Terapi Kortikosteroid Sistemik untuk Sindrom Steven Johnson (SSJ)- Nekrolisis Epidermal Toksik (NET) di RSUD DR Moewardi, Surakarta, Indonesia
DOI:
https://doi.org/10.55175/cdk.v48i4.60Keywords:
Kortikosteroid sistemik, SSJ-NETAbstract
Latar belakang :Sindrom Steven Johnson (SSJ) dan nekrolisis epidermal toksik (NET) adalah manifestasi reaksi alergi obat paling berat dan mengancam jiwa yang dimediasi sel T. Salah satu terapi SSJ-NET yaitu kortikosteroid sistemik. Tujuan : Mengetahui pola terapi kortikosteroid sistemik di Instalasi Rawat Inap RSUD Dr. Moewardi Surakarta periode Januari 2014-Desember 2018. Metode : Penelitian deskriptif retrospektif atas data rekam medis pasien SSJ-NET di Instalasi Rawat Inap RSUD Dr. Moewardi Surakarta periode Januari 2014-Desember 2018. Hasil: Didapatkan 80 pasien SSJ-NET, usia terbanyak 46-65 tahun (39%), lebih banyak laki-laki (52%). Diagnosis SSJ paling banyak (61%) dibandingkan SSJ overlap NET (24%) ataupun NET (15%) dengan keterlibatan mukosa mulut terbanyak (64%). Penyakit penyerta terbanyak adalah diabetes melitus (18 %). Penyebab SSJ-NET terbanyak diduga lebih dari satu obat (44%). Terapi kortikosteroid sistemik berupa injeksi metilprednisolon dengan rata-rata dosis 65 mg/hari dan lama perawatan 10 hari. Simpulan: Kortikosteroid sistemik merupakan terapi semua kasus SSJ-NET di RSUD dr. Moewardi Surakarta.
Background: Steven Johnson syndrome (SSJ) and toxic epidermal necrolysis (TEN) are the severest primarily T-cell mediated manifestation and life threatening drug reaction. Systemic corticosteroid is used for SSJ-TEN management. Objective: To study the pattern of systemic corticosteroid therapy for SSJ-TEN in Dr. Moewardi General Hospital Surakarta Januari 2014-December 2018. Method: A descriptive retrospective study on medical record data of SSJ-TEN patients hospitalized at Dr. Moewardi General Hospital Surakarta between January 2014 and December 2018. Results: From a total 80 SSJ–TEN patients in this study, 39% was 46-65 year-old, male (52%). The most frequent diagnosis was SSJ (61%) followed by SSJ overlap TEN (24%) and TEN (15%), mostly with mucosal mouth involvement (64%). The most frequent comorbidities were DM (18%). More than one drug was related to SSJ-TEN (44%). Therapy for all cases was systemic corticosteroids with an average dose of methylprednisolone 65 mg per day in 10 days. Conclusion: Systemic corticosteroids were used in all cases of SSJ-NET in Dr. Moewardi General Hospital Surakarta.
Downloads
References
White KD, Abe R, Jones MA, Beachkofsky T, Bouchard C, Carleton B, et al. SSJ/TEN 2017: Building multidisiplinary networks to drive science and translation. J Allerg Clin Immunol Pract. 2018;6(1):38-69.
Yang SC, Hu S, Zhang SZ, Huang JW, Zhang J, Ji C, et al. The epidemiology of steven johnson syndrome and toxic epidermal necrolysis in China. J Immunol Res. 2018;1(1):1-10.
Yamane Y, Matsukura S, Watanabe Y, Yamaguchi Y, Nakamura K, Kambara T, et al. Retrospective analysis of steven johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients-treatment and outcome. Allergol Int. 2016;65(1):74-81.
Rahmawati YW, Indramaya DM. Studi retrospektif: Sindrom steven johnson dan nekrolisis epidermal toksik di Rumah Sakit Umum Daerah Dr. Soetomo Surabaya. e-journal.unair.ac.id. 2016;28(2):68-76.
Allanore LV, Roujeau JC. Epidermal necrolysis in: Fitzpatrick’s dermatology in general medicine. 8th Ed. New York: McGraw Hill; 2012 .p. 439-48.
Shear NH, Knowles SR. Cutaneous reactions to drugs in: Fitzpatrick's dermatology in general medicine. 8th Ed. New York: McGraw Hill; 2012 .p. 449-57.
Fakoya AOJ, Omenyi P, Anthony P, Anthony F, Etti P, Otohinoyi DA, et al. Stevens-johnson syndrome and toxic epidermal necrolysis; Extensive review of reports of drug-induced etiologies, and possible therapeutic modalities. Maced J Med Sci. 2018;6(4):730-8.
Pinto BP, Araujo L, Freitas A, Correia O, Delgado L. Stevens-johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug related hospitalizations in national administrative database. Clin Transl Allerg. 2018;8(2):1-10.
Kim HI, Kim SW, Park GY, Kwon EG, Jeong JY, Chang HH, et al. Causes and treatment outcomes of stevens-johnsons syndrome and toxic-epidermal necrolysis in 82 adult patients. Korean J Intern Med. 2012;27(2):203-10.
Pirmohamed M, Ostrov DA, Park BK. New genetic finding lead the way to a bettter understanding of fundamental mechanism of drug hypersensitivity. J Allerg Clin Immunol. 2015;136(2):236-42.
Michael B, Rosso JQ. The role of systemic corticosteroid therapy in erythema multiforme major and stevens-johnson syndrome: A review of past and current opinions. J Clin Aesthetic Dermatol. 2009;2(3):51-5.
David S, Hamilton JP. Drug induced liver injury. US Gastroenterol Hepatol Rev. 2010;6(1):73-80.
Patel TK, Brvaliya MJ, Sharma D, Tripathi C. A systematic review of the drug induced steven-johnson syndrome and toxic epidermal necrolysis in Indian population. Indian J Dermatol Venereol Leprol. 2013;79(3):389-98.
Iqbal H, Qureshi S, Shah O. Steven johnson syndrome - a triad of mucosal lesions, cutaneous involvement and history of recent drug exposure. Int Arch BioMed Clin. 2016;2(2):87-90.
Werth VP. Systemic therapy in: Fitzpatrick’s dermatology in general medicine. 8th Ed. New York: Mc Graw Hill; 2012 .p. 2714-20.
Wiryo IT, Karmila ID. Laporan kasus sindrom stevens-johnson overlapping toksik epidermal nekrolisis pada seorang anak penderita HIV yang diduga disebabkan oleh obat di Rumah Sakit Umum Pendidikan Sanglah Denpasar. 2016; 1-20.
Kariosentono H. Sindroma Stevens Johnson dan Nekrolisis Epidermal Toksika (NET). Dalam: Mochtar M, editor. Penyakit Kulit Gawat Darurat. Edisi 1. Surakarta: UPT. Penerbitan dan Percetakan UNS; 2015 .p. 1-31.
Das S, Roy AK, Biswas I. A six month prospective study to find out the treatment outcome, prognosis and offending drugs in toxic epidermal necrolysis from an urban institution in Kolkata. Indian J Dermatol. 2013;58:191-3.
Gupta LK, Martin AM, Agawal N, D’Souza P, Das S, Kumar R, et al. Guidelines for the management of stevens-johnson syndrome/toxic epidermal necrolysis: An Indian perspective. Indian J Dermatol Venereol Leprol. 2016;82(6):603-25.
Law EH, Leung M. Cortocosteroids in stevens-johnson syndrome/toxic epidermal necrolysis: Current evidence and implications for future research. Annals of Pharmacotherapy. 2015;49(3):335-42.
Arantes LB, Reis CS, Novaes AG, Carvalho MR, Gottems LBD, Novaes MR. Stevens-johnson syndrome and toxic epidermal necrolysis: Epidemiological and clinical outcomes analysis in public hospitals. An Bras Dermatol. 2017;92(5):661-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Cermin Dunia Kedokteran
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
