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Vesicobullous Skin Dise
Dermato-Venereology Department
Medical Faculty of Syiah Kuala University/dr !ainoel "bidin #en
%anda "ceh &'()
dr. Fitria Salim, M.Sc., SpKK
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Steven-*ohnson Syndrome +,oic .pidermal ecrolysis 01%
Rare & life threatening reaction, mainly drug
Widespread apoptosis of keratinocytes acta cell- mediated cytotoic reaction & ampliedcytokines, mainly granlysin
!on"ent prpric and eryt#ematos macles ev3accid blisters and epidermal detachmentpredominating on t#e trnk and pper limbs andassociated $it# mucous membraneinvolvemenmot#, genital
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S*S + ,.
'(tractaneos symptoms fever, pain,
plmonary & digestive complication %profsmalabsorption, melena,colic perforation
)at#ologic fll-t#ickness necrosis of eassociated $it# mild mononclear cell inltr
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.tiology
*enetic Drugs+nfection %M.Pneumoniae,
viral &immniation
Radbon
tran
SJS &
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Medication + the risk of S*S/,.
$igh risk 4o5er risk Doubthful risk o ev
lloprinol cetic acid S+/s )aracetamol spirinSlfamet#o(aole minopenicilin )yraolone analgesic SlfonySlfadiaine !ep#alosporins !orticosteroid 0#iaid
Slfapyridine 1inolone 2t#er S+/ %e(ceptaspirin
Frose
Slfado(ine !ycline Sertraline ldactoSlfasalaine Macrolides !alcim
!arbamaepine 3eta b
4amotrigine ngioteenym
)#enobarbital ngioteantago
)#enytoin Statin
)#enybtaone 5ormo
evirapine 6itamin
2(icam S+/s
0#iacetaone
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Di6erential diagnosis
'M mayor
6aricella
*')
3llos F/'
S7
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4ab
RR & blood o(ygenation
rterial blood gas level, serm bicarbonat
'lectrolyte & "id imbalances
5isto)
Skin test & oral provocation test
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,reatment
Stop sspicios drgs
Maintaining #emodynamic e8ilibrim & prevet#reatening complications
+!9: brn centers
4ip & mot#; bora(-gliserin or steroid in vaselin
/e(ametason -m
Gentamisin 2x80mg or clindamisin 2x00mg i! "o# salt & $ig$ %rotein diet
'l (x)00mg*da+ lo# alium
-luid imalance /-1 1arro# & ) glucose
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