Vesicobullous Skin Diseases

dr. Fitria Salim, M.Sc., SpKK

Dermato-Venereology Department
Medical Faculty of Syiah Kuala University/dr. Zainoel Abidin General Hospital
Banda Aceh 2015
Steven-Johnson Syndrome &
Toxic Epidermal Necrolysis (3B)
 Rare & life threatening reaction, mainly drug induced
 Widespread apoptosis of keratinocytes  activation of a cell-
mediated cytotoxic reaction & amplified by cytokines, mainly
granulysin
 Confluent purpuric and erythematous macules evolving to
flaccid blisters and epidermal detachment predominating on
the trunk and upper limbs and associated with mucous
membrane involvement (eye, mouth, genital)
SJS & TEN
 Extracutaneous symptoms  fever, pain, weakness,
pulmonary & digestive complication (profuse diarrhea,
malabsorption, melena,colic perforation)
 Pathologic  full-thickness necrosis of epidermis
associated with mild mononuclear cell infiltrate
 SJS & TEN …

Etiology

Infection (M.
Radiotherapy,
Pneumoniae,
Genetic Drugs bone marrow
viral &
transplantation
immunization)
 Medication & the risk of SJS/TEN
High risk Lower risk Doubthful risk No evidence of risk
Allopurinol Acetic acid NSAIDs Paracetamol Aspirin
Sulfamethoxazole Aminopenicilin Pyrazolone analgesic Sulfonylurea
Sulfadiazine Cephalosporins Corticosteroid Thiazide diuretic
Sulfapyridine Quinolone Other NSAID (except Furosemide
aspirin)
Sulfadoxine Cycline Sertraline Aldactone
Sulfasalazine Macrolides Calcium chanel blocker
Carbamazepine Beta blocker
Lamotrigine Angiotensin converting
enzyme inhibitor
Phenobarbital Angiotensin II receptor
antagonis
Phenytoin Statin
Phenybutazone Hormones
Nevirapine Vitamin
Oxicam NSAIDs
Thiacetazone
Differential diagnosis

 EM mayor
 Varicella
 AGEP
 Bullous FDE
 S4
Lab

 RR & blood oxygenation

 Arterial blood gas level, serum bicarbonat
 Electrolyte & fluid imbalances
 HistoPA
 Skin test & oral provocation test
Treatment
 Stop suspicious drugs
 Maintaining hemodynamic equilibrium & preventing life
threatening complications
 ICU/ burn centers
 Lip & mouth: borax-gliserin or steroid in vaselin (topical)
 Dexametason 0,15-0,2 mg/kgbb/day  4-6x5mg/day iv
 Gentamisin 2x80mg or clindamisin 2x600mg iv
 Low salt & high protein diet
 KCl 3x500mg/day  low kalium
 Fluid imbalance  IVFD Darrow & 5% glucose