Nekrolisis Epidermal Toksik(n
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NEKROLISIS EPIDERMAL TOKSIK(N.E.T)
Pembimbing: dr. Hastono, Sp.KK
Oleh : DM kelompok D
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SINONIM
Sindrom Lyella
Toxic Epidermal Necrolysis (TEN)
Epidermolisis Nekrotikans Kombustiformis
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DEFINISI
Epidermolisis generalisata
Kelainan selaput lendir, orifisium, mata
Lesi eritema, vesikel, bula, erosi & purpura
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ETIOLOGI
Derivat Penicilin
(25%)
Paracetamole (17%)
Carbamazepin (14%)
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GEJALA KLINIS
Gejala Prodormal• Demam Tinggi• Kesadaran menurun (soporo-komatosa)
Kelainan Kulit• Eritema generalisata• Vesikel, Bula multiple, dan purpura• Erosi, Ekskoriasi, & krusta Berwarna merah
hitam pada selaput lendir & bibir
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GEJALA KHAS
Epidermiolisis
Nikolsky sign +
Onikolisis
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NIKOLSKY SIGN (+)
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EPIDERMOLISIS GENERALISATA
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PATOGENESIS
IMUNOPATOLOGIS= Seven Johnson
Sindrom
Hipersensitivitas Type II (Sitolitik)
Gambaran Klinis
Tergantung Sel Target
Nekrosis Epidermal Toksik
Sel Target = Epidermis
Epidermolisis
Dapat mengenai Sel Normal
Lainnya
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REAKSI HIPERSENSITIVITAS TIPE II
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NEKROLISIS EPIDERMAL TOKSIK
DIAGNOSIS
GEJALA KLINIK
ANAMNESA
Bila ragu LABORATORIUM, HISTOPATOLOGI
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HISTOPATOLOGI
Vaskuolisasi & Nekrosis sel basal sepanjang perbatasan dermal- epidermal
Sel radang di dermis sedikit (limfohistiosit)
Nekrosis eosinofilik sel dermis
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Vakuolisasi
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Pembentukan Celah pada
lapisan Sub-epidermal
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LABORATORIUM
Leukositosis
Enzim transaminase serum ↑
Gangguan keseimbangan elektrolit & cairan
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DIAGNOSIS BANDING
• Kombusio • SJS• Staphylococcus Scalded Skin
Syndrome ( SSSS)
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STEVEN JOHNSON SYNDROME
Staphylococcus scalded skin syndrome
Kombusio
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PERBANDINGAN NET DAN SJS
NET
SJS
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PENATALAKSANAAN
•Obat yg dicurigai Penyebab AlergiSTOP
• Dextrose 5%: Nacl 0,9%: RL =1:1:1
• Kortikosteroid = Deksametason 30-40 mg/hr, i.v. dibagi 3-4 x/hr
• Obat Topikal : Sulfadiazin perak (dermazin cream, silvadine)
MEDIKAMENTOSA
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PROGNOSIS• Jika Penyebabnya Infeksi
Prognosisnya Lebih Baik Dari Pada
Alergi Obat
• Kelainan Kulit >50-70%
Prognosisnya Jelek
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TERIMA KASIH