Dress Syndrome vs SJS: Differences & Treatment

DRESS syndrome, a severe drug-induced reaction, presents diagnostic challenges, especially when differentiating it from Stevens-Johnson Syndrome (SJS), another life-threatening condition; notable clinical distinctions guide this differential diagnosis. The National Institutes of Health (NIH) acknowledges the importance of understanding the nuances between these conditions to ensure appropriate intervention. Allopurinol, a common medication, is associated with both DRESS syndrome and SJS, underscoring the need for clinicians to consider these adverse reactions in susceptible patients. Furthermore, advancements in cutaneous pathology contribute to more accurate diagnoses through detailed analysis of skin biopsies, aiding in the distinction between dress syndrome vs stevens johnson.

Severe Cutaneous Adverse Reactions (SCARs) represent a spectrum of life-threatening dermatologic emergencies. These reactions are characterized by extensive skin and/or mucosal involvement. They are often accompanied by systemic manifestations.

SCARs pose a significant clinical challenge. The incidence, while relatively low, belies the potential for severe morbidity and mortality. Early recognition and swift intervention are paramount.

Defining SCARs and Their Impact

SCARs encompass a group of severe drug-induced hypersensitivity reactions. These include Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, and Acute Generalized Exanthematous Pustulosis (AGEP).

The impact of SCARs extends far beyond the skin. These conditions can lead to long-term sequelae, including ocular complications, pulmonary fibrosis, and chronic skin conditions. The psychological toll on affected individuals and their families is also substantial.

The Critical Importance of Early Recognition and Management

The cornerstone of improving patient outcomes in SCARs lies in prompt diagnosis and management. Delays in diagnosis can lead to increased morbidity and mortality.

Early recognition requires a high index of suspicion. Clinicians must be vigilant for the characteristic signs and symptoms, especially in patients recently started on new medications. Rapid discontinuation of the offending drug is crucial. Supportive care and specialized treatment should be initiated without delay.

DRESS Syndrome and SJS: Distinct Yet Related Entities

Among the SCARs, DRESS syndrome and Stevens-Johnson Syndrome (SJS) are two frequently encountered entities. While both are drug-induced hypersensitivity reactions, they exhibit distinct clinical and pathological features.

DRESS syndrome is characterized by a delayed onset, typically weeks after drug exposure. It involves fever, skin rash, hematologic abnormalities (eosinophilia), lymphadenopathy, and internal organ involvement.

SJS, on the other hand, presents with acute mucocutaneous involvement. It features epidermal detachment, blistering, and erosions of the skin and mucous membranes.

The Necessity of Accurate Differentiation

Accurate differentiation between DRESS and SJS is essential for guiding appropriate management strategies and predicting prognosis. While clinical overlap can occur, key differentiating features, such as the presence of eosinophilia and lymphadenopathy in DRESS, can aid in diagnosis.

Moreover, the extent of skin involvement and the specific organs affected can differ between the two conditions. This differentiation allows for tailored treatment plans.

DRESS Syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms): In-Depth Analysis

Severe Cutaneous Adverse Reactions (SCARs) represent a spectrum of life-threatening dermatologic emergencies. These reactions are characterized by extensive skin and/or mucosal involvement. They are often accompanied by systemic manifestations.

SCARs pose a significant clinical challenge. The incidence, while relatively low, belies the potential for severe morbidity and mortality. Among the SCARs, DRESS syndrome stands out as a particularly complex and multifaceted condition.

This section provides a comprehensive overview of DRESS syndrome. This includes its definition, diagnostic criteria (RegiSCAR score), etiology, pathogenesis, clinical presentation, diagnostic tests, differential diagnoses, and treatment strategies. Understanding these aspects is crucial for effective clinical management.

Definition and Diagnostic Criteria

DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe, potentially life-threatening drug-induced hypersensitivity reaction. It is characterized by a constellation of clinical and laboratory findings. These include fever, skin rash, eosinophilia, lymphadenopathy, and internal organ involvement.

Diagnosis of DRESS can be challenging due to its variable presentation and overlap with other conditions. The RegiSCAR (Registry of Severe Cutaneous Adverse Reactions) scoring system is a valuable tool. It aids in standardizing the diagnostic process.

The RegiSCAR score incorporates several clinical and laboratory parameters. These include the extent of skin involvement, presence of fever, lymph node enlargement, hematological abnormalities (eosinophilia), and internal organ involvement. A higher RegiSCAR score indicates a greater likelihood of DRESS.

Etiology and Pathogenesis

DRESS syndrome is primarily triggered by certain medications. It is essential to identify and discontinue the offending drug as quickly as possible. Several classes of drugs have been implicated in the development of DRESS.

Common Drug Triggers

• Anticonvulsants: Carbamazepine, phenytoin, and lamotrigine are frequently associated with DRESS. These drugs are commonly used to treat epilepsy and other neurological conditions.
• Antibiotics: Sulfonamides (e.g., sulfamethoxazole) and minocycline are known triggers. These antibiotics are widely used to treat bacterial infections.
• Allopurinol: This medication, used to treat gout, is also a recognized cause of DRESS.
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Though less common, NSAIDs like ibuprofen and naproxen can induce DRESS in susceptible individuals.
• Antiretrovirals: Abacavir and other antiretroviral medications used in the treatment of HIV infection have been linked to DRESS.

The Role of Viral Infections

Viral infections, particularly Human herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), and cytomegalovirus (CMV), may play a role in the pathogenesis of DRESS. Viral reactivation can occur during the immune dysregulation associated with DRESS. This can exacerbate the systemic inflammation and organ damage.

Genetic Predisposition

Genetic factors, particularly certain HLA (Human Leukocyte Antigen) alleles, can predispose individuals to DRESS. Specific HLA alleles have been associated with increased risk of DRESS. These occur in response to particular drugs. Understanding genetic susceptibility is critical for risk assessment.

Clinical Presentation

The clinical presentation of DRESS syndrome is highly variable. It can range from mild to life-threatening. The onset of symptoms typically occurs weeks to months after starting the offending medication.

Classic Signs and Symptoms

• Fever: Fever is a common early symptom. It often precedes other manifestations of DRESS.
• Skin Rash: A maculopapular rash is the most characteristic cutaneous finding. It often starts on the face and upper trunk, then spreads to other parts of the body. The rash may become confluent and develop into erythroderma.
• Eosinophilia: Elevated eosinophil count in the blood is a hallmark laboratory finding. This reflects the hypersensitivity reaction.
• Lymphadenopathy: Enlargement of lymph nodes, both local and generalized, is frequently observed.
• Systemic Symptoms: Systemic involvement can affect multiple organs. This includes the liver, kidneys, lungs, and heart.
• Hepatitis: Liver inflammation, indicated by elevated liver enzymes, is common. Severe cases can lead to liver failure.
• Nephritis: Kidney involvement can manifest as elevated creatinine levels and proteinuria.
• Pneumonitis: Lung inflammation can cause cough, shortness of breath, and respiratory distress.

Diagnosis and Differential Diagnosis

The diagnosis of DRESS syndrome requires a high degree of clinical suspicion. This is due to its diverse presentation. It also requires careful evaluation of clinical, laboratory, and histopathological findings.

Diagnostic Tests and Procedures

• Complete Blood Count (CBC): A CBC helps to identify eosinophilia, which is a key diagnostic criterion.
• Liver Function Tests (LFTs): LFTs are essential for assessing liver involvement and monitoring liver function.
• Renal Function Tests: Renal function tests are used to evaluate kidney involvement. This is measured by assessing creatinine and blood urea nitrogen (BUN) levels.
• Skin Biopsy: A skin biopsy can help to confirm the diagnosis. This is done by ruling out other dermatologic conditions. Histopathological findings in DRESS typically show a lymphocytic infiltrate. It is characterized by eosinophils in the dermis.

Differential Diagnosis

DRESS must be differentiated from other conditions that can cause similar symptoms. These include viral exanthems, other drug reactions, and autoimmune disorders. Careful consideration of the patient's history, physical examination findings, and laboratory results is critical for accurate diagnosis.

Treatment and Management

The management of DRESS syndrome requires a multidisciplinary approach. It involves dermatologists, internal medicine specialists, and other healthcare professionals. The primary goals of treatment are to discontinue the offending drug. It is also important to provide supportive care, and manage systemic complications.

Immediate Discontinuation of the Offending Drug

The first and most critical step in managing DRESS is to immediately stop the medication suspected of causing the reaction. This can help to prevent further progression of the disease. This also aids in reducing the severity of symptoms.

Supportive Care

Supportive care is essential for managing the systemic complications of DRESS.

• Fluid and Electrolyte Management: Maintaining adequate hydration and electrolyte balance is crucial. This is especially important in patients with fever, diarrhea, or kidney involvement.
• Nutritional Support: Providing adequate nutrition is essential to support the body's healing processes. Patients may require enteral or parenteral nutrition if they are unable to eat due to mucositis or other complications.
• Temperature Regulation: Managing fever with antipyretic medications and cooling measures can help to improve patient comfort.

Pharmacological Interventions

• Corticosteroids (e.g., Prednisone): Systemic corticosteroids are often used to suppress the inflammatory response. This helps to reduce the severity of symptoms and prevent organ damage.
• Immunosuppressants: In severe cases or those unresponsive to corticosteroids, immunosuppressants such as cyclosporine or mycophenolate mofetil may be considered.

The Role of Dermatologists and Other Specialists

Dermatologists play a central role in the diagnosis and management of DRESS. They can help to confirm the diagnosis, manage skin manifestations, and monitor for complications. Other specialists, such as hepatologists, nephrologists, and pulmonologists, may be needed. This is especially important for managing specific organ involvement.

Stevens-Johnson Syndrome (SJS): A Comprehensive Overview

Building upon the understanding of DRESS syndrome, it's crucial to examine another critical SCAR, Stevens-Johnson Syndrome (SJS). SJS represents a distinct yet related entity demanding careful consideration. This section delves into the intricacies of SJS. We will cover its definition, diagnostic criteria, etiology, pathogenesis, clinical presentation, diagnostic approaches, differential diagnoses, and ultimately, treatment strategies. We will also clarify its relationship to the more severe Toxic Epidermal Necrolysis (TEN).

Definition and Diagnostic Criteria

Stevens-Johnson Syndrome (SJS) is classified as an acute, severe mucocutaneous reaction. It is most often triggered by medications, and less commonly, by infections.

SJS is characterized by:

• Widespread blistering
• Erosion of the skin and mucous membranes.

The extent of skin detachment is a critical factor in differentiating SJS from TEN.

Toxic Epidermal Necrolysis (TEN) is regarded as a more severe form of the same disease process. It is distinguished from SJS by a greater percentage of body surface area (BSA) involvement.

SJS is generally defined as involving less than 10% BSA detachment. TEN involves greater than 30% BSA detachment.

Cases with between 10-30% BSA involvement are often categorized as SJS/TEN overlap. This distinction is important for prognosis and management.

Etiology and Pathogenesis

SJS is most commonly triggered by an adverse drug reaction. Identifying the causative agent is paramount for effective management.

Common Culprit Drugs

Several medications are frequently implicated in SJS. These include, but are not limited to:

• Anticonvulsants: Such as lamotrigine, carbamazepine, and phenytoin.
• Antibiotics: Including sulfonamides, penicillins, and cephalosporins.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Particularly oxicams.

Role of Infections and Other Triggers

While drugs are the primary cause, infections can occasionally trigger SJS. Mycoplasma pneumoniae is one of the most notable infectious agents associated with SJS.

Other potential triggers, although less common, may include:

• Vaccinations
• Idiopathic causes (where the trigger remains unknown).

Genetic Predisposition

Genetic factors can influence an individual's susceptibility to developing SJS. Certain Human Leukocyte Antigen (HLA) alleles have been linked to an increased risk of SJS in response to specific medications. For example, HLA-B*15:02 is strongly associated with carbamazepine-induced SJS in individuals of Asian descent.

Clinical Presentation

The clinical presentation of SJS is often dramatic and can rapidly progress.

Characteristic Signs and Symptoms

The onset of SJS is typically marked by prodromal symptoms, which appear 1-3 days before skin manifestations. These symptoms can include:

• Fever
• Malaise
• Sore throat
• Burning eyes.

The characteristic skin rash begins as erythematous, macules and papules, which evolve into blisters. These blisters are fragile and easily rupture. This leads to painful erosions.

Mucositis is a hallmark of SJS, involving two or more mucosal surfaces. This commonly includes:

• Oral mucosa (mouth sores and difficulty eating).
• Ocular mucosa (conjunctivitis, eye pain, and potential for long-term visual complications).
• Genital mucosa (painful erosions and ulcerations).

Skin detachment is a key diagnostic feature. It is assessed using Nikolsky's sign (epidermal separation with gentle lateral pressure).

Diagnosis and Differential Diagnosis

Diagnosing SJS requires careful clinical evaluation and, in many cases, a skin biopsy.

Diagnostic Tests and Procedures

• Skin biopsy: A skin biopsy is crucial to confirm the diagnosis. Histopathological examination typically reveals full-thickness epidermal necrosis with blister formation.

Differential Diagnosis

SJS must be differentiated from other blistering diseases, including:

• Erythema multiforme (EM): EM typically has target-like lesions and less mucosal involvement.
• Bullous pemphigoid: An autoimmune blistering disease that mainly affects elderly patients.
• Staphylococcal scalded skin syndrome (SSSS): Primarily affects young children and is caused by staphylococcal toxins.
• Acute generalized exanthematous pustulosis (AGEP): Characterized by numerous small, non-follicular pustules.

Treatment and Management

Management of SJS requires a multidisciplinary approach, often involving dermatologists, ophthalmologists, and intensivists.

Immediate Discontinuation of Offending Drug

The first and most critical step in managing SJS is the immediate discontinuation of any suspected causative medications.

Supportive Care

Supportive care is essential for minimizing complications and promoting healing.

• Fluid and Electrolyte Management: Maintaining adequate hydration and electrolyte balance is crucial, especially given extensive skin loss.
• Wound Care: Gentle cleansing and non-adherent dressings are necessary to prevent infection and promote re-epithelialization.
• Pain Management: SJS is extremely painful, requiring aggressive pain control with analgesics.
• Nutritional Support: Patients may have difficulty eating due to oral mucositis, necessitating nutritional support via nasogastric tube or intravenous feeding.

Pharmacological Interventions

The use of systemic therapies in SJS remains controversial, and evidence is limited.

• Intravenous Immunoglobulin (IVIG): Some studies suggest that IVIG may reduce the severity and mortality of SJS, but results have been inconsistent.
• Cyclosporine: Has shown promise in some case series by inhibiting T-cell activation.

Specialized Care in Burn Units

Patients with severe SJS, particularly those with extensive skin detachment, often benefit from management in a burn unit. Burn units provide specialized wound care, infection control, and intensive supportive care.

Multidisciplinary Approach

• Dermatologists: Play a central role in diagnosis, skin care, and management of systemic therapies.
• Ophthalmologists: Are essential for managing ocular complications and preventing long-term vision loss.
• Intensivists: Provide critical care support, including fluid management, respiratory support, and monitoring for complications such as sepsis.

DRESS vs. SJS: A Comparative Analysis

Building upon the understanding of DRESS syndrome, it's crucial to examine another critical SCAR, Stevens-Johnson Syndrome (SJS). SJS represents a distinct yet related entity demanding careful consideration. This section delves into the intricacies of SJS. We will cover its definition, diagnostic approach, etiology, pathogenesis, clinical presentation, diagnostic measures, differential diagnoses, and treatment strategies. The goal is to highlight similarities and critical differences. We also explore how these distinctions impact prognosis and management.

Shared Ground: Commonalities in SCARs

Despite their distinct presentations, DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) and SJS (Stevens-Johnson Syndrome) share fundamental characteristics, highlighting their classification under the umbrella of Severe Cutaneous Adverse Reactions (SCARs).

Drug-Induced Etiology

Both DRESS and SJS are most commonly triggered by medications. Identifying the offending drug is paramount in both conditions. Common culprits include anticonvulsants, antibiotics, and NSAIDs. This shared etiology underscores the critical importance of thorough medication reconciliation in patients presenting with symptoms suggestive of a SCAR.

Systemic Involvement: Beyond the Skin

While the skin manifestations are the most visible aspects of these conditions, both DRESS and SJS involve systemic inflammation and organ involvement. DRESS is characterized by eosinophilia and potential damage to organs like the liver, kidneys, and lungs. SJS frequently manifests with mucositis, conjunctivitis, and can cause significant damage to internal organs due to widespread inflammation.

The Imperative of Early Diagnosis

Early and accurate diagnosis is critical for both DRESS and SJS. Timely identification allows for immediate cessation of the causative agent, thereby preventing further progression and minimizing long-term sequelae. The sooner the offending drug is stopped and appropriate treatment initiated, the better the prognosis.

Divergent Paths: Key Differences Between DRESS and SJS

While DRESS and SJS share some underlying features, the differences in their clinical presentation, pathogenesis, and prognosis are significant. These differences necessitate tailored diagnostic and management approaches.

Clinical Features: Distinguishing Hallmarks

The clinical presentation of DRESS and SJS can often provide valuable clues to differentiate these conditions.

DRESS typically presents with a triad of fever, rash, and internal organ involvement. Other common features include facial edema, lymphadenopathy, and hematologic abnormalities, particularly eosinophilia.

SJS, on the other hand, primarily manifests with mucocutaneous involvement, characterized by blistering, skin detachment, and erosions. Mucosal involvement is typically more prominent in SJS, affecting the oral, ocular, and genital regions. The extent of skin detachment is a key factor in distinguishing SJS from Toxic Epidermal Necrolysis (TEN), a more severe variant.

Pathogenesis: Underlying Mechanisms

The underlying pathogenic mechanisms also differ between DRESS and SJS.

DRESS is thought to be primarily driven by T-cell-mediated hypersensitivity reactions, often involving reactivation of herpesviruses, such as HHV-6.

SJS pathogenesis is believed to involve drug-induced apoptosis (programmed cell death) of keratinocytes. This is triggered by cytotoxic T cells and other inflammatory mediators.

While both involve immune-mediated mechanisms, the specific pathways and effector cells involved differ significantly.

Prognosis: Long-Term Outcomes

The prognosis for DRESS and SJS can vary considerably.

DRESS often has a more protracted course, with symptoms potentially persisting for weeks or even months despite discontinuation of the causative drug. Furthermore, patients with DRESS may experience long-term sequelae such as autoimmune disorders.

SJS, while acute, can be life-threatening due to severe skin loss and associated complications such as infection and fluid imbalance. Prompt and aggressive supportive care is essential for improving survival rates. Long-term complications of SJS include scarring, ocular complications, and psychological distress.

Synthesis: Implications for Clinical Practice

The similarities and differences between DRESS and SJS emphasize the need for a comprehensive and nuanced approach to diagnosis and management. Clinicians must carefully evaluate the clinical presentation, laboratory findings, and medical history to accurately differentiate these conditions. Early identification of the offending drug, prompt discontinuation, and appropriate supportive care are essential for improving patient outcomes in both DRESS and SJS.

Management Strategies for SCARs: A Unified Approach

DRESS and SJS, while distinct in their pathophysiology, share a critical need for prompt and effective management. The overarching principles of SCARs management revolve around immediate recognition, comprehensive supportive care, and judicious use of pharmacological interventions. These principles, when applied cohesively, significantly impact patient outcomes.

Importance of Early Recognition: The First Line of Defense

Timely identification of the initial signs and symptoms of DRESS and SJS is paramount. A high index of suspicion is crucial, particularly in patients recently started on medications known to be implicated in SCARs. These early signs can include fever, skin rash, and mucositis.

Prompt discontinuation of the offending drug is the single most important step in managing both DRESS and SJS. The longer the offending medication is continued, the greater the risk of disease progression and severe complications.

Supportive Care: Addressing Systemic Manifestations

Supportive care forms the cornerstone of SCARs management. This involves meticulous attention to various aspects of the patient's physiological needs.

Fluid and Electrolyte Management

Patients with SCARs often experience significant fluid losses due to skin and mucosal damage. Careful monitoring of fluid balance and electrolyte levels is essential. Intravenous fluids are often required to maintain adequate hydration and electrolyte balance.

Wound Care

In SJS, the sloughing of skin creates large areas of denudation. Meticulous wound care is crucial to prevent infection and promote healing. This may involve the use of sterile dressings, topical antimicrobials, and specialized wound care techniques.

Pain Management

Both DRESS and SJS can be intensely painful. Effective pain management is essential to improve patient comfort and facilitate wound care. Analgesics, including opioids, may be required to control pain.

Nutritional Support

Many patients with SCARs are unable to eat due to mucositis and general debility. Nutritional support is therefore crucial. Enteral or parenteral nutrition may be necessary to maintain adequate caloric intake and prevent malnutrition.

Pharmacological Interventions: Modulating the Immune Response

Pharmacological interventions aim to modulate the immune response and reduce inflammation.

Corticosteroids

Corticosteroids, such as Prednisone, are commonly used in the treatment of DRESS. They can help to suppress the inflammatory response and improve systemic symptoms. However, their use is controversial in SJS.

Immunosuppressants

Immunosuppressants, such as cyclosporine or intravenous immunoglobulin (IVIG), may be considered in severe cases of DRESS or SJS. These agents can help to dampen the immune response and prevent further tissue damage.

Role of the Pharmacist: A Critical Member of the Team

Pharmacists play a vital role in the management of SCARs. Their expertise in medication reconciliation and adverse drug reaction monitoring is invaluable.

Medication Reconciliation

Pharmacists can help to identify potential drug triggers by carefully reviewing the patient's medication history. This includes prescription medications, over-the-counter medications, and herbal supplements.

Adverse Drug Reaction Monitoring

Pharmacists are often the first healthcare professionals to suspect a drug-induced reaction. They can monitor for signs and symptoms of SCARs and alert the medical team to the possibility of a drug-induced reaction.

Legal and Ethical Considerations in SCARs Management

DRESS and SJS, while distinct in their pathophysiology, share a critical need for prompt and effective management. The overarching principles of SCARs management revolve around immediate recognition, comprehensive supportive care, and judicious use of pharmacological interventions. These principles must be coupled with an unwavering commitment to legal and ethical standards to ensure patient safety and autonomy in the context of potentially devastating adverse drug reactions.

The Imperative of Clear Drug Labeling

Accurate and unambiguous drug labeling is paramount in mitigating the risk of SCARs. Pharmaceutical manufacturers bear a significant responsibility to clearly articulate the potential for severe adverse reactions, including DRESS and SJS, on product labels and package inserts.

These warnings must be prominent, easily understandable, and accessible to both healthcare professionals and patients. The information should include:

• A clear description of the potential signs and symptoms of SCARs.

• Risk factors that may predispose individuals to these reactions.

• Instructions for immediate action should signs and symptoms arise.

Regulatory Oversight and Compliance

Regulatory bodies like the FDA play a crucial role in ensuring that drug labeling meets rigorous standards for accuracy and completeness. However, vigilance is required to promptly update labels as new safety information emerges from post-market surveillance and clinical trials.

Manufacturers must be held accountable for providing comprehensive and up-to-date information. The absence of clear warnings can have significant legal and ethical ramifications.

Informed Consent: Empowering Patient Autonomy

Informed consent is the cornerstone of ethical medical practice. It requires that patients receive adequate information about the potential risks, benefits, and alternatives to proposed treatments, enabling them to make autonomous decisions about their healthcare.

Specifically, with medications known to carry a risk of SCARs, healthcare providers have an ethical obligation to proactively discuss this risk with patients. This discussion should include:

• A clear explanation of DRESS and SJS, including their potential severity and long-term consequences.

• The signs and symptoms that patients should be vigilant for.

• The importance of seeking immediate medical attention if these symptoms develop.

Addressing Vulnerable Populations

Special consideration must be given to vulnerable populations, such as pediatric patients, the elderly, and individuals with cognitive impairments. Healthcare providers must ensure that these patients, or their legal guardians, fully understand the risks and benefits of medications.

This may necessitate the use of simplified language, visual aids, or the involvement of interpreters to facilitate effective communication. Failure to obtain informed consent not only violates ethical principles but also carries potential legal liabilities.

So, there you have it! While both DRESS syndrome vs Stevens-Johnson Syndrome are serious and can look similar, understanding the key differences in symptoms, causes, and progression is crucial for getting the right diagnosis and treatment. If you suspect you or someone you know might be experiencing either of these conditions, don't hesitate to seek medical attention immediately. Stay informed and stay safe!