EMERGENCIES IN

DERMATOLOGY
Dr. Citra Cahyarini, SpKK

Department of dermatovenereology
Faculty of medicine YARSI University
Emergencies in dermatology :
Stevens Johnson Syndrome
Toxic Epidermal Necrolysis
Stapylococcal Scalded Skin Syndrome
Pemfigus Vulgaris

Erythema Multiforme
Reaction pattern of blood vessels in the
dermis with secondary epidermal
changes manifests clinically as
characteristic erythematous iris-shaped
papular and vesicobulous lession
typically involving the extremities
(especially the palms and soles) and
mucous membranes
Etiology
A cutaneous reaction to variety of
antigenic stimuli :

- drug : sulfonamide, phenytoin,
barbiturates, phenylbutazone,
penicillin, allopurinol
- Infection : mycoplasma
- Idiopathic : >50%
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
Erythema Multiforme:
Papular, urticarial, vesiculer target lesions
in acral distribution
Herpes Iris of Bateman
Vesicular and target lesions of EM
SJS:
Initial Stage: Partially confluent erythematous
lesions with dusky centers, presenting as flat
atypical target lesions
SJS: Advanced stage:
Generalized macular eruption with
detachment of necrotic epidermis
SJS:
Extensive necrosis and erosions of the lips
and oral mucosa
Typical iris lessions
Target lesions: margin of vesicles with
red centers
SJS: involvement of lips and tounge
Involvement of the lips and palate
Diffuse erythema, shedding of the cilia
and epidermis of the eyelids, severe
erosions, hemorrhagic crusting of the
lips
Diffuse generalized shedding of the
epidermis
TEN: confluent morbilliformis eruption, with
positive Nikolsky sign
TEN


TEN

TEN

TEN
TEN

TEN

TEN

TEN

TEN

Staphylococcal Scalded Skin Syndrome (S4)
Staphylococcal Scalded Skin Syndrome (S4)
S4

S4

S4

S4

S4

S4

S4

S4

Pemfigus Vulgaris
PERBEDAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET
EM
MINOR
STEVEN
JOHNSON
NET

ETIOLOGI

VHS AKUT

OBAT

OBAT
PERJALANAN
PENYAKIT
AKUT,
SWASIRNA
REKUREN
AKUT,
SWASIRNA,
EPI
AKUT,
SWASIRNA,
EPI

PRODOMAL
TIDAK
ADA /
RINGAN

ADA
ADA, NYERI
KULIT
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
PERBEDAAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET
EM
MINOR
STEVEN
JOHNSON
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
GEJALA
KONSTITUSI
TIDAK ADA /
RINGAN
ADA / BERAT ADA / BERAT
ORGAN
DALAM
TIDAK TERKENA KADANG
KADANG
SERING
PERBEDAAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET
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
PERBEDAAN NET DENGAN S4
NET SSSS
ETIOLOGI OBAT EKSOTOKSIN
RIWAYAT
KELUARGA
TIDAK
MENUNJANG
ANGGOTA LAIN;
IMPETIGO
USIA > 40 TAHUN < 5 TAHUN
EKSANTEM GENERALISATA KHAS: WAJAH,
LEHER, KETIAK,
SELA PAHA
PERBEDAAN NET DENGAN S4
NET SSSS
NYERI PADA
KULIT
RINGAN
SEDANG
JELAS
TANDA
NIKOLSKY
PADA LESI JUGA PADA
KULIT
SEHAT

MUKOSA
TERKENA
DENGAN
BERAT
TIDAK
TERKENA
PERJALANAN
PENYAKIT
2-3 MINGGU 2-4 HARI
PERBEDAAN NET DENGAN S4
NET SSSS
TERAPI
SISTEMIK
KORTIKOSTEROID
DOSIS TINGGI
PENISILINASE
RESISTEN
HISTOPA NEKROLISIS EPIDERMIS
STR. BASALIS
AKANTOLISIS,
CELAH
SUBGRANULAR
MORTALITAS 25-50 % 2-3 %