Stevens-Johnson Syndrome( Part 2)

Stevens-Johnson Syndrome( Part 2):gift_heart::gift_heart:

:radioactive:Investigation‚Äč:radioactive:
:raised_hand:Nonspecific laboratory abnormalities
(( leukocytosis, elevated ESR, increased liver enzymes
decreased serum albumin))

:raised_hand:Skin biopsy to confirm the diagnosis & to exclude (SSSS) &
other generalised rashes with blisters (dermnet. Com)

:raised_hand:Anaemia in all cases, Leucopenia esp lymphopenia (90%).

:raised_hand:Neutropenia if present, is a bad prognostic sign.

:radioactive:Differential Diagnosis‚Äč:radioactive:
:arrow_forward: ((TEN, M. pneumoniae‚Äďassociated mucositis,
DRESS syndrome, Kawasaki, Ssss syndrome))
:arrow_forward:SJS has rarely been reported in patients with SLE.

:radioactive:Management :radioactive:

:raised_hand:Mainly:supportive and symptomatic.

:raised_hand:Admission to ICU may required.

:raised_hand:Causative drugs must be discontinued as soon as possible.

:raised_hand:Control temperature.

:radioactive:Eye lesions :point_right:Ophthalmologic consultation is mandatory to
prevent comp (corneal scarring can lead toūüė®vision lossūüė®)
:arrow_forward:cryopreserved amniotic membrane :point_right:limit destruction &
long-term sequelae if used during acute phase
:arrow_forward: Early topical steroid may also reduce ocular sequelae.

:radioactive:Oral lesions :point_right:mouthwashes and glycerin swabs.
:arrow_forward:Topical anesthetics(diphenhydramine, viscous lidocaine)
relief pain before eating.

:radioactive: Vaginal lesions :point_right:observed closely & treated
(to prevent vaginal stricture or fusion)

:radioactive:SKIN LESIONS :radioactive:
:raised_hand:Denuded skin lesions can be cleansed with saline or
Burrow solution compresses.
:raised_hand:Avoid using adhesive tapes and unnecessary removal of
dead skin.
:raised_hand:leave the blister roof as a ‚Äėbiological dressing‚Äô.

:raised_hand:Topical antiseptics can be used.

:raised_hand:((daily saline or Burrow solution compresses paraffin
gauze or colloidal gel (Hydrogel) dressing of denuded
areas, saline compresses on the eyelids, lips, or nose,
analgesics, and urinary catheterization (when needed).

:raised_hand:ESSENTIAL DAILY exam for infection & ocular as a major
cause of long-term morbidity.

:radioactive:SYSTEMIC ANTIBIOTIC‚Äč:radioactive:

:arrow_forward:Infection is the leading cause of death.
:arrow_forward:Indicated for documented urinary or cutan infections.
&
:arrow_forward:Indicated for suspected bacteremia(S.aureus or Pseudo)

:arrow_forward:Prophylactic systemic antibiotics‚Äč:point_right: not necessary‚Äč:fearful:

:radioactive:CORTICOSTEROID‚Äč:radioactive:
:arrow_forward:Sometimes advocated in early, severe cases of SJS.
:arrow_forward:No prospective double-blind studies evaluating their
efficacy have been reported.
:arrow_forward:Most authorities discourage their use because of
increased morbidity and mortality (sepsis) with their
administration.
:arrow_forward:definitive trials in children are lacking.

:radioactive:IV immunoglobulin‚Äč:radioactive:
:arrow_forward:(IVIG 1.5-2.0 g/kg/day √ó 3 days):point_right:should considered early.

:arrow_forward:Total dose greater than 2 g/kg has show improving.
:arrow_forward:Not statistically significant outcomes in children
compared to adults.

:radioactive:Other immunosuppressive regimens have not demonstrated
clear benefit or repeated success in multiple studies.

:radioactive:Prognosis :radioactive: our pictures.

1ÔłŹ‚É£ SCORTEN SCORE& 2ÔłŹ‚É£ABCD.10 SCORE