What is the role of systemic steroids in the treatment of Stevens-Johnson syndrome (SJS)?

Updated: Jan 17, 2019
  • Author: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Answer

The use of systemic steroids remains controversial. Some authors believe that they are contraindicated, especially because there may be some question about the diagnosis. Patients with infection-induced erythema multiforme do worse when steroids are given. (Note that the differentiation between Stevens-Johnson syndrome and erythema multiforme should be possible even in the acute stage.) [36] Prolonged treatment with systemic steroids has been associated with an increased prevalence of complications.

However, concerns about the safety of systemic corticosteroids in the treatment of Stevens-Johnson syndrome are based on a few case series; in those reports, systemic corticosteroids were administered too late in the course of the disease, in inappropriately low doses, and for a very long duration that actually impaired the healing process and increased the risk of sepsis. The currently advocated approach for corticosteroid use suggests the early use of short-term (4-7 days), high-dose intravenous corticosteroids. [37, 38]

The ophthalmology literature contains several papers that advocate systemic and topical steroids to minimize ocular morbidity. [39, 40] Authors have cited salvage of vision when pulse steroid therapy has been given. [36, 40] Others have concluded that IV steroids and immunoglobulins do not improve outcome. [41]


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