medications: Allopurinol is a frequently cited cause [1.4.1, 1.4.2].
- Anticonvulsants: Medications for seizures like carbamazepine, lamotrigine, and phenytoin are strongly linked to SJS [1.4.2, 1.4.5].
- Antibiotics: Sulfa antibiotics (sulfonamides), penicillins, and cephalosporins are known triggers [1.4.2, 1.4.4].
- NSAIDs: Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) and naproxen (Aleve) also carry a risk of causing SJS [1.4.1].
Comparison of Severe Skin Reactions
It can be challenging to distinguish SJS from other skin reactions. Here is a comparison of key features.
| Feature | Stevens-Johnson Syndrome (SJS) | Toxic Epidermal Necrolysis (TEN) | Erythema Multiforme (EM) |
|---|---|---|---|
| Primary Cause | Usually medications [1.5.1] | Usually medications [1.5.1] | Mostly infections (e.g., Herpes Simplex Virus) [1.8.1, 1.8.2] |
| Skin Detachment | <10% of Body Surface Area [1.5.2, 1.8.3] | >30% of Body Surface Area [1.5.2, 1.8.3] | Typically none, or less than 10% [1.8.2] |
| Lesion Type | Flat, atypical targets or purpuric macules that may blister [1.8.2] | Widespread blisters and sheet-like peeling of skin [1.5.2] | Typical "target" lesions, often raised [1.8.2, 1.8.4] |
| Mucosal Involvement | Almost always present (mouth, eyes, genitals) [1.8.3] | Almost always present and often severe [1.5.2] | Can be present (EM major) or absent (EM minor) [1.8.4, 1.8.5] |
| Systemic Symptoms | Prodrome of fever, malaise is common [1.8.3] | Severe, systemic illness is characteristic [1.5.2] | Mild or no systemic symptoms [1.8.3] |
Long-Term Effects and Recovery
Recovery from SJS can take weeks to months and may result in long-term complications [1.5.1]. The mortality rate for SJS is around 5-10% [1.5.1]. Survivors often face lasting physical and psychological sequelae.
Common long-term problems include:
- Cutaneous Issues: Scarring, changes in skin pigmentation, chronic dry or itchy skin, and abnormal nail or hair growth [1.9.1, 1.9.5].
- Ocular Problems: Severe dry eye is the most common long-term complication [1.9.2]. Other issues include light sensitivity (photophobia), corneal scarring, and in some cases, impaired vision or blindness [1.9.1].
- Oral and Mucosal Damage: Chronic oral pain, dry mouth, and dental problems are common [1.9.1]. Genitourinary scarring can also occur [1.9.4].
- Psychological Impact: Survivors report high rates of depression, anxiety, and post-traumatic stress disorder (PTSD). Many express a fear of taking new medications [1.9.1, 1.9.3].
Conclusion
In conclusion, while Tylenol (acetaminophen) is a widely used and generally safe medication, it is associated with a rare but serious risk of causing Stevens-Johnson syndrome [1.2.2, 1.6.2]. The FDA has mandated warning labels to reflect this risk [1.6.6]. The reaction is unpredictable and not dose-dependent. Given the severity of SJS, any individual who develops a rash or blistering, especially when starting a new medication, should immediately stop taking the drug and seek emergency medical care [1.2.1]. Awareness of the signs and prompt action are crucial for improving outcomes.
For more information on drug safety, you can visit the FDA's Drug Safety and Availability page.
