Despite its long track record as an anti-epilepsy medication, Dilantin is one of many medications that in rare cases can cause severe skin reactions known as Stevens Johnson syndrome and toxic epidermal necrolysis.

Dilantin (phenytoin) is an anti-epileptic drug whose anticonvulsant properties were discovered in 1936. It received FDA approval in January 1953 and is now approved as a treatment to control generalized tonic-clonic and complex partial seizures and for use to prevent and treat seizures that occur during or after neurosurgery.

Stevens Johnson syndrome and its related condition toxic epidermal necrolysis are severe conditions that mainly attack the skin. The first symptoms to appear are often fever, cough and body aches – symptoms that resemble those of the flu. Soon after that, areas of red discoloration appear on the skin, and blisters begin to form.

Blisters can also form on the mucous membranes of the mouth, nose and genitals. The eyes can also be affected with inflammation and scarring that may cause blindness. Hair and nails sometimes fall out.

As the condition progresses, the blisters grow and large areas of skin can peel away. The amount of surface area affected defines whether the diagnosis is SJS or TEN. SJS typically affects less than 10 percent of the skin area, and TEN affects 30 percent or more.

The loss of the top layer of skin puts the patient at risk for cellulitis, a type of skin infection. The most extreme cases of SJS and TEN can lead to sepsis, a potentially deadly blood infection. Fluid may accumulate in the lungs, making breathing more difficult. Some cases also end in organ failure.

Treatment requires hospitalization and careful maintenance of symptoms. Patients are often treated in a hospital’s burn unit. In cases in which SJS or TEN is caused by a drug like Dilantin, the drug must be immediately discontinued. Patients generally need replacement of fluids and electrolytes and changing of dressings. Full recovery can take weeks or months.

Even after successful treatment, SJS and TEN can leave residual issues that last for years or may be permanent. Some patients must live with scarring or discoloration of the skin. Eyes may always be  dry and sensitive to bright light.

Dilantin SJS

Though SJS and TEN are rare, they most often occur as reactions to a drug. Dilantin is one of over 100 drugs that can cause SJS and TEN.

The FDA-approved label for Dilantin notes that Stevens Johnson syndrome and toxic epidermal necrolysis have been reported to occur with phenytoin treatment, usually with an onset after 28 days.