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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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