Tatalaksana lesi oral untuk mendukung asupan nutrisi pasien toxic epidermal necrolysis

Helen Christine; Tenny Setiani Dewi; Dewi Kania Intan Permatasari

doi:10.22146/mkgk.72005

Tatalaksana lesi oral untuk mendukung asupan nutrisi pasien toxic epidermal necrolysis

https://doi.org/10.22146/mkgk.72005

Helen Christine^(1*), Tenny Setiani Dewi⁽²⁾, Dewi Kania Intan Permatasari⁽³⁾

(1) Program Pendidikan Dokter Gigi Spesialis Ilmu Penyakit Mulut, Fakultas Kedokteran Gigi, Universitas Padjadjaran, Bandung, Jawa Barat
(2) Departemen Ilmu Penyakit Mulut, Fakultas Kedokteran Gigi, Universitas Padjadjaran, Bandung, Jawa Barat
(3) Program Pendidikan Dokter Gigi Spesialis Ilmu Penyakit Mulut, Fakultas Kedokteran Gigi, Universitas Padjadjaran, Bandung, Jawa Barat
(*) Corresponding Author

Abstract

Toxic Epidermal Necrolysis (TEN) merupakan reaksi kulit yang berat akibat hipersensitifitas berupa gangguan mukokutaneus akut ditandai epidermolisis lebih dari 30% luas permukaan tubuh disertai gangguan sistemik dan dapat mengancam jiwa. Asupan nutrisi yang adekuat sangat penting untuk pemulihan dari kerusakan jaringan, terutama asupan protein. Keterlibatan mukosa rongga mulut pada TEN berupa lesi erosi pada membran mukosa yang menimbulkan kesulitan makan. Seorang wanita berusia 31 tahun dirujuk dari bagian Ilmu Kesehatan Kulit
dan Kelamin dengan keluhan lecet dan gelembung berisi cairan jernih pada hampir seluruh tubuh disertai nyeri menelan sehingga pasien sulit makan sejak 2 hari yang lalu. Pasien didiagnosis TEN ec suspect fenitoin, diazepam dan asam mefenamat. Anemia defisiensi Fe, infeksi saluran kencing, drug induced liver injury, hipoalbuminemia dan hiponatremia. ditemukan dari hasil pemeriksaan laboratorium. Pemeriksaan ekstra oral menunjukan seluruh wajah, leher dan dada terdapat makula kecoklatan disertai daerah erosi pada bagian leher, mata anemis, sklera non ikterik, bibir atas dan bawah bengkak disertai krusta sanguinolenta. Pemeriksaan intra oral ditemukan lesi erosif eritema multipel pada hampir seluruh mukosa rongga mulut. Diagnosis kerja yaitu lesi oral terkait Toksik Epidermal
Nekrolisis. Terapi yang diberikan berupa kompres bibir larutan dexametason bergantian dengan NaCl 0,9% serta pemberian chlorhexidine gluconate 0,2% mouthwash. Seminggu kemudian pasien mengalami perbaikan dan dapat
makan makanan biasa. Kesimpulan dari penanganan dini yang adekuat terhadap manifestasi oral pasien TEN akan mendukung kondisi sistemik dengan meningkatnya asupan nutrisi sebagai bagian dari perawatan komprehensif.

Keywords

asam mefenamat; diazepam; fenitoin; toxic epidermal necrolysis

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DOI: https://doi.org/10.22146/mkgk.72005