Serious rashes caused by Stevens Johnson Syndrome

Stevens Johnson Syndrome (SJS) and related diseases can cause serious rashes that result in blistering and skin breakdown which can lead to deadly infections. The cause of these diseases is usually a reaction to certain medications like Bextra and other non-steroidal anti-inflammatory drugs (NSAIDs) including Vioxx and Ibuprofen. Bextra seems to carry the highest risk of causing these skin diseases, though researchers do not know why NSAIDs in general and Bextra in particular are linked to these conditions.

Sulfa causes an allergic reaction when the body does not properly deal with the active agents. The first step the body takes in this process is to convert the sulfonamides into a harmless particle called an “acetylated non-toxic metabolite.” Think of a conveyor belt, with all these sulfa molecules getting shipped into the body. A team of people in receiving unloads the sulfa as it comes along the conveyor belt, processes it, and sends it safely back out of the body. The problem is that everyone’s body works differently and at different speeds, and some don’t “unload the conveyor belt” fast enough. Sulfa particles get through, and make their way further into the body. In fact, about half of Americans have a slow processing rate.

But there are other mechanisms in the body to deal with this problem. “Guards” or certain types of enzymes can also neutralize the sulfa particles, and send them back to shipping before they get too far into the body. If they get past the guards, the even bigger and stronger guards of your immune system kick into action, and usually take care of the problem.

In the rare 1-3% of people, the sulfa particles make it past them too, and start really affecting the body. It can destroy cells and trigger a “hypersensitive reaction,” sort of like a panic button where the body is thrown into total disorganization. This is the allergic reaction that the body displays, leading to rash, blistering, and the severe effects of SJS and other skin diseases.

Usually discontinuing the drug is enough to stop the reaction. Which makes sense: don’t let the sulfa particles in, and they can’t cause any damage. The body slowly overpowers the particles already there, and returns to normal.

It seems likely that Bextra and other NSAIDs invade the body in a similar way, though researchers do not know for sure. It will probably take several years to find out the exact mechanisms of the allergic reaction.

Of course the real question is, with the strong evidence to link Bextra and severe skin reactions now, was enough done to protect the public in the first place? Allergic reactions are well known, shouldn’t the drug companies considered and investigated this possibility before selling it to the general consumer?