Tata Laksana Terintegrasi Sindrom Stevens-Johnson (SJS) dan Nekrolisis Epidermal Toksik (NET)
DOI:
https://doi.org/10.55175/cdk.v50i10.760Kata Kunci:
Nekrolisis epidermal toksik, sindrom Stevens-Johnson, SSJ-NETAbstrak
Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan reaksi mukokutan akut yang mengancam nyawa, dengan karakteristik nekrosis epidermis luas dan terlepasnya epidermis. Insiden SSJ di Jepang adalah 2,3 kasus/100.000 penduduk/tahun. Tingkat mortalitas SSJ-NET di Saudi Arabia adalah 1 dari 10 kasus (10%). Penyebab SSJ-NET dapat terkait obat-obatan, idiopatik, infeksi, setelah transplantasi sumsum tulang, imunisasi, radioterapi, ataupun terkait genetik. Patogenesis SSJ-NET diduga akibat reaksi sitotoksik terhadap sel keratinosit yang menyebabkan apoptosis masif. Manifestasi klinis diawali gejala prodromal diikuti dengan munculnya lesi makula eritema dan lesi target atipikal yang dapat berkonfluens, kemudian menjadi bula, erosi, dan oozing dengan keterlibatan mukosa. Pemantauan tanda-tanda vital harus dilakukan untuk menentukan prognosis. Pemeriksaan penunjang dilakukan apabila dipertimbangkan diagnosis banding lain. Tata laksana SSJ-NET adalah dengan menghentikan obat terduga, penanganan awal seperti resusitasi cairan, pemberian nutrisi dini, perawatan, serta evaluasi mata dan lesi kulit. Keterlibatan multiorgan dapat terjadi pada SSJ-NET, sehingga tata laksana multidisiplin diperlukan untuk terapi optimal. Pemberian corticosteroid dan cyclosporine A dapat menguntungkan. Prognosis SSJ-NET diperhitungkan dengan menggunakan SCORTEN.
Unduhan
Referensi
Djuanda A, Suriadiredja ASD, Sudharmono A, Wiryadi BE, Kurniati DD. Ilmu penyakit kulit dan kelamin. In: Menaldi SLS, Bramono K, Indriatmi W, eds. 7th Ed. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2016.
Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al. Fitzpatrick’s dermatology. 9th ed. New York: McGraw-Hill Education; 2019.
James WD, Elston D, Treat J, Rosenbach M, Neuhaus I. Andrews’ diseases of the skin clinical dermatology. 13th ed. Philadelphia: Elsevier; 2020.
Ubukata N, Nakatani E, Hashizume H, Sasaki H, Miyachi Y. Risk factors and drugs that trigger the onset of Stevens-Johnson syndrome and toxic epidermal necrolysis: A population-based cohort study using the Shizuoka Kokuho database. J Am Acad Dermatol. 2022;11:24–31.
Alajaji A, Shekaran JC, Aldhabbah OM, Alhindi HA, Almazyad NS, Aljutayli ZA, et al. Toxic epidermal necrolysis (TEN)/Stevens-Johnson syndrome (SJS) epidemiology and mortality rate at King Fahad Specialist Hospital (KFSH) in Qassim region of Saudi Arabia: A retrospective study. Dermatol Res Pr. 2020;2020:1–3.
Yang MS, Lee JY, Kim J, Kim GW, Kim BK, Kim JY, et al. Incidence of stevens-johnson syndrome and toxic epidermal necrolysis: A nationwide population-based study using national health insurance database in Korea. PLoS One. 2016;11(11):1–12.
Sunagaa Y, Michiko K, Hirotaka O, Hideaki W, Hirohiko S, Hiroaki A, et al. The nationwide epidemiological survey of Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan, 2016-2018. J Dermatol Sci. 2020;100(3):175–82.
Khosama H, Budikayanti A, Khor AHP, Lim KS, Ng CC, Mansyur IG, et al. HLA-B*1502 and carbamazepine induced Stevens-Johnson syndrome/toxic epidermal necrolysis in Indonesia. Neurol Asia 2017;22(2):113–6.
Oki S, Yuwita W, Dharmadji, Hartati Purbo Sutedja E. Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013. Asia Pac Allergy. 2016;6(1):43–7.
Isaac WA, Damayanti, Fatimah N, Hidayati AN. The profiles of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) patients in tertiary hospital. Berk Ilmu Kes Kulit Kelamin (Period Dermatol Venerol). 2021;33(2):116–22.
Chan F, Benson MD, Plemel DJA, Mahmood MN, Chan SM. A diagnosis of Stevens-Johnson syndrome (SJS) in a patient presenting with superficial keratitis. Am J Ophthalmol. 2018;19(11):167–9.
Łabno ES, Gabzdyl N, Misiak-Galazka M, Pawłowska-Kisiel M, Łazowski T, Rudnicka L. Stevens–Johnson syndrome and toxic epidermal necrolysis in an academic hospital setting: a 5-year retrospective study. Our Dermatol Online. 2016;7(4):381–4.
Lim JH, Cho SH, Lee JD, Kim HS. A case of Stevens-Johnson syndrome probably induced by herbal medicine. Ann Dermatol. 2018;30(4):481–3.
Oluwo AO, Folakemi Olutoyin FO, Mabogunje CA. Oral manifestations of herbal medicine induced Steven Johnson Syndrome in 3 Nigerian paediatric patients: case report. Pan Afr Med J. 2020;4:1–8.
Ye Z, Li C, Zhang H, Zhang C, Lu X. Mapping of susceptible variants for cold medicine-related Stevens–Johnson syndrome by whole-genome resequencing. Clin. 2022;15:1979–90.
Meyerle JH. Evaluation of vesicular-bullous rash [Internet]. 2019. Available from: https://bestpractice.bmj.com/topics/en-us/775
Wolf R, Davidovici BB, Parish JL, Parish LC, eds. Emergency dermatology. 1st ed. New York: Cambridge University Press; 2010.
Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol. 2002;8:1.
Gupta LK, Martin AM, Agarwal N, Souza PD, Das S, Kumar R, et al. Guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis: An Indian perspective. IJDVL. 2016;82:603–25.
Surowiecka A, Bara´nska-Rybak W, Struzyna J. Multidisciplinary treatment in toxic epidermal necrolysis. Int J Environ Res Public Heal. 2023;20:2217.
Shanbhag SS, Chodosh J, Fathy C, Goverman J, Mitchell C, Saeed HN. Multidisciplinary care in Stevens-Johnson syndrome. Ther Adv Chronic Dis. 2020;11:1–17.
Ingen‑Housz‑Oro S, Schmidt V, Ameri MM, Abe R, Brassard A, Mostaghimi A, et al. Post‑acute phase and sequelae management of epidermal necrolysis: An international, multidisciplinary DELPHI‑based consensus. Orphanet J Rare Dis. 2023;18:1–10.
Unduhan
Diterbitkan
Cara Mengutip
Terbitan
Bagian
Lisensi
Hak Cipta (c) 2023 Cermin Dunia Kedokteran
Artikel ini berlisensi Creative Commons Attribution-NonCommercial 4.0 International License.
