PENYAKIT KULIT

GAWAT DARURAT
1. Erythema Multiforme
2. Stevens-Johson Syndrome and
Toxic Epidermal Necrolysis
3. Urticaria
4. Exfoliative Erythroderma Syndrome
5. Staphylococcal Scalded Skin
Syndrome

ERYTHEMA MULTIFORME
Def :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.
Etiol : a cutaneous reaction to variety of
antigenic stimuli
- drug : sulfonamide, phenytoin,
barbiturates, phenylbutazone,
penicillin, allopurinol
- infection : mycoplasma
- idiopathic : >50%

Physical exam:
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

EM Major :
most often : drug reaction
severe, extensive, nikolsky sign (+),
mucous membrane always involment.
- Syst symptom : fever, prostration.
- Cheilitis & stomatitis, vulvitis &
balanitis, conjunctivitis can lead to keratitis &
ulceration
Skin lesion : developed 10 d
- dull red macule (48h) papule
vesicles & bullae in center of the papule (iris,
target like lesion) extensive
bulllae
Predilection sites : = EM Minor + penis,
vulva, eyes & lip

DD : psoriasis, secondary syphilis,

urticaria.
Tx : glucocorticoid prednisone 5080mg/dquickly tapered

STEVENS-JOHNSON SYNDROME
& TOXIC EPIDERMAL
NECROLYSIS

Def :
mucocutaneous drug-induced or
idiophatic reaction patterns
characterized by skin tenderness and
erythema of skin and mucousa, followed
by extensive cutaneous and mucosal
epidermal necrosisand sloughing
potentially life-threatening due to
multisystem involvement

Pathogenesis : partially understand

drug
(hapten)><keratinocytes
antigeniccytokines local cell death,
fever & malaise
History : 1-3 w drug exposure
prodrome : fever, influenza-like
sympt 1-3d mucocutaneous lessions

Physical exam :
- prodromal rash : morbiliform, EM- like, diffuse erythema
- early : necrotic epidermis macule with crinkled surface
enlarge and coalesce raised flaccid blisters
(Niklosky sign +)
- distribution :

erythema face & extremities

few h/d
confluent

generalized epidermal sloughing

large denuded areas

mucous membranes : lips, buccal mucosa,
conjunctiva, genital & anal skin

*hair & nail : TEN shed eyelashes & nail

DD :
- early : EM major, exanthematous drug
eruption, scarlet fever, phototoxic
eruptions.
- fully evolved : EM major thermal burns,
SSSS, generalized bullous fixed drug
eruption, exfoliative dermatitis.

Prognosis : ~extent of skin necrosis.

Management :
- withdrawal of suspected drugs
- best cared in intensive care unit
- manage replacement of IV fluids &
electrolytes ~III degree thermal burn
- syst glucocorticoid high doses & early
- high doses iv immunoglobulin TEN
- suction frequently oropharyngeal
involvement
- treat complicating inf
- treat eye lesions erythromycin oint