3. PHÂN LOẠI
• SJS is the less severe condition, in which skin detachment is <10 percent of the body surface
(picture 1A-C).
• TEN involves detachment of >30 percent of the body surface area (BSA) (picture 2A-D).
• SJS/TEN overlap describes patients with skin detachment of 10 to 30 percent of BSA.
• We will use the term "SJS/TEN" to refer collectively to SJS, TEN, and SJS/TEN overlap syndrome.
SJS : <10 % BSA
TEN > 30% BSA
SJS/TEN 10-30 % BSA
4.
5. NGUYÊN NHÂN
• Thuốc
• Mycoplasma pneumoniae
infection
• Khác
-Infections, including Mycoplasma pneumoniae
infection, are the next most common trigger of
SJS/TEN, particularly in children [31-33]
-In over one-third of SJS/TEN cases, no cause can
be identified
7. • Type IV
• Phản ứng type IV không qua kháng thể mà qua T cells.
• T cells, sensitized after contact with a specific antigen,
are activated by continued exposure or reexposure to the
antigen; they damage tissue by direct toxic effects or
through release of cytokines, which activate eosinophils,
monocytes and macrophages, neutrophils, or natural killer
cells.
• Disorders involving type IV reactions include Stevens-
Johnson syndrome, toxic epidermal necrolysis (SJS/TEN),
drug rash with eosinophilia and systemic symptoms
(DRESS) , contact dermatitis (eg, poison ivy), subacute and
chronic hypersensitivity pneumonitis, acute and chronic
allograft rejection, the immune response to tuberculosis,
and many forms of drug hypersensitivity.
9. CHẨN ĐOÁN :
• no universally accepted diagnostic criteria for Stevens-Johnson syndrome/toxic epidermal
necrolysis (SJS/TEN), and histologic findings are neither specific nor diagnostic. Despite these
limitations, the diagnosis of SJS or TEN would be appropriate in a patient with the following
clinical features:
14. CHẨN ĐOÁN PHÂN BIỆT
Hồng ban đa dạng
(Erythema
multiforme)
Đỏ da (Erythroderma)
và hồng ban do thuốc .
Hội chứng mụn mủ
ngoại ban toàn thân
cấp tính (AGEP)
Phát ban cố định
thuốc thể bọng nước
lan tỏa (Generalized
Bullous Fixed Drug
Eruption)
Hồng ban do phản ứng
ánh sáng
Staphylococcal scalded
skin syndrome
Paraneoplastic
pemphigus
Bệnh IgA bọng nước
thành dải (LABD)
Chikungunya fever
15.
16. ĐIỀU TRỊ
PHASE CẤP PHASE MẠN
5-7 days
Bệnh sinh
cutaneous detachment
mucositis
disease arrest and re-epithelization
Biến chứng
Quản lý
hồi phục
fluid and electrolyte imbalances, sepsis,
organ decompensation, and death
supportive care and prevention of short-
and long-term complications
Physical and psychologic sequelae
screening and treatment of these complications in
order to maintain life quality
20. Systemic
corticosteroids
-Prednisolone 60 -250 mg/ngày x 2 -12 days,
-Dexamethasone IV 1.5 mg/kg/ngày x 3 ngày
- Methylprednisolone IV 250 -1000 mg/day
x3 ngày
efficacy of systemic corticosteroids has not been
proven. Thus, routine use of systemic
corticosteroids cannot be recommended
Cyclosporine 3 -5 mg/kg/ngày trong 24-48h khởi phát triệu
chứng
-reduced mortality
-use of cyclosporine early in the course of the
disease has consequently been advocated by
some experts
Intravenous immune
globulin
a dose of 2 to 4 g/kg over two to five days initially proposed as a treatment for SJS/TEN
based on the hypothesis that Fas ligand (FasL) was
the main mediator of widespread keratinocyte
apoptosis in TEN and on the finding that high-dose
IVIG was able to antagonize FasL effects [95].
However, it is now widely accepted that
granulysin, a cytotoxic protein found in cytotoxic T
cells, is the most important mediator
21.
22.
23.
24.
25. Kumar R, Das A, Das S. Management of Stevens-Johnson
Syndrome-Toxic Epidermal Necrolysis: Looking Beyond
Guidelines! Indian J Dermatol. 2018 Mar-Apr;63(2):117-124.
doi: 10.4103/ijd.IJD_583_17. PMID: 29692452; PMCID:
PMC5903040.
