Refreshing SSJ Dan Eritroderma
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7/23/2019 Refreshing SSJ Dan Eritroderma
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REFRESHING
SINDROM STEVEN JOHNSONDAN ERITRODERMA
Ahmad Fauzi
Devi Kharisma
Dr. Hj. Vita Noor’Aini AH ,
Sp. KK ,
STASE ILMU PENYAKIT KULIT DAN KELAMINFAKULTAS KEDOKTERAN DAN KESEHATAN
UNIVERSITAS MUHAMMADIYAH JAKARTA
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. Hamzah M. Erupsi Obat Alergik . I!" I#mu $e!%a&i' Ku#i' da! Ke#ami!. ('h edi'i)!. *a+ia! I#mu $e!%a&i' Ku#i' da! Ke#ami! Fa&u#'as Ked)&'era! !iversi'asI!d)!esia. *a#ai $e!er-i' Fa&u#'as Ked)&'era! !iversi'as I!d)!esia. Ja&ar'a. //0. 1"(23(4.
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. 6he!, $ei. /. 6ar-amaze1i!e3I!du8ed T):i8 E;e8's a!d H<A3*=(/ S8ree!i!+ i! Tai>a!. The New England Journal ofMediine 592" 9355(. D ua!da, Adhi? Hamzah, M)8h'ar?//. Sindrom Stevens- ohnson dalam !uku A ar #lmu $en akit %ulit dan %elamin edisi ke
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1. Parri!!o J St"#"n, DO, FA$OEP, FA$EP % S'eve!s3J)h!s)! S%!dr)me. Direvisi 'era&hir ( Mei //. Di a&ses 'a!++a# " 5/ Mei //. Diu!duh dari "h''1"@@emedi8i!e.meds8a1e.8)m@ar'i8#e@0(9(53)vervie>
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A!'i1ire'i&
B2(C Jamu B5.5C
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(. Djua!da, Adhi? Hamzah, M)8h'ar?//. Sindrom Stevens-Johnson dalam !uku A"ar #lmu $enyakit %ulit dan %elamin edisi ke enam. Ja&ar'a " *ada! $e!er-i' Fa&u#'asKed)&'era! !iversi'as I!d)!esia.
Kehi#a!+a!8aira!
S'ressh)rm)!a#
I!7e&si
Ke+a+a#a!
7u!+si imu!
Ke+a+a#a!'erm)re+u#asi
$D()*"r+i-
$D
)"pi*"r+i-
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Ke#ai!a! &u#i'Ke#ai!a! mu&)sa
)risiumKe#ai!a! Ma'a
A *
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$emeri&saa! darah'e1i
$emeri&saa!imu!)#)+is
his')1a')#)+i& -i)1si&u#i' imu!)his')&imia
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- d id # #i i
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$er-edaa! E1iderma# Ne8r)#isisda! S'a1h%#)8)8a# s&a#ed s&i!
s%!dr)mE1iderma# Ne&r)#isisB Si!dr)m S'eve! J)h!s)! da!Ne&r)#isis e1iderma# ')&si&
S'a1h%#)8)8a# S&a#ed S&i! S%!dr)m
Me!%era!+ umum!%a 1ada
de>asa &are!a -iasa!%adise-a-&a! )#eh a#er+i )-a'
Me!%era!+ a!a& ( 'ahu!.
<e'a& 6e#ah di Su-e1i'e# <e'a& 8e#ah di s'ra'um+ra!u#)sum
Terda1a' se# se# !e&r)sis dise&i'ar 8e#ah da! -a!%a&'erda1a' se# rada!+
Mu&)sa da! a#a' da#am 'da&disera!+ dimu#ai dari mu&a,#eher, a&si#a da! #i1a' 1aha
$e!+)-a'a! de!+a!K)r'i&)s'er)id
$e!+)-a'a! de!+a! a!'i-i)'i&
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mum
(. Djua!da, Adhi? Hamzah, M)8h'ar?//. Sindrom Stevens-Johnson dalam !uku A"ar #lmu $enyakit %ulit dan %elamin edisi keenam. Ja&ar'a " *ada! $e!er-i' Fa&u#'as Ked)&'era! !iversi'as I!d)!esia.. Arder!3 )!es, Mi8hae#? Friedma!!, $e'er S? /. Skin Manifestations of dru aller . *ri'ish )ur!a# )7 6#i!i8a#
Ji&a 1e!deri'a &)ma, #a&u&a!'i!da&a! darura' 'erhada1&eseim-a!+a! O da! 6O
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Khusus
Korti/ot"roi**oi tin00i, 1red!is)!
5/32/ m+ Bse-a+ai 'i!da&a! life-saving se8ara 1are!'era#,
&emudia! d)sis!%a di'uru!&a!
1er#aha!3#aha!.(
A6TH Bsi!'e'i& m+
vi'.6 (// m+ a'au///m+ sehari IV.(
Tra!s7usi darah
in*i/ai p"+"rian tran23"*ara4 5ait3 %
.-i#a 'e#ah di)-a'i de!+a! &)'i&)s'er)idde!+a! d)sis ade&ua' se'e#ah dua hari-e#um ada 1er-ai&a!..-i#a 'erda1a' 1ur1ura +e!era#isa'a.
5.ji&a 'erda1a' #eu&)1e!ia.(
(. Djua!da, Adhi? Hamzah, M)8h'ar?//. Sindrom Stevens-Johnson dalam !uku A"ar #lmu $enyakit %ulit dan %elamin edisi keenam. Ja&ar'a " *ada! $e!er-i' Fa&u#'as Ked)&'era! !iversi'as I!d)!esia.
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(. Djua!da, Adhi? Hamzah, M)8h'ar?//. Sindrom Stevens-Johnson dalam !uku A"ar #lmu $enyakit %ulit dan %elamin edisi ke enam. Ja&ar'a " *ada!$e!er-i' Fa&u#'as Ked)&'era! !iversi'as I!d)!esia.0. Ma!sj)er, Ari7. //. %apita Selekta %edokteran. Ja&ar'a" Media Aes8u#a1ius.
O2ta!+o!o0i%u#serasi &)r!ea,1a!)1h'ha#mi'is,
&e-u'aa!
6at"ro"nt"ro!o0i%es)1ha+ea# s'ri8'ure.
6"nito3rinaria%!e&r)sis 'u-u#ar +i!ja#,
1e!i#e s8arri!+, s'e!)sisva+i!a, +a+a# +i!ja#
P3!+onari%*r)!&)1!eum)!ia
B9C &asus
K3tan"3% jari!+a! 1aru' da! &erusaa&a! &u#i' 1erma!e!,se1sis, i!7e&sis sis'emi&, dehidrasi -era', s%)&.0
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ERITRODERMA
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DEFINISI
• Ke#ai!a! &u#i' %a!+ di'a!dai de!+a!ada!%a &emeraha! a'au eri'ema%a!+ -ersi7a' +e!era#isa'a %a!+
me!8a&u1 /C 1ermu&aa! 'u-uh%a!+ -er#a!+su!+ da#am -e-era1ahari sam1ai -e-era1a mi!++u.
• Derma'i'is e&s7)#ia'iva dia!++a1si!)!im de!+a! eri'r)derma
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E'i)#)+i
• Eri'r)derma da1a' dise-a-&a! )#eha&i-a' a#er+i )-a' se8ara sis'emi&,1er#uasa! 1e!%a&i' &u#i', 1e!%a&i'
sis'emi& 'ermasu& &e+a!asa!.
• $e!%a&i' &u#i' %a!+ da1a' me!im-u#&a!
eri'r)derma di a!'ara!%a ada#ah1s)riasis, derma'i'is se-)r)i&, a#er+i)-a', 6T6< a'au Si!dr)m Sezar%.
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E$IDEMIO<OGI
• I!side!s eri'r)derma sa!+a'-ervariasi.
• $ria de!+a! rasi) " sam1ai 2 " ,
• O!se' usia ra'a3ra'a 2/ 'ahu!
• I!side! eri'r)derma ma&i!
-er'am-ah
$e!%e-a- u'ama!%aada#ah 1s)riasis
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$ATOFISIO<OGI
• Me&a!isme 'erjadi!%a eri'r)derma-e#um di&e'ahui de!+a! je#as.
• $e!e#i'ia! 'er-aru imu!)1a')+e!esisi!7e&si %a!+ dimediasi ')&si!me!u!ju&&a! -ah>a #)&us1a')+e!esi'as s'a1h%#)8)88us
me!+&)de&a! su1era!'i+e! mu!+&i! memai!&a! 1era!a! 1ada1a'h)+e!esis eri'r)derma.
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• a&i-a' sua'u a+e! da#am 'u-uh -ai& i'u)-a'3)-a'a!, 1er#uasa! 1e!%a&i' &u#i' da!1e!%a&i' sis'emi& ma&a, 'u-uh -era&si
-eru1a 1e#e-ara! 1em-u#uh darah &a1i#erBeri'ema %a!+ +e!era#isa'a a#ira!darah &e &u#i' me!i!+&a' &ehi#a!+a!1a!as -er'am-ah di!+i! da! me!++i+i#.
• $e!+ua1a! 8aira! %a!+ ma&i! me!i!+&a'da1a' me!%e-a-&a! dehidrasi
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• Kehi#a!+a! s&uama da1a' me!8a1ai +ram@m 1ermu&aa! &u#i' a'au#e-ih sehari sehi!++a me!%e-a-&a!
&ehi#a!+a! 1r)'ei! Bhi1)1r)'ei!emia
• A#-umi! -er&ura!+, 1e!i!+&a'a!re#a'i7 +#)-u#i! 'eru'ama
+amma+#)-u#i! meru1a&a! &e#ai!a!%a!+ &has.
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$a')si)#)+i$a')si)#)+i
A+e!'
Rea&si imu!
Di#a'asi $.darah
Eri'em
$er1i!daha! 8aira!&e e&s'ravas&u#er
Hi1)'ermiaMe!++i+i
#
Dehidrasi
Hi1erme'a-)#isme
Hi1)a#-umi!
Kehi#a!+a! s&uama+ram@m a'au
#e-ih sehari
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Geja#a K#i!isGeja#a K#i!is
Eri'r)derma a&i-a'a#er+i )-a' se8ara
sis'emi&
Eri'r)derma a&i-a'1er#uasa!
1e!%a&i' &u#i'.
Eri'r)derma a&i-a'1e!%a&i' sis'emi&
'ermasu&&e+a!asa!
Eri'r)derma&are!a
1s)riasis
$e!%a&i' #ei!erSi!dr)mSezar%
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masu&!%a )-a' &e da#am -ada! de!+a! 8ara a1a saja,
misa#!%a me#a#ui mu#u', me#a#ui hidu!+, de!+a! 8ara
su!'i&a!@i!7use, me#a#ui re8'um da! va+i!a. Se#ai! i'ua#er+i da1a' 1u#a 'erjadi &are!a )-a' ma'a, )-a' &umur,
'a1a# +i+i, da! me#a#ui &u#i' se-a+ai )-a' #uar.
Eritro*"r+a a/iat a!"r0i oat
"7ara it"+i/
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$ada a!am!esis he!da&!%a di'a!%a&a!, a1a&ah
1er!ah me!deri'a 1s)riasis. $e!%a&i' 'erse-u' me!ahu!
da! -ersi7a' residi7, &e#ai!a! &u#i' -eru1a s&uama %a!+
-er#a1is3#a1is da! &asar di a'as &u#i' %a!+ eri'ema')sa da!
sir&um1s&ri1.
Eri'r)derma Kare!a $s)riasisEri'r)derma Kare!a $s)riasis
Eri'r)derma
$e!%a&i'!%ase!diri
$e!+)-a'a!
$s)riasis
Ter &)!se!'rasi'i!++i
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$ada $emeri&saa! Fisi&
•Eri'ema')sa a+a& me!i!++i dari 1ada se&i'ar!%a da! s&uama di'em1a' i'u
#e-ih 'e-a#.
•Ku&u ju+a 1er#u di#iha', di8ari a1a&ah ada 1i''i!+ !ai# -eru1a #e&u&a!
mi#iar, 'a!da i!i ha!%a me!%)&)!+ da! 'ida& 1a')+!)m)sis u!'u&
1s)riasis.
• Ji&a ra+u3ra+udi#a&u&a! -i)s1i u!'u& 1emeri&saa! his')1a')#)+i&.
•*aru me!+e'ahui -ah>a 1e!%e-a-!%a 1s)riasis se'e#ah di-eri 'era1i
&)r'i&)s'er)id. $ada saa' eri'r)derma!%a me!+ura!+, ma&a mu#ai#ah
'a!da3'a!da 1s)riasis.
Geja#a K#i!isGeja#a K#i!is
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• E'i)#)+i!%a -e#um di&e'ahui 1as'i
• Ada 1e!da1a' %a!+ me!+a'a&a! 1e!%a&i'
i!i dise-a-&a! )#eh derma'i'is se-)r)i&
%a!+ me#uas.
•
sia 1e!deri'a a!'ara 23/ mi!++u.• Ke#ai!a! &u#i' -eru1a eri'ema u!iversa#
diser'ai s&uama %a!+ &asar.
$e!%a&i' <ei!er$e!%a&i' <ei!er
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Si!dr)m Sezar%
•$e!%a&i' i!i 'ermasu& #im7)ma, ada %a!+
-er1e!da1a' meru1a&a! s'adium di!i mi&)sis
7u!+)ides.
•Me!%era!+ 1ada )ra!+ de>asa, 1ada 1ria
-erumur ra'a3ra'a 92 'ahu!, seda!+&a!
1erem1ua! -erumur (5 'ahu!.
Eritro*"r+a a/iat p"n5a/it
it"+i/
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• Eri'ema -er>ar!a merah %a!+
u!iversa#
• S&uama da! rasa +a'a#.
•
i!#'ra'e 1ada &u#i' da! edema.• $ada se1er'i+a hi!++a
se'e!+ah 1asie! 'erda1a'
s1#e!)me+a#i, #im7ade!)1a'i
su1er8ia#, a#)1esia,
hi1er1i+me!'asi,
h%1er&era')sis $a#maris da!
1#a!'aris, ser'a &u&u %a!+
dis'r)&.
Geja#a K#i!isGeja#a K#i!is
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GAM*ARAN K<INIS
• Mu#a3mu#a 'im-u# -er8a& eri'ema %a!+da1a' me#uas &e se#uruh 'u-uh da#am>a&'u 324 jam.
•
Des&uamasi %a!+ di7us dimu#ai dari daerah#i1a'a!, &emudia! me!%e#uruh.
• Da1a' me!+e!ai mem-ra!e mu&)sa,'eru'ama %a!+ dise-a-&a! )#eh )-a'.
• *i#a &u#i' &e1a#a sudah 'er&e!a, da1a''erjadi a#)1esia, 1eru-aha! &u&u, da! &u&uda1a' 'er#e1as
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• Da1a' 'erjadi #im7ade!)1a'i da! he1a')me+a#i.
• S&uama 'im-u# se'e#ah 39 hari, seri!+ mu#aidi daerah #i1a'a!.
•
S&uama!%a -esar 1ada &eadaa! a&u', da!&e8i# 1ada &eadaa! &r)!is. ar!a 1u'ihsam1ai &u!i!+.
• Ku#i' merah 'era!+, 1a!as, &eri!+ da! &a#au
dira-a 'e-a#.• $asie! me!+e#uh &edi!+i!a! $e!+e!da#ia!
re+u#asi suhu 'u-uh me!jadi hi#a!+
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$EMERIKSAAN $ENNJANG
• His')1a')#)+i – mem-a!'u me!+ide!'i&asi 1e!%e-a-
eri'r)derma 1ada sam1ai de!+a! (/C
&asus, -i)1si &u#i' da1a' me!u!ju&&a!+am-ara! %a!+ -ervariasi
– $ada 'aha1 a&u', s1)!+i)sis da!
1ara&era')sis me!)!j)#, 'erjadi edema – $ada s'adium &r)!is, a&a!')sis da!
1er1a!ja!+a! re'e rid+e #e-ih d)mi!a!.
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• #eu&)si')sis, de!+a! e)si!)#ia da! #im7)si')sis.
• #im7)si' a'i1i& %a!+ dise-u' Sezar%.
• Se# i!i 'erda1a' da#am darah, KG* da! &u#i'.
• *i)1s% 1ada &u#i' 'erda1a' i!#'ra'e 1ada
dermis -a+ia! a'as da! 'erda1a' se# Sezar%.
• Dise-u' si!dr)m sezar%, ji&a #im7)si' a'i1i& %a!+
-eredar ///@mm5 a'au #e-ih.
<a-)ra')rium<a-)ra')rium
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DIAGNOSIS
• Dia+!)sis a+a& su#i' di'e+a&&a!
• Harus me#iha' dari 'a!da da! +eja#a%a!+ sudah ada se-e#um!%a misa#!%a,
>ar!a hi'am3&emeraha! di 1s)riasisda! &u!i!+3&emeraha! di 1i#aris ru-ra1i'iriasis? 1eru-aha! &u&u &has
1s)riasis• De!+a! -e-era1a -i)1si -iasa!%a
da1a' me!e+a&&a! dia+!)sis.
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DIAGNOSIS *ANDING
a. $s)riasis-. Derma'i'is a')1i&
8. Derma'i'is Se-)r)i&
a. $s)riasis-. Derma'i'is 8. D. se-)r)i&
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$ENATA<AKSANAAN
• $ada +)#)!+a! I, %a!+ dise-a-&a! )#eha#er+i )-a' se8ara sis'emi&, d)sis1red!is)!e 2 : / m+. 1e!%em-uha!
'erjadi 8e1a', umum!%a da#am -e-era1ahari sam1ai -e-era1a mi!++u.
• $ada +)#)!+a! II a&i-a' 1er#uasa! 1e!%a&i'&u#i' ju+a di-eri&a! &)r'i&)s'er)id. D)sis
mu#a 1red!is)!e 2 : / m+ sam1ai ( m+sehari. Ji&a se'e#ah -e-era1a hari 'ida&'am1a& 1er-ai&a!, d)sis da1a' di!ai&&a!
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• $ada 1e!+)-a'a! de!+a!&)r'i&)s'er)id ja!+&a #ama Blongterm, %a&!i ji&a me#e-ihi -u#a!
#e-ih -ai& di+u!a&a!me'i#1red!is)#)! dar1iada 1red!is)!
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• $ada eri'r)derma &r)!is di-eri&a!1u#a die' 'i!++i 1r)'ei! 'er#e1as!%as&uama me!+a&i-a'&a! &ehi#a!+a!
1r)'ei!.• Ke#ai!a! &u#i' 1er#u 1u#a di)#esi
em)#ie! u!'u& me!+ura!+i radiasi
a&i-a' vas)di#a'asi )#eh eri'emamisa#!%a de!+a! sa#e1 #a!)#i! /Ca'au &rim urea /C.
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$ROGNOSIS
• $r)+!)sis eri'r)derma 'er+a!'u!+ 1ada1r)ses 1e!%a&i' %a!+ me!dasari!%a.
• Kasus &are!a 1e!%e-a- )-a' da1a'
mem-ai& se'e#ah 1e!++u!aa! )-a'dihe!'i&a! da! di-eri 'era1i %a!+ sesuai.
• $e!+)-a'a! de!+a! &)r'i&)s'er)id ha!%ame!+ura!+i +eja#a!%a, 1asie! a&a!me!+a#ami &e'er+a!'u!+a! &)r'i&)s'er)id -i#a 1e!%e-a-!%a 'ida& di&e'ahui
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