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Kuliah SMTR V
Kuliah SMTR V
mucocutaneous intolerance
factor.
Minority infections,
vaccination etc.
Pathogenesis
Hypersensitivity reaction
Trias sign :
1. Skin.
2. Mucous-membrane.
3. Eye.
It begins nonspecific prodrome :
• Fever • Malaise
• Headache • Rhinitis
• Cough • Sore throat
• Chest pain • Vomiting
• Diarrhea • Myalgia
• Arthralgia.
Skin :
• Erythematous (sometimes
morbiliform rash).
• Vesicle.
Anal erosi.
Eye : Conjunctiva
erosions.
• Bilateral lacrimation.
• Purulent conjunctivitis with
photophobia &
pseudomembran.
stages) epidermal
subepidermal separation.
• Mononuclear cell infiltrate
papillary dermis.
• Exocytosis epidermis.
Laboratory
Trias sign :
• Acute GVHD.
• Viral exanthems.
Complication
balance.
• Supportive care :
Pulmonary care (suctioning,
postural drainage, etc).
Ophthalmologic care.
High-calorie & high protein
diet.
• Topical treatment :
Sofratulle / sulfadiazine
cream.
lesion.
Prognosis
2. There is no ethnic
preponderance; females appear
to be about twice as frequently
affected as males.
3. It is most often found in
adults.
4. It typically occurs
sporadically, but epidemics
have been observed with
the mass use of drugs.
ETIOLOGY
It is a polyetiologic reason pattern :
Inducing apoptosis
destruction of epidermis &
keratinocyte
CLINICAL FEATURES
nonspecific prodrome of 1
patients.
A macular at times morbiliform
rash appears first on the face,
neck, chin, & central trunk
areas & may then spread to the
extremities & the rest of the
body.
The lesions rapidly increase in
numbers & size : maximal
disease expression is usually
reached within 4 to 5 days.
The rash is paralleled or even
preceded by mucous membrane
lesions.
Extra cutaneous symptoms :
Constitutional sign.
membrane.
LABORATORY
INVESTIGATIONS
An elevated blood
sedimentation rate.
Moderate leukocytosis,
anemia.
Fluid-electrolyte imbalances,
microalbuminuria,
hypoproteinemia.
A transient decrease of
peripheral CD4+ T lymphocyte
counts.
DIAGNOSIS
diagnosis.
DIFFERENTIAL DIAGNOSIS
Systemic glucocorticoids
80 to 120 mg of methyl-
decreased.
Prophylactic antibiotic
be avoided (aminopenicilline,
cephalosporins).
Topical treatment may be
carried out with hydrocolloid or
more conservatively, with
gauze dressing.
Obviously, sulfonamide-
containing topical agents
should be avoided.
PROGNOSIS
Usually followed by
exfoliation of scale.
Synonym
Exfoliative dermatitis
Etiology
Drug reaction.
Expansion of other skin
disease i.e psoriasis,
seborrhoeic dermatitis,
atopic dermatitis.
Systemic disease or
malignancy.
Unknown.
Pathophysiology
Erythema disorder of
thermoregulation basal
hypermetabolism.
hypoalbuminemia.
Clinical Manifestation
I. Erythroderma due to drug
reaction.
Acute, occurs within 10 days
after the suspected drug
administrated.
The eruption start as
generalized morbiliform
erythema, initially without
scale.
II. Erythroderma as an
expansion of other skin
disease.
Characterized by exfoliative
& desquamative skin
lesions.
Psoriatic erythroderma
4 - 20 weeks of age).
III. Erythroderma due to systemic
disease or malignancy.
Hodgkin’s disease &
mycosis fungoides / sezary
syndrome.
Universal erythema,
accompanied by scale &
severe pruritus.
Laboratory
severity an duration of
inflammatory process :
I. Acute stage (type I) :
Spongiosis.
Parakeratosis.
Non specific inflammatory
infiltrate.
II. Chronic Stage :
Acanthosis.
Elongation of rete ridges.
III. Type III :
Lymphoid infiltrate at
dermo-epidermal junction.
Atypical cerebriform
mononuclear cells.
Pautrier’s micro-abscesses.
Diagnosis
Anamnesis.
Clinical features.
Histopathology.
Differential Diagnosis
Pemphigus foliaccus.
prednisone dose.
3 - 4 x 10 mg/d type I.
4 x 10 - 15 mg/d type II
(adult).
30 mg/d + Chlorambucyl 2
1 - 2 mg/kgBW Leiner’s
disease.
3. Topical treatment :
Triamcinolone acetonide
(Type III) .
Depend on the causative factor
Type I : Although can be
fatal at the acute phase, it
has the best prognosis if
treated with adequate
treatment. Often resolving in
2 – 6 weeks.
Type II : relapses often
occur.
Type III :
Poor prognosis.
intolerance reaction.
• Von Hebra descriptions EM
associated HSV.
• Steven & Johnson as EM
linked SJS because the same
pathologic, differ only in
severity & term EM minor &
major.
• EM major synonym SJS.
Two main subset
cutaneus intolerance
by drugs.
Incidence & Epidemiology
• Relatively common.
• Can be observer in all ages,
predominantly in adolescent
& young adult.
Rare in under 3 years olds &
over 50 years.
• Female = male.
No predominance for ethnic
groups.
• Often recurrent in short
interval & reappear for many
years.
Etiology
destruction of keratocytes
days.
• Up to hundred of lesion
may form.
• Symmetric, extensor surfaces
(centripetal).
• Early :
Lymphocyte accumulation at
the epidermis.
Scattered keratinocyte necrosis
cell necrosis).
Spongiosis, vacuolar
layer.
epidermal necrosis.
Differential Diagnosis
• Acute annular urticaria.
• Urticaria vasculitis.
• Disseminated lesion of
contact dermatitis.
• Bullous pemphigoid.
• Linear IgA dermatosis.
• Herpes gestationes.
Treatment
• Symptomatic : shake lotion,
topical steroid, analgetic &
anti histamin.
• Systemic glucocorticoids :
Unnecessary & possibly
worsened.
• Because recurrent EM most
often by triggered HSV
infection the ideal
approach : prevention of HS
episodes with oral acyclovir
or derivates.
Alternatives Treatment
• Dapsone.
• Anti malaria.
• Azathioprine.
• Thalidomide.
Prognosis
• Self limited, recovery is
complete & there are no
sequelae.
• Antibiotika
• Pengobatan cairan yang tepat