Which drug is commonly implicated in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis?

• A. Penicillin
• B. Ibuprofen
• C. Carbamazepine
• D. Acetaminophen

Answer: (C)

Severe mucocutaneous adverse reactions like Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are strongly linked to certain drugs, with anticonvulsants being classic culprits. The strongest association among common meds is with carbamazepine, an anticonvulsant used for seizures and other nerve pain conditions. The underlying issue is an abnormal immune reaction where drug-triggered cytotoxic T cells target keratinocytes, leading to widespread epidermal death and mucosal involvement that characterizes SJS/TEN. This risk is well documented and makes carbamazepine a leading cause in exam-style questions.

Other listed drugs can rarely cause SJS, but they are not as consistently linked as carbamazepine. Penicillins, ibuprofen, and acetaminophen have far less prominent associations with these conditions, so they’re not the classic triggers clinicians worry about in this context. In certain populations, there's also genetic risk (for example, a specific HLA type) that raises the likelihood of SJS/TEN with carbamazepine, which helps explain why this drug stands out in discussions of these reactions.

If SJS/TEN is suspected, the offending drug must be stopped immediately, and the patient receives intensive supportive care, often in a burn-unit setting, with attention to fluid balance, wound care, pain control, and prevention of secondary infection.