Syafei Hamzah,SpKK,FINSDV,FAADV
SMF/Bagian I.K.Kulit dan Kelamin
RSUD Dr.H.Abdul Moeloek/
FK Unila/FK Malahayati
1. ANGIOEDEMA
2. NEKROLISIS EPIDERMAL :
- SINDROMA STEVENS-JOHNSON (SSJ)
- NEKROLISIS EPIDERMAL TOKSIKA (TEN)
3. SINDROM DRESS
- PENDERITAAN
- KECACATAN AKIBAT KOMPLIKASI
- KEMATIAN
= kondisi ditandai edem mendadak pada
dermis bagian dalam dan jaringan subkutan
atau membran mukosa disertai nyeri atau
rasa terbakar (bukan gatal), menyerang
hampir seluruh bagian tubuh dapat telibat.
Klasifikasi:
1. alergik
2. terkait obat (ACE inhibitor,NSAID,Salisilat)
3.C1 inhibitory deficiency
4. Idiopatik
Histamin yang berlebihan menyebabkan
peningkatan aliran darah, permeabilitas
endotelial dan edema yang bermanifestasi
sebagai angioedema,urtikaria dan pada kasus
berat dapat menimbulkan anafilasis.
Pada reaksi yang diperantarai IgE, ikatan
alergen menghasilkan cross-linking IgE-cell
mast yang menyebabkan degradasi sel mast
serta pelepasan histamin dan mediator lain
misalnya : triptase
- edema non pitting
- eritematosa atau sewarna kulit dg batas yg
tidak tegas
- kesulitan menelan atau bernapas
- urtikaria ada/tidak
- nyeri abdomen
SIMILAR in:
• clinical findings
DIFFER in:
• histopathology
% BSA involved
• drug etiology
• mechanisms
Epidermal Necrolysis
SJS TEN
DEFINISI :
= kumpulan gejala penyakit pada
kulit dan mukosa disertai
gejala sistemik,
-> Eritema multiforme berat ;
bersifat akut, ditandai trias ->
kulit, mukosa, mata.
- insiden 1,2 – 6 per sejuta tiap th
- tidak ada perbedaan ras
- semua umur
-> pasti belum diketahui.
1. Alergi obat >>
a.l. sulfa, penisilin, NSAID,
antikonvulsi, antipiretik, jamu.
Kematian -> 5 - 15 %
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ARTICLE LINKS:
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World Allergy Organization Journal:Volume WAC 2007 AbstractsNovember 2007p S276
Background:
Stevens Johnson Syndrome (SJS) is severe form of erythema multiforme with related mucocutaneus disorder, often with severe constitutional
symptoms and associated high rate of mortaliy and morbidity.
Objective:
To find out the incidence, etiology, treatment, lenght of stay and complication.
Methods:
A 3 years retrosprctive study (January 1, 2004 through December 31, 2006) of patients admitted to dermatology department of Dr. Abdul Moeloek
Hospital Lampung.
Results:
Among 24 cases reviewed there were 11 (45,8%) male and 13 (54,2%) female. The youngest patient was a 10 years old girl and the oldest one a 54
years old female. We assume that the caused were antibiotic (penicillin derivate) 10 (41,6%), analgesic/antipyretic 8 (33,3%), anticonvulsant
(carbamazepin) 3 (12,5%), and 3 (12,5%) patient unknown. There was a variety in the length of stay of hospitalization from 1 until 27 days with an
average of 7,2 days.
Systemic corticosteroid was the of choice against fatality, 19 (79,2%) recovered, 5 (20,8%) patient died, the cause of death were 3 (60%)
broncopneumonia, 1 (20 %) septicemia and 1 (20 %) gastrointestinal bleeding.
Conclusion:
The incidence of Steven Johnson Syndrome in Dr. Abdul Moeloek Hospital was found female is bigger than male, the highest group of age was 24-44
(54,1%) and the drugs most commonly involved were antibiotics (41,6 %) followed by analgesic/antipyretic (33,3%), broncopnemoni was the mostly
cause of death (60%).
© 2007 World Allergy Organization
DEFINISI :
= penyakit yang berat yg ditandai
dengan gejala kulit yg khas ->
epidemolisis menyeluruh dapat
disertai kelainan mukosa di orifisium
dan mata
Alergi obat ~ SJS
Infeksi
~ SJS yg berat
Prodromal : - sakit berat
- demam tinggi
- kesadaran menurun
Kulit eritem generalisata -> vesikel, bula
Mukosa erosi, eksoriasi – krusta
Epidermolisis
Nikolsky (+)
~ Steven Johnson Syndrome
Prognosis :
50 - 70 % buruk
Infeksi > baik dari obat
Kematian 28,6 %
Sindrom Stevens Johnson 1 %
Definisi:
= merupakan kumpulan gejala dan tanda
reaksi obat idiosinkratik berat pada pemberian
obat dosis terapi, yang secara khas ditandai :
- demam
- erupsi kulit
- abnormalitas hematologi
- keterlibatan sistemik (limadenofati,
hepatitis sitolitik,nefritis interstitial)
Sindrom terjadi akut 2-8 mg setelah makan
obat
Keadaan umum : buruk
Demam dapat terjadi 2-3 hari sebelum
atau bersamaan munculnya erupsi
kulit.
• Demam sering disertai mialgia,atralgia,
faringitis
• Erupsi kulit bervariasi ; makula papular
Vesikobulosa, eritroderma .
Sering dijumpai edema pada wajah.
Darah rutin, urin rutin ,SGOT, SGPT
HbsAg , Ab anti virus hepatitis A/C
• Sistemik :
- prednisolon : 0,5 mg – 0,2 mg/kgBB selama
1-8 minggu tappering off
- antibiotika profilkasis
- antipiretik : bila demam