1.png)
* Corresponding Author
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
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
Full Text:
PDFReferences
1. Gerull R, Nelle M, Schaible T. Toxic epidermal necrolysis and Stevens-Johnson syndrome: a review. Crit Care Med. 2011; 39(6): 1521-1532. doi: 10.1097/CCM.0b013e31821201ed
2. Schwartz RA, McDonough PH, Lee BW. Toxic epidermal necrolysis: Part I. Introduction, history, classification, clinical features, systemic manifestations, etiology, and immunopathogenesis. J Am Acad Dermatol. 2013; 69(2): e1-13.
doi: 10.1016/j.jaad.2013.05.003
3. Schwartz RA, Hon D, Edin F, Mcdonough PH, Lee BW. Toxic epidermal necrolysis. J Am Dermatology. 2013; 69(2): e1-187.e16. doi: 10.1016/j.jaad.2013.05.002
4. Maverakis E, Wang EA, Shinkai K, Mahasirimongkol S, Margolis DJ, Avigan
M, Chung WH, Goldman J, La Grenade L, Pirmohamed M, Shear NH, Tassaeeyakul
W, Hoetzenecker W, Klaewsongkram J, Rerkpattanapipat T, Manuyakorn W, Yasuda
SU, Sharon VR, Sukhov A, Micheletti R, Struewing J, French LE, Cheng MY. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Standard Reporting and Evaluation Guidelines: Results of a National Institutes of Health Working Group. JAMA Dermatol. 2017; 153(6): 587-592. doi: 10.1001/jamadermatol.2017.0160
5. Hoetzenecker W, Mehra T, Saulite I, Glatz M, Schmid-Grendelmeier P, Guenova E, Cozzio A, French LE. Toxic epidermal necrolysis. F1000Res. 2016; 5: F1000.
doi: 10.12688/f1000research.7574.1
6. Suwarsa O, Yuwita W, Dharmadji HP, Sutedja E. Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013. Asia Pac Allergy. 2016; 6(1): 43-47. doi: 10.5415/apallergy.2016.6.1.43
7. Almira RDF, Sapartini G, Dewi VYK. Drug allergy clinical characteristics in pediatrics 1. Althea Med J. 2017; 4: 299–303. doi: 10.15850/amj.v4n2.1097
8. Rahmawati Y, Indramaya D. Studi retrospektif: sindrom stevens-johnson dan toxic epidermal necrolysis. Period Dermatology Venereol. 2016; 28(2): 68–76.
9. Mockenhaupt M. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol. 2011; 7(6): 803-813.
doi: 10.1586/eci.11.66
10. Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS. Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. Ann Allergy Asthma Immunol. 2005; 94(4): 419-436.
doi: 10.1016/S1081-1206(10)61112-X
11. French LE. Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. Allergol Int. 2006; 55(1): 9-16. doi: 10.2332/allergolint.55.9.f
12. McCullough M, Burg M, Lin E, Peng D, Garner W. Steven Johnson Syndrome and Toxic Epidermal Necrolysis in a burn unit: A 15-year experience. Burns. 2017; 43(1): 200-205. doi: 10.1016/j.burns.2016.07.026.
13. D C, Lee HY, Dart JKG, Setterfield J, Bunker CB, Ardern-jones MR, et al. UK guidelines for the management of Stevens e Johnson syndrome / toxic epidermal necrolysis in adults 2016. Br J Plast Surg. 2016; 69(6): e119–53. doi: 10.1111/bjd.14530
14. Knowles S, Shear NH. Clinical risk management of Stevens-Johnson syndrome/
toxic epidermal necrolysis spectrum. Dermatol Ther. 2009; 22(5): 441-451.
doi: 10.1111/j.1529-8019.2009.01260.x.
15. Al-Quteimat OM. Phenytoin-induced toxic epidermal necrolysis: Review
and recommendations. J Pharmacol Pharmacother. 2016; 7(3): 127-132.
doi: 10.4103/0976-500X.189662.
16. Schroeder J, Aversano MG, Citterio A, Scibilia J, Gamba C, Mirone C, et al. New insights in Stevens Johnson syndrome / toxic epidermal necrolysis syndrome. Clin Transl Allergy. 2014; 4: 92. doi: 10.1186/2045-7022-4-S3-P92
17. Tohyama M, Hashimoto K. Immunological mechanisms of epidermal damage in toxic epidermal necrolysis. Curr Opin Allergy Clin Immunol. 2012; 12(4): 376-382.
doi: 10.1097/ACI.0b013e328355b865.
18. Farah CS, Balasubramaniam R, McCullough MJ. Contemporary oral medicine a
comprehensive approach to clinical practice. Springer Nature Switzerland; 2019.
19. Zajicek R, Pinta D, Broz L, Suca H, Konigova R. Toxic epidermal necrolysis and Stevens-Johnson syndrome at the Prague Burn Centre 1998 – 2008. J Eur Acad Dermatology Venereol. 2011; 1–5.
20. Graves C, Faraklas I, Maniatis K, Panter E, La Force J, Aleem R, Zavala S, Albrecht M, Edwards P, Cochran A. Nutrition in Toxic Epidermal Necrolysis: A Multicenter Review. Nutr Clin Pract. 2016; 31(6): 836-840.
doi: 10.1177/0884533616642746
21. Fernando SL. The management of toxic epidermal necrolysis. Australas J Dermatol. 2012; 53(3): 165-71. doi: 10.1111/j.1440-0960.2011.00862.x
22. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015; 91(5): 299-307.
23. Sen S, Tran N, Chan B, Palmieri TL, Greenhalgh DG, Cho K. Sodium variability is associated with increased mortality in severe burn injury. Burns Trauma. 2017; 5: 34. doi: 10.1186/s41038-017-0098-4
24. Moenadjat Y. Luka bakar masalah dan tata laksana. 4th ed. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2009.
25. Devarbhavi H, Raj S, Aradya VH, Rangegowda VT, Veeranna GP, Singh R, et al. Liver injury/regeneration. Journal of Hepatology. 2016; 63(3): 993–999.
26. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical
significance. J Parenter Enteral Nutr. 2019; 43(2): 181-193. doi: 10.1002/jpen.1451
27. Ballmer PE. Causes and mechanisms of hypoalbuminaemia. Clin Nutr. 2001; 20(3): 271-273. doi: 10.1054/clnu.2001.0439
28. Ang CC, Tay YK. Hematological abnormalities and the use of granulocyte-colony-stimulating factor in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Int J Dermatol. 2011; 50(12): 1570-1578.
doi: 10.1111/j.1365-4632.2011.05007.x.
29. Kirchhof MG, Miliszewski MA, Sikora S, Papp A, Dutz JP. Retrospective review of
Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. J Am Acad Dermatol. 2014; 71(5): 941-947. doi: 10.1016/j.jaad.2014.07.016.
30. Viard-Leveugle I, Gaide O, Jankovic D, Feldmeyer L, Kerl K, Pickard C, Roques S, Friedmann PS, Contassot E, French LE. TNF-α and IFN-γ are potential inducers of
Fas-mediated keratinocyte apoptosis through activation of inducible nitric oxide synthase in toxic epidermal necrolysis. J Invest Dermatol. 2013; 133(2): 489-498.
doi: 10.1038/jid.2012.330.
31. Orime M, Abe R. Histopathology of severe drug eruptions. In: Advances in Diagnosis and Management of Cutaneous Adverse Drug Reactions. Springer Nature Singapore; 2019.
32. McKelvey K, Jackson CJ, Xue M. Activated protein C: A regulator of human skin epidermal keratinocyte function. World J Biol Chem. 2014; 5(2): 169-179.
doi: 10.4331/wjbc.v5.i2.169.
DOI: https://doi.org/10.22146/mkgk.72005
Article Metrics
Abstract views : 1420
| 
views : 1571
Refbacks
- There are currently no refbacks.
Copyright (c) 2021 MKGK (Majalah Kedokteran Gigi Klinik) (Clinical Dental Journal) UGM
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.