The skinny: Two rare diseases wreak havoc

Rash people do rash things, including giving other people a psychological rash. We all do rash things— well, unless you're Arnold Schwarzenegger who knows how to keep his mouth shut about a love child for years.  In my opinion, American Idol voters are rash to vote for lame singers. (C’mon. First Pia is off the show, then Casey, James Durbin, and Haley. I bet even JLo would lose on that stupid show!)

What do you call the rash of the century?

Let’s talk about two real rashes: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN).  These two diseases involve inflammation and sloughing of the skin. SJS is not as severe as TEN because SJS involves only 10 percent of the body’s skin, while TEN affects at least 30 percent. They occur in two to seven in a million people annually, but you often see them listed in the side effects profile of many prescription medications.

Flu-like symptoms occur (as they seem to in a million other diseases): feeling poorly and a fever. During this period, the skin can become tender. The eyes become extremely sensitive to light— even looking at a 40-watt bulb is painful as staring into the sun.

One to three days after this flu-like period, the skin starts to form red or violet lesions– like bruises. In SJS, red lesions can look like an archery target. Soon the lesions blend into one another to form large blotches. Many lesions become blisters: the ill person looks like bubble-wrap.

The scalp is usually not affected: the lesions start on the face and chest and then spread outwards symmetrically to the arms and legs.

The mucosa is membrane lining the internal tracts in our body, such as the mouth, urethra, eyelids, and breathing pipes to the lungs. The mucosa usually gets hit hard.  Mouth/lip erosions are painful, crusty, and make oral herpes look like a field of flowers. If the urethra has lesions, urination feels like peeing acid mixed with broken glass. Eye pain, burning, and excessive tearing can occur.

If TEN affects the lungs, the ill person has difficulty breathing, and the body doesn’t get enough oxygen.  Bacterial pneumonia and/or irritated breathing pipes can severely impair the TEN patient.

The skin dies, and so– like the worst sunburn you can think of– the skin peels off within days of formation of the lesion. A few days later, the sloughing finally stops. It takes two to three weeks for healthy skin and mucosa to grow back, so the patient usually stays in the hospital for two to four weeks. Hopefully no infections result from the impaired skin.

Medication is the number-one cause of SJS/TEN. If you watch TV, there are some God-awful lawyer commercials that try to recruit people who have contracted SJS/TEN from medicine. 

SJS/TEN is a terrible condition. But is it the fault of the pharmaceutical industry, or is it that a small number of people have an unfortunate reaction to some common medications that include sulfa-containing antibiotics, penicillin, NSAIDs, anti-epileptics, and some psychiatric medicines?

Some infections– such as the microorganism that causes walking pneumonia– can cause children to be more susceptible to SJS/TEN. An antibiotic given during a viral infection might increase the risk of SJS/TEN. 

HIV positive persons are three times more likely to have SJS/TEN. There might be a genetic disposition to these dermatologic disasters, particularly in Asians. Cancer, lupus, UV light, and radiation therapy increase the risk as well.

It's hard not to be rash at times in this fast-paced world.  We're all human. Just be sure if you do any rash acts,  everyone in your life can safely respond, “It’s no skin off my back.”
Dr. Hook cracks a joke or two but he's a respected physician wiht an interesting website,