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    Vesicobulous Skin Diseases

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    thesaananda
    Steven-Johnson Syndrome and Toxic Epidermal Necrolysis are rare and life-threatening drug-induced reactions characterized by widespread apoptosis of keratinocytes and activation of a cell-mediated cytotoxic reaction. This leads to confluent purpuric and erythematous macules evolving into flaccid blisters and epidermal detachment, predominantly on the trunk and upper limbs and often involving mucous membranes. Treatment involves stopping suspected culprit drugs, intensive care management to prevent complications, topical and intravenous steroids, antibiotics, and careful management of fluid and electrolyte imbalances.

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    Vesicobulous Skin Diseases

    Uploaded by

    thesaananda
    17 views14 pages
    Steven-Johnson Syndrome and Toxic Epidermal Necrolysis are rare and life-threatening drug-induced reactions characterized by widespread apoptosis of keratinocytes and activation of a cell-mediated cytotoxic reaction. This leads to confluent purpuric and erythematous macules evolving into flaccid blisters and epidermal detachment, predominantly on the trunk and upper limbs and often involving mucous membranes. Treatment involves stopping suspected culprit drugs, intensive care management to prevent complications, topical and intravenous steroids, antibiotics, and careful management of fluid and electrolyte imbalances.

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    Steven-Johnson Syndrome and Toxic Epidermal Necrolysis are rare and life-threatening drug-induced reactions characterized by widespread apoptosis of keratinocytes and activation of a cell-mediated cytotoxic reaction. This leads to confluent purpuric and erythematous macules evolving into flaccid blisters and epidermal detachment, predominantly on the trunk and upper limbs and often involving mucous membranes. Treatment involves stopping suspected culprit drugs, intensive care management to prevent complications, topical and intravenous steroids, antibiotics, and careful management of fluid and electrolyte imbalances.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    17 views14 pages

    Vesicobulous Skin Diseases

    Uploaded by

    thesaananda
    Steven-Johnson Syndrome and Toxic Epidermal Necrolysis are rare and life-threatening drug-induced reactions characterized by widespread apoptosis of keratinocytes and activation of a cell-mediated cytotoxic reaction. This leads to confluent purpuric and erythematous macules evolving into flaccid blisters and epidermal detachment, predominantly on the trunk and upper limbs and often involving mucous membranes. Treatment involves stopping suspected culprit drugs, intensive care management to prevent complications, topical and intravenous steroids, antibiotics, and careful management of fluid and electrolyte imbalances.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 14

    Vesicobullous Skin Diseases

    dr. Fitria Salim, M.Sc., SpKK

    Dermato-Venereology Department
    Medical Faculty of Syiah Kuala University/dr. Zainoel Abidin General Hospital
    Banda Aceh 2015

    Steven-Johnson Syndrome &


    Toxic Epidermal Necrolysis (3B)
    Rare & life threatening reaction, mainly drug induced
    Widespread apoptosis of keratinocytes activation of
    a cell- mediated cytotoxic reaction & amplified by
    cytokines, mainly granulysin
    Confluent purpuric and erythematous macules evolving to
    flaccid blisters and epidermal detachment
    predominating on the trunk and upper limbs and
    associated with mucous membrane involvement (eye,
    mouth, genital)

    SJS & TEN


    Extracutaneous symptoms fever, pain, weakness,
    pulmonary & digestive complication (profuse diarrhea,
    malabsorption, melena,colic perforation)
    Pathologic full-thickness necrosis of epidermis
    associated with mild mononuclear cell infiltrate

    SJS & TEN

    Etiology

    Genetic

    Drugs

    Infection (M.
    Pneumoniae,
    viral &
    immunization)

    Radiotherapy,
    bone marrow
    transplantation

    Medication & the risk of SJS/TEN


    High risk

    Lower risk

    Allopurinol
    Sulfamethoxazole
    Sulfadiazine
    Sulfapyridine

    Acetic acid NSAIDs


    Aminopenicilin
    Cephalosporins
    Quinolone

    Sulfadoxine
    Sulfasalazine
    Carbamazepine
    Lamotrigine

    Cycline
    Macrolides

    Phenobarbital
    Phenytoin
    Phenybutazone
    Nevirapine
    Oxicam NSAIDs
    Thiacetazone

    Doubthful risk
    Paracetamol
    Pyrazolone analgesic
    Corticosteroid
    Other NSAID (except
    aspirin)
    Sertraline

    No evidence of risk
    Aspirin
    Sulfonylurea
    Thiazide diuretic
    Furosemide
    Aldactone
    Calcium chanel blocker
    Beta blocker
    Angiotensin converting
    enzyme inhibitor
    Angiotensin II receptor
    antagonis
    Statin
    Hormones
    Vitamin

    Differential diagnosis
    EM mayor
    Varicella
    AGEP
    Bullous FDE
    S4

    Lab
    RR & blood oxygenation
    Arterial blood gas level, serum bicarbonat
    Electrolyte & fluid imbalances
    HistoPA
    Skin test & oral provocation test

    Treatment
    Stop suspicious drugs
    Maintaining hemodynamic equilibrium & preventing life
    threatening complications
    ICU/ burn centers
    Lip & mouth: borax-gliserin or steroid in vaselin (topical)
    Dexametason 0,15-0,2 mg/kgbb/day 4-6x5mg/day iv
    Gentamisin 2x80mg or clindamisin 2x600mg iv
    Low salt & high protein diet
    KCl 3x500mg/day low kalium
    Fluid imbalance IVFD Darrow & 5% glucose

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