emergency in dermatology

5/24/2018 Emergency in Dermatology

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EMERGENCIES INDERMATOLOGY

Dr. Citra Cahyarini, SpKK

Department of dermatovenereology

Faculty of medicine YARSI University


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Emergencies in dermatology :

Stevens Johnson Syndrome

Toxic Epidermal Necrolysis

Stapylococcal Scalded Skin Syndrome

Pemfigus Vulgaris


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Erythema Multiforme

Reaction pattern of blood vessels in the

dermis with secondary epidermal

changes manifests clinically ascharacteristic erythematous iris-shaped

papular and vesicobulous lession

typically involving the extremities

(especially the palms and soles) and

mucous membranes


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Etiology

A cutaneous reaction to variety ofantigenic stimuli :

- drug : sulfonamide, phenytoin,barbiturates, phenylbutazone,penicillin, allopurinol

- Infection : mycoplasma- Idiopathic : >50%


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1. Erythema multiforme minor (EM Minor)

2. Erythema multiforme major (EM Major)

EM Minor :

litle, mucous membrane (-), systemic symp (-)Skin lesion : developed 10 d

dull red macule (48h)

papule

vesicles & bullae in center of the papule(iris, target like lesion)

Predilection sites : dorsa of hand, palms & soles,

forearms, feet, elbow & knees


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Erythema Multiforme:

Papular, urticarial, vesiculer target lesionsin acral distribution


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Herpes Iris of Bateman


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Vesicular and target lesions of EM


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SJS:

Initial Stage: Partially confluent erythematous

lesions with dusky centers, presenting as flatatypical target lesions


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SJS: Advanced stage:

Generalized macular eruption with

detachment of necrotic epidermis


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SJS:

Extensive necrosis and erosions of the lips

and oral mucosa


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Typical iris lessions


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Target lesions: margin of vesicles withred centers


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SJS: involvement of lips and tounge


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Involvement of the lips and palate


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Diffuse erythema, shedding of the ciliaand epidermis of the eyelids, severeerosions, hemorrhagic crusting of the

lips


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Diffuse generalized shedding of theepidermis


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TEN: confluent morbilliformis eruption, withpositive Nikolsky sign


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TEN


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TEN


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TEN


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TEN


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TEN


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TEN


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TEN


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TEN


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TEN


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Staphylococcal Scalded Skin Syndrome (S4)


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Staphylococcal Scalded Skin Syndrome (S4)


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S4


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S4


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S4


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S4


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S4


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S4


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S4


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S4


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Pemfigus Vulgaris


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PERBEDAAN GAMBARAN KLINIS EM MINOR,SINDROM STEVENS-JOHNSON, NET

EMMINOR

STEVENJOHNSON

NET

ETIOLOGI VHS AKUT OBAT OBAT

PERJALANANPENYAKIT

AKUT,

SWASIRNA

REKUREN

AKUT,

SWASIRNA,

EPI

AKUT,

SWASIRNA,

EPI

PRODOMAL

TIDAK

ADA /

RINGANADA

ADA, NYERI

KULIT

PERBEDAAAN GAMBARAN KLINIS EM MINOR


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PERBEDAAAN GAMBARAN KLINIS EM MINOR,SINDROM STEVENS-JOHNSON, NET

EM MINOR STEVEN

JOHNSON

NET

ERUPSI

SIMETRIS,

DISEMINATA

SIMETRIS,

KONFLUEN

MORBILIFOR

MIS, ERITEM,

LUAS,

KONFLUEN

PREDILEKSI AKRAL

AKRAL,

WAJAH

WAJAH,

PUNGGUNG

LESI KULIT LESI TARGET LESI TARGET,LEPUH

MAKULA,

ERITEM,PELEPASAN

EPIDERMIS

MUKOSA

BEBAS /

SEDIKIT

JELAS,

2/LEBIH

JELAS,

2/LEBIH


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EMMINOR

STEVENJOHNSON NET

HISTOPA

KERATINOSIT

NEKROTIK

SETEMPAT,

UDEM, INFILTRAT

PMN DI DERMIS

KERATINOSIT

NEKROTIK

SETEMPAT,

UDEM, INFILTRAT

PMN DI DERMIS

TAK BEGITU

JELAS

KERATINOSIT

NEKROTIK

SETEMPAT,

UDEM,

INFILTRAT PMN

DI DERMIS

TIDAK ADA

/SEDIKIT

GEJALAKONSTITUSI

TIDAK ADA /

RINGAN

ADA / BERAT ADA / BERAT

ORGAN

DALAM

TIDAK TERKENA KADANG

KADANG

SERING


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EM

MINOR

STEVEN JOHNSON NET

LAMA 1-3 MGG 2-4 MGG 3-6 MGG

KOMPLIKASI

TIDAK

ADA

JARANG (SEPTIKEMI,

PNEUMONI,PERDARAHAN

GASTROINTESTINAL,

GAGAL GINJAL,

JANTUNG

SERING

MORTALITAS 0 % 5-15 % 5-50 %

PENYEMBUHAN

TANPA

PARUT MUNGKIN

DAPAT

TERJADI

G S


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PERBEDAAN NET DENGAN S4

NET SSSS

ETIOLOGI OBAT EKSOTOKSIN

RIWAYATKELUARGA

TIDAKMENUNJANG

ANGGOTA LAIN;IMPETIGO

USIA > 40 TAHUN < 5 TAHUN

EKSANTEM GENERALISATA KHAS: WAJAH,LEHER, KETIAK,

SELA PAHA


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NET SSSSNYERI PADA

KULIT

RINGAN

SEDANG

JELAS

TANDANIKOLSKY

PADA LESI JUGA PADAKULIT

SEHAT

MUKOSA

TERKENA

DENGANBERAT

TIDAK

TERKENA

PERJALANAN

PENYAKIT

2-3 MINGGU 2-4 HARI


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NET SSSS

TERAPISISTEMIK

KORTIKOSTEROID

DOSIS TINGGI

PENISILINASE

RESISTEN

HISTOPA NEKROLISIS EPIDERMISSTR. BASALIS

AKANTOLISIS,

CELAH

SUBGRANULAR

MORTALITAS 25-50 % 2-3 %


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emergency in dermatology

Documents

tounge5242018 emergency

palate5242018 emergency

50r42018 emergency

elbow knees5242018 emergency

diffuse erythema

involvement of lips

palms soles

systemic symp skin lesion