SINDROM STEVENS

JOHNSON
 Tujuan Pembelajaran :

Mahasiswa mampu memahami dan menjelaskan:

1. Definisi, Klasifikasi, dan Epidemiologi dari Sindrom Stephen-Johnson +
Efloresensi
2. Etiologi dan Faktor Risiko dari Sindrom Stephen-Johnson
3. Patofisiologi dari Sindrom Stephen-Johnson + reaksi obat selain
carbamazepine
4. Alur diagnosis dari Sindrom Stephen-Johnson (Anamnesis, Pemeriksaan
Fisik, dan Pemeriksaan Penunjang) +SCORTEN
5. Diagnosis Banding dari Sindrom Stephen-Johnson
6. Tatalaksana dan Pencegahan dari Sindrom Stephen-Johnson
 01.

Definisi, Klasifikasi, dan Epidemiologi dari

Sindrom Stevens Jhonson + Efloresensi
DEFINISI

Merupakan bagian dari nekrolisis epidermal yang merupakan reaksi

mukakutaneus yang mengancam jiwa, ditandai dengan nekrosis
dan pelepasan epidermis yang ekstensif.

Sindrom kelainan kulit berupa eritema, vesikel, bula, dapat disertai

purpura yang mengenai kulit, selaput lendir orifisium, dan mata
dengan keadaan umum bervariasi dari baik sampai buruk.
KLASIFIKASI

Klasifikasi menurut luas area permukaan kulit yang terlepas

(epidermolysis):
SSJ : < 10 % luas permukaan tubuh
SSJ overlap NET : 10-30% luas permukaan tubuh
NET : >30% luas permukaan tubuh
 EPIDEMIOLOGI

Mortality rate :
● 10% SJS
7x
● 30% SJS/NET
● >30% NRT

2-7 kasus/ 1 juta orang/

tahun ANGKA MORTALITAS
KESELURUHAN
● Dekade ke-4 ● 23% pada 6 minggu
● wanita ● 28% pada 3 bulang
● 34% pada 1 tahun
 02.

Etiologi Dan Faktor

Resiko Sindrom Steven
Johnson
 ETIOLOGI SINDROM STEVEN JOHNSON

Penyebab yang pasti belum diketahui, dikatakan multifaktorial.

Ada yang beranggapan bahwa sindrom ini merupakan eritema
multiforme yang berat dan disebut eritema multiforme mayor,
sehinga dikatakan mempunyai penyebab yang sama.
Erupsi awal SSJ biasanya berupa makula eritema dengan lesi
target atipikal menyerupai eritema multiformis. Diagnosis SSJ
dilakukan terutama berdasarkan gejala klinis berupa ruam makula
morbiliformis disertai purpura dengan bentuk tidak rata dan
umumnya tidak gatal.
FAKTOR RISIKO SINDROM STEVEN JOHNSON

Infeksi Virus Terkait

Keganasan

Diinduksi
Idiopatik
Obat
 03.

Patofisiologi Sindrom
Stephen-Johnson
3. Patofisiologi Sindrom Stephen-Johnson

Analgetik (45%)

Karbamazepine
Obat- Obatan
(20%)

Jamu (13,3%)
Sindroma
Stephen-Johnson

Tipe III
Hipersensitivitas

Tipe IV
 04.

Alur Diagnosis
Stephan-Johnson
4. Alur Diagnosis

a. anamnesis
Pada anamnesis ditemukan beberapa gejala seperti keadaan umum yang berat, disertai demam,
dehidrasi, gangguan pernafasan, muntah, diare, melena, pembesaran kelenjar getah bening,
hepatosplenomegali, sampai pada penurunan kesadaran dan kejang.
b. Pemeriksaan Fisik
Pada pemeriksaan fisik dijumpai keadaan umum pasien lemah, pada mata dijumpai konjungtiva
hiperemis dan ditemukan sekret purulen. Pada pemeriksaan dermatologi dijumpai makula
hiperpigmentasi hampir menutupi seluruh wajah, erosi, ekskoriasi sebagian tertutup krusta pada regio
nasalis dan oralis, makula eritema, erosi, ekskoriasi, krusta, deskuamasi pada regio generalisata
(badan, punggung, ekstremitas superior, ekstremitas inferior, genitalia).
4. Alur Diagnosis

c. Pemeriksaan Penunjang
Pada pemeriksaan laboratorium didapati Hb: 12,2 g/dl, leukosit: 14000 sel/mm 1,6 3 , LED: 35 mm/jam,
trombosit: 287.000 sel/mm3 , eritrosit: 3,92 juta/mm3 , sedangkan dari pemeriksaan urin rutin, fungsi
ginjal, fungsi hati, kadar gula darah, kolesterol berada dalam batas yang normal.
D. SCORTEN

.
 05.

Diagnosis Banding
Sindrom stephen johnson
 Diagnosis banding
Sindrom Steven Jhonson

Eritema Staphylococcal
Toxic Epidermolysis Scalded Skin
Necrotikans Multiform
Syndrome
 TATALAKSANA
1. Rawat inap
2. Preparat kortikosteroid
Penggunaan kortikosteroid
merupakan tindakan life saving. Kortikosteroid yang biasa diguna- kan berupa deksametason
secara intravena dengan dosis permulaan 4-6 x 5mg sehari. Masa kritis biasanya dapat segera
diatasi dalam 2-3 hari, dan apabila keadaan umum membaik dan tidak timbul lesi baru,
sedangkan lesi lama mengalami involusi, maka dosis segera diturunkan 5mg secara cepat setiap
hari.
3. Antibiotik
Antibiotik yang memenuhi syarat tersebut antara lain siprofloksasin dengan dosis 2 x 400mg
intravena, klindamisin dengan dosis 2 x 600mg intravena dan gentamisin dengan dosis 2 x 80
mg.
4. Infus dan transfusi darah
5. KCL
6. Adenocorticotropichormon (ACTH)
7. Agen hemostatik
8. Diet
9. Vitamin
 PENCEGAHAN

1. Menghentikan semua obat-obatan yang

mungkin menjadi penyebab.
2. Perawatan pada kulit
3. Perawatan mata
4. Perawatan pada genital
5. Perawatan pada oral
6. Pencangkokan kulit
Daftar Pustaka
1. Fitriany J, Altrastida F. Steven-Johnson Sindrom. Jurnal
Averrous. 2019; 5(1)
2. Amtha R, Sasanti H. Sindroma Stevens-Johnson Akibat
Carbamazepin Pada Penderita Gangguan Kejiwaan. 2013;
17(3): 288-293
3. Putri ND, Mutiara H, Hasudungan, Sibero Ht, Sukohat A.
Steven-Johnson Syndrom et causa Paracetamol. J Medula
Unila; 6(1): 101-7
4. Rahmayanti S.Manifestasi Oral dan Penatalaksanaan Pada
Penderita Sindrom Stevens Johnson.Majalah Kedokteran
Andalas.2011;35(2):91-97
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OUR HEALTHCARE CENTER
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second planet from the Sun

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is a cold place and the smallest one
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