EMERGENCIES IN

DERMATOLOGY

Dr. Citra Cahyarini, SpKK

Department of dermatovenereology
Faculty of medicine YARSI University
Emergencies in dermatology :

• Stevens Johnson Syndrome

• Toxic Epidermal Necrolysis
• Stapylococcal Scalded Skin Syndrome
• Pemfigus Vulgaris
Erythema Multiforme

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
Etiology
A cutaneous reaction to variety of
antigenic stimuli :

- drug : sulfonamide, phenytoin,

barbiturates, phenylbutazone,
penicillin, allopurinol
- Infection : mycoplasma
- Idiopathic : >50%
 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
Erythema Multiforme:
Papular, urticarial, vesiculer target lesions
in acral distribution
Herpes Iris of Bateman
Vesicular and target lesions of EM
SJS:
Initial Stage: Partially confluent erythematous
lesions with dusky centers, presenting as flat
atypical target lesions
SJS: Advanced stage:
Generalized macular eruption with
detachment of necrotic epidermis
SJS:
Extensive necrosis and erosions of the lips
and oral mucosa
Typical ‘iris’ lessions
Target lesions: margin of vesicles with
red centers
SJS: involvement of lips and tounge
Involvement of the lips and palate
Diffuse erythema, shedding of the cilia
and epidermis of the eyelids, severe
erosions, hemorrhagic crusting of the
lips
Diffuse generalized shedding of the
epidermis
TEN: confluent morbilliformis eruption, with
positive Nikolsky sign
TEN
TEN
TEN
TEN
TEN
TEN
TEN
TEN
TEN
Staphylococcal Scalded Skin Syndrome (S4)
Staphylococcal Scalded Skin Syndrome (S4)
S4
S4
S4
S4
S4
S4
S4
S4
Pemfigus Vulgaris
PERBEDAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET

EM STEVEN NET
MINOR JOHNSON

ETIOLOGI VHS AKUT OBAT OBAT

PERJALANAN AKUT, AKUT, AKUT,

PENYAKIT SWASIRNA SWASIRNA, SWASIRNA,
REKUREN EPI EPI

TIDAK ADA, NYERI

PRODOMAL ADA / ADA KULIT
RINGAN
PERBEDAAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET
EM MINOR STEVEN NET
JOHNSON

SIMETRIS, SIMETRIS, MORBILIFOR

ERUPSI DISEMINATA KONFLUEN MIS, ERITEM,
LUAS,
KONFLUEN
AKRAL, WAJAH,
PREDILEKSI AKRAL WAJAH PUNGGUNG

MAKULA,
LESI KULIT LESI TARGET LESI TARGET, ERITEM,
LEPUH PELEPASAN
EPIDERMIS
BEBAS / JELAS, JELAS,
MUKOSA SEDIKIT 2/LEBIH 2/LEBIH
PERBEDAAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET

EM STEVEN NET
MINOR JOHNSON

KERATINOSIT KERATINOSIT KERATINOSIT

NEKROTIK NEKROTIK NEKROTIK
SETEMPAT, SETEMPAT, SETEMPAT,
HISTOPA UDEM, INFILTRAT UDEM, INFILTRAT UDEM,
PMN DI DERMIS PMN DI DERMIS INFILTRAT PMN
TAK BEGITU DI DERMIS
JELAS TIDAK ADA
/SEDIKIT
GEJALA TIDAK ADA / ADA / BERAT ADA / BERAT
RINGAN
KONSTITUSI

ORGAN TIDAK TERKENA KADANG SERING

KADANG
DALAM
PERBEDAAAN GAMBARAN KLINIS EM MINOR,
SINDROM STEVENS-JOHNSON, NET
EM STEVEN JOHNSON NET
MINOR

LAMA 1-3 MGG 2-4 MGG 3-6 MGG

JARANG (SEPTIKEMI,
TIDAK PNEUMONI,
KOMPLIKASI ADA PERDARAHAN SERING
GASTROINTESTINAL,
GAGAL GINJAL,
JANTUNG

MORTALITAS 0% 5-15 % 5-50 %

TANPA DAPAT
PENYEMBUHAN PARUT MUNGKIN TERJADI
 PERBEDAAN NET DENGAN S4

NET SSSS

ETIOLOGI OBAT EKSOTOKSIN

RIWAYAT TIDAK ANGGOTA LAIN;

KELUARGA MENUNJANG IMPETIGO

USIA > 40 TAHUN < 5 TAHUN

EKSANTEM GENERALISATA KHAS: WAJAH,

LEHER, KETIAK,
SELA PAHA
 PERBEDAAN NET DENGAN S4

NET SSSS

NYERI PADA RINGAN – JELAS

KULIT SEDANG

TANDA PADA LESI JUGA PADA

NIKOLSKY KULIT
SEHAT
TERKENA TIDAK
MUKOSA DENGAN TERKENA
BERAT
PERJALANAN 2-3 MINGGU 2-4 HARI
PENYAKIT
 PERBEDAAN NET DENGAN S4

NET SSSS

TERAPI KORTIKOSTEROID PENISILINASE

SISTEMIK DOSIS TINGGI RESISTEN

HISTOPA NEKROLISIS EPIDERMIS AKANTOLISIS,

STR. BASALIS CELAH
SUBGRANULAR
MORTALITAS 25-50 % 2-3 %