Toxic Epidermal Necrolysis and SJS : Case Reports & Brief Review
|
|
- Andrew Harmon
- 6 years ago
- Views:
Transcription
1 Case Report Toxic Epidermal Necrolysis and SJS : Case Reports & Brief Review Deepali P. Mohite*, Satyajitraje Tekade*, Amol Gadbail*, M. S. Chaudhary** Abstract : Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are considered part of a spectrum of adverse cutaneous drug reactions showing severe skin detachment. Both are morphologically characterised by active apoptotic keratinocyte cell death that results in the separation of epidermis from the dermis. Almost all cases appear to be caused by an idiosyncratic drug reaction. We report two cases- one TEN and other SJS and the current opinion in the probable pathophysiologic mechanisms and management. Keywords: Toxic epidermal necrolysis, Stevens Johnson Syndrome. Introduction : Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare cutaneous diseases marked by substantial epidermal denudation and are often complicated by sepsis and multiple organ failure(1). Early description of toxic epidermal necrolysis (TEN) dates back to 1956 by Alan Lyell when he described toxic epidermal necrolysis as "an eruption resembling scalding of the skin (2). Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are grave disorders with mortality rates ranging from 20 to 30%. The incidence of SJS is 1 to 6 cases per million person-years, and the incidence of TEN is 0.4 to 1.2 cases per million personyears.the classification of these disorders is based on the degree of involvement of skin and other organs - SJS is an acute mucocutaneous disease defined as a rapidly expanding macular eruption affecting less than 10% of body surface area (BSA) and involving more than one mucosal surface (oral, conjunctival, or anogenital). The overlapping entity of SJS-TEN is described as a disorder with 10 to 30% epidermal involvement. A diagnosis of TEN requires involvement of greater than 30% of BSA. (1, 3) Case Reports : Two cases one with Steven's Johnson syndrome and other Toxic Epidermal Necrolysis are described below: Case 1 A 14-year-old female patient reported with the complaint of lesions all over the body since 6 days. She took antipyretics for fever and chills and was afforded no relief. Then her drug profile was changed to include antipyretics and antihistaminic; following which red lesions appeared all over the body and on the 2nd day the Fig 1 : Picture showing extensive desquamation of skin of face & lips (SJS) Senior Lecturer * Prof and Head** Dept. of Oral Pathology and Microbiology Sharad Pawar Dental College, DMIMS(DU), Sawangi (Meghe), Wardha, Maharashtra, India. Fig 2 : Extensive exfoliation of skin (SJS) 136
2 fig 3 : Multiple large bullae over the skin (SJS) lesions turned black. There was edema of both hands and feet and itching over the lesions. She did not give history of allergy to any drug. Examination revealed well to ill-defined hyperpigmented plaques, macules, bullae and some vesicles all over the body, face and neck with epidermal detachment and sloughing. The hair was normal, there was discharge from the eyes and crusting was seen over lips and ears along with serous discharge. Intra-oral findings included variably sized erosions and ulcerations over the buccal mucosa, tongue and vermillion border of the lips. The erosions over the buccal mucosa demonstrated varying degrees of erythema from pale pink to fiery red. The mucosa over the hard palate and gingiva showed ulcerations and few Petechial spots. Movement of tongue was restricted and speech was difficult due to extreme pain associated with the lesions. The dorsal surface of the tongue was erythematous. Few hemorrhagic areas were also noticed. Teeth were not affected & nontender; though complain of sensitivity was associated. Further intraoral examination was not possible due to extreme pain associated with mouth opening (Fig : 1-3). Case 2 : A 22-year-old female reported with history of fever, cough and cold, itching, burning sensation in mouth and black lesions over the face since 8 days which spread to other areas 3 days later. She gave history of drug consumption, though she could not specify which drug. She also complains of crusting over lips and discharge from eyes. Examination revealed multiple hyperpigmented macules, papules and vesicles all over the body. There were erosions, crusting and serous discharge from the ears, eyes and lips. Intraoral examination revealed extensive erosions over the buccal mucosa on both right & left sides. These erosions were irregular in outline and at the level of the occlusal plane showed hypertrophic margins. Many large Fig 4 : Erosions, crusting and serous discharge from the ears, eyes and lips (TEN). Fig 5 : Erosions, crusting and serous discharge from the ears, eyes and lips (TEN). Fig 6 : multiple hyperpigmented macules, papules and vesicles (TEN). & small irregular hyperpigmented spots were noted in few areas of the buccal mucosa. The hard palate and gingiva were relatively spared with few hyperpigmented macules over the gingival part of hard palate. Pain was associated with these lesions and increased during mastication and speech. (Fig 4-6) Discussion : Toxic epidermal necrolysis is a potentially lifethreatening skin disorder that most commonly is drug induced. However, other etiologies, including infection, malignancy, and vaccinations may exist. Toxic epidermal necrolysis is idiosyncratic and its occurrence is not predicted easily. Some authors believe Stevens-Johnson syndrome (SJS) is a manifestation of the same process, 137
3 with the former representing more extensive necrotic epidermal detachment (1,2). The mucocutaneous reaction is characterized by widespread erythema, necrosis and bullous detachment of the epidermis and mucous membranes resulting in exfoliation, sepsis and death. Mucous membrane involvement can result in gastrointestinal hemorrhage, respiratory failure and ocular and genitourinary complications (3). Erythema multiforme major (EMM), once thought to be a mild variant of this disease spectrum, differs from SJS/TEN in its distribution, lesion morphology, and etiology. Acrally distributed, raised target lesions characterize EMM. The skin lesions of SJS and TEN are predominately central, consist of blisters that arise on erythematous or purpuric macules and involve two or more mucosal surfaces. A classification system based largely on the extent of epidermal detachment and morphology of the skin lesions helps in differentiating the disease entities (3). Bullous Erythema Multiforme (EM) - Typical round targets with 3 different zones and well-defined borders, prominent on the extremities characterize bullous EM. Confluence of the lesions and epidermal detachment is limited to less than 10% of the body surface area (3). SJS - Widespread, irregularly shaped erythematous or purpuric macules with blistering that occur on all or part of the macule characterize SJS. Confluence of individual lesions and epidermal detachment is limited, involving less than 10% of the body surface area (3). Overlap SJS-TEN - Widespread, irregularly shaped erythematous or purpuric macules with blistering that occurs on all or part of the macule characterize overlap SJS-TEN. Blisters become confluent and result in detachment of the epidermis and erosions on 10-29% of the body surface area (3). TEN "with spots" - Widespread, irregularly shaped erythematous or purpuric macules with blistering that occurs on all or part of the macule characterize TEN with spots. Blisters become more confluent and result in detachment of the epidermis and erosions on greater than 30% of the body surface area (3). TEN "without spots" - Widespread, large erythematous areas with no discrete lesion characterizes TEN without spots (3). The pathophysiology has not been fully elucidated; however, multiple pathophysiologic mechanisms for the development of TEN have been proposed. Current opinion suggests that epidermolysis is the result of keratinocyte cell apoptosis an organized series of biochemical reactions leading to cell changes and cell death. Cytotoxic T-cell lymphocytes, found in the blister fluid of patients with TEN, is believed to induce a cascade of intracellular enzymes that results in a rapid, triggered cell death(2,3,4). Role of humoral immunity (auto antibodies) which was believed to be the main culprit in the past has completely fallen into disfavour. Several lines of evidence support the Cytotoxic T-cell lymphocytes (CTL) mediated pathogensis of TEN. These include (1) Link to some specific HLA haplotypes to increased susceptibility to TEN, (2) Characteristic lag between the exposure and disease onset (1 to 45 days, mean 14 days), (3) Increased inflammatory CD8+ T cells in the epidermis, and (4) Increased apoptosis of the keratinocytes in TEN patients (5). Although a specific link between the drug metabolite and the immunologic hypothesis is still lacking, drug-reactive T cells have been shown in the skin and blood of patients with various types of adverse cutaneous drug reaction demonstrating that a CTLmediated immune response against drugs occurs. Recent studies indicate that TEN, like some other cutaneous drug eruptions, is an HLA class I-restricted, specific drug sensitivity, resulting in clonal expansion of CD8+ CTLs. Cytotoxicity is mediated by CTL granzyme and possibly death receptor (DR) ligand (DR-L), probably Fas ligand (FasL). Particular to TEN, there is then an amplification sequence involving further DR-L expression. FasL is likely to be particularly important but tumour necrosis factor (TNF) may well contribute, via the TNF receptor 1 (TNF-R1) death pathway. Alternatively, the possibility of upregulation of an antiapoptotic TNF- R1 nuclear factor κb pathway, which would proscribe treatments which downregulate this pathway(6). Tumor necrosis factor - α (TNF-α) and IL-6 have also been involved in the pathogensis of TEN as increased amount of these cytokines are found in the blister fluids in TEN patients. These inflammatory cytokines may play their damaging roles by recruiting the cytotoxic T cells to the epidermis. They may also cause damages directly as cytokines such as TNF - α are known to cause increased apoptosis(7,8). French and co-workers have found that epidermal keratinocytes in TEN patients express large amount of lytically active Fas ligand (CD95L) and interactions between these CD95L and Fas (CD 95) on the effector cells are directly involved in the epidermal necrolysis (7,8,9). The current trend in the management of such cases involves the use of naturally occurring anti-fas 138
4 immunoglobulins (in the plasma) which is concentrated in human intravenous immunoglobulin (IVIG) to quickly reverse the disease progression in TEN patients (8-13). Many proinflammatory cytokines have been shown to upregulate Fas ligand expression and cause enhanced apoptosis. It is tempting to speculate that increased production of inflammatory cytokines e.g. TNF-α in TEN patients may also indirectly cause necrolysis by upregulating expression of Fas ligand (14,15,16). In that scenario, resolution of TEN may also be achieved by treating patients with specific anti -cytokine antibodies. The difficulty towards understanding the molecular changes in the T cells or keratinocytes in TEN patients is also due to the lack of a suitable system to study human T cells at a clonal level in vitro. Using immortalized human T cell clones with a strain of Herpes virus saimiri (HVS), to understand the specific pathogenesis has been proposed. To summarize the management protocol (Clinical significance):- 1) Basic laboratory tests may be helpful in planning symptomatic or supportive therapy. 2) Diffuse skin involvement may cause significant fluid loss and electrolyte abnormalities. 3) Renal failure can result from hypovolemic shock or sepsis. Surveillance cultures of blood, skin, and urine should be obtained. 4) No specific imaging studies are indicated. 5) Chest radiography should be performed in the setting of respiratory distress because tracheobronchial inflammation may predispose to diffuse interstitial pulmonary disease or pneumonia. 6) TEN is diagnosed by histopathologic analysis. Skin biopsy, harvested at the earliest possible stage, is important in establishing an accurate diagnosis and directing specific therapeutic modalities. Therefore, early involvement of a dermatologist and dermatopathologist is recommended. Currently a multifaceted regimen for management of TEN & SJS appears indicated, targeting various likely intermediary mechanisms, including elimination of residual drug, immunosuppression, inhibition of DR pathways, general antiapoptotic strategies, and aggressive supportive care. Particular attention has been directed at avoiding potential conflicts between different treatments and avoiding agents that theoretically might have a net proapoptotic rather than antiapoptotic effect. The primary objective for a favourable outcome depends on rapid and aggressive supportive care until the skin regenerates itself in this self- limiting acute skin condition. Sterile handling of the patients is a must and cannot be over emphasized to minimize nosocomial infection. References: 1. Heng-Leong Chan, Robert S. Stern, Kenneth A. Arndt et al. The Incidence of Erythema Multiforme, Stevens - Johnson syndrome and Toxic Epidermal Necrolysis. Arch Dermatol, 126:43-47, A case report and a proposed algorithm for the transfer of patients with Stevens - Johnson syndrome and toxic epidermal necrolysis to a burn center. Military Medicine, Toxic Epidermal Necrolysis, Uchenna R Ofoma, Edward K Chapnick. Fluconazole induced toxic epidermal necrolysis: a case report. Cases Journal ; 2: 9071, Toxic Epidermal Necrolysis, Amal Nassif, Homayoun Moslehi, Sabine Le Gouvello et al. Evaluation of the Potential Role of Cytokines in Toxic Epidermal Necrolysis. Journal of Investigative Dermatology; 123: , Chave T.A, Mortimer N.J, Sladden M.J et al. Toxic epidermal necrolysis: current evidence, practical management and future directions. British Journal of Dermatology. ; Vol 153 Issue 2: , Isabelle Viard, Philippe Wehrli, Roberto Bullani et al. Inhibition of Toxic Epidermal Necrolysis by Blockade of CD95 with Human Intravenous Immunoglobulin. Science : Vol. 282; No. 5388: , Sidney Hurwitz. Erythema Multiforme: A Review of Its Characteristics, Diagnostic Criteria, and Management. Pediatr. Rev. ; 11: , Sylvie Bastuji-Garin, Berthold Rzany, Robert S. Stern et al. Clinical Classification of Cases of Toxic Epidermal Necrolysis, Stevens - Johnson syndrome, and Erythema Multiforme. Arch Dermatol.; 129(1):92-96, Benoît Côté, Janine Wechsler, Sylvie Bastuji-Garin, et al. Clinicopathologic Correlation in Erythema Multiforme and Stevens - Johnson syndrome. Arch Dermatol. ; 131(11): , Karan K. Sra, Michelle Babb-Tarbox, Sina Aboutalebi et al. Molecular Diagnosis of Cutaneous Diseases. Arch Dermatol.; 141: , Soluble Interleukin 2 Receptor and Interleukin 1 in Toxic Epidermal Necrolysis: A Comparative Analysis of Serum and Blister Fluid Samples. Arch Dermatol. 2002; 138: Ueta M., Sotozono C., Inatomi T., Hamuro J. et al. Gene Expression Analysis of Monocytes Derived From the Patients of Stevens-johnson Syndrome With Ocular Complications. Invest Ophthalmol Vis Sci. ; 48: 386,
5 Toxic Epidermal Necrolysis & SJS 15. Aurelian, L, Ono, F, and J Burnett. Herpes simplex virus (HSV)-associated erythema multiforme (HAEM): A viral disease with an autoimmune component. Dermatology Online Journal 9 (1): 1, Junko Murata1 and Riichiro Abe. Soluble Fas Ligand: Is It a Critical Mediator of Toxic Epidermal Necrolysis and Stevens Johnson Syndrome? Journal of Investigative Dermatology. ; 127: , Financial Support : Declared None Conflict of Interest : Declared None Month of Receipt : January 2012 Month of Acceptance : June of Author : deepalipmohite@rediffmail.com Manuscript no. : 2012 / D
Skin Manifestations of Drug Reactions
Skin Manifestations of Drug Reactions Dr Carol Hlela, Division of Dermatology Department of Medicine, University of Cape Town and Red Cross Children s Hospital What are the Skin Manifestations of Drug
More informationFuture of Pediatrics: Blisters, Hives and Other Tales from the Emergency Room June 14 th, 2016
A. Yasmine Kirkorian MD Assistant Professor of Dermatology & Pediatrics Children s National Health System George Washington University School of Medicine & Health Sciences Future of Pediatrics: Blisters,
More informationDepartment of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
Bullous pemphigoid mimicking granulomatous inflammation Abhilasha Williams, Emy Abi Thomas. Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India. Egyptian Dermatology
More informationCutaneous Conditions Associated with Systemic Disease
Cutaneous Conditions Associated with Systemic Disease Johnnie M Woodson, M.D., F.A.A.D. Assistant Professor of Dermatology University of Nevada School of Medicine Director of J. Woodson Dermatology & Associates,
More informationA. Erythema multiforme and related diseases
Go Back to the Top To Order, Visit the Purchasing Page for Details Chapter Erythema, Erythroderma (Exfoliative Dermatitis) Erythema is caused by telangiectasia or hyperemia in the papillary and reticular
More informationREGISTRY OF SEVERE CUTANEOUS ADVERSE REACTIONS TO DRUGS AND COLLECTION OF BIOLOGICAL SAMPLES. R e g i S C A R PATIENT'S DATA. Age country of birth
REGISTRY OF SEVERE CUTANEOUS ADVERSE REACTIONS TO DRUGS AND COLLECTION OF BIOLOGICAL SAMPLES R e g i S C A R PATIENT'S DATA Initials of the patient date of birth Age country of birth Gender male female
More informationLESIONS OF THE ORAL CAVITY ORAL CAVITY. Oral Cavity Subsites 4/10/2013 LIPS TEETH GINGIVA ORAL MUCOUS MEMBRANES PALATE TONGUE ORAL LYMPHOID TISSUES
LESIONS OF THE ORAL CAVITY David I. Kutler, MD, FACS Associate Professor Division of Head and Neck Surgery Department of Otolaryngology HNS Weill Cornell Medical Center ORAL CAVITY LIPS TEETH GINGIVA ORAL
More informationEmergency Dermatology. Emergency Dermatology
Emergency Dermatology These are rapidly progressive skin conditions and some are potentially lifethreatening. Early recognition is important to implement prompt supportive care and therapy. Some are drug
More informationEarly View Article: Online published version of an accepted article before publication in the final form.
: Online published version of an accepted article before publication in the final form. Journal Name: International Journal of Case Reports and Images (IJCRI) Type of Article: Case Report Title: A Case
More informationDiagnosis and Management of Drug-induced Stevens-Johnson Syndrome: Report of Two Cases
10.5005/jp-journals-10011-1189 CASE REPORT JIAOMR Diagnosis and Management of Drug-induced Stevens-Johnson Syndrome: Report of Two Cases 1 M Venkateshwarlu, 2 B Radhika 1 Professor and Head, Department
More informationA Retrospective Study of Spectrum of Nevirapine Induced Cutaneous Drug Reactions in HIV Positive Patients
Journal of US-China Medical Science 12 (2015) 85-89 doi: 10.17265/1548-6648/2015.02.008 D DAVID PUBLISHING A Retrospective Study of Spectrum of Nevirapine Induced Cutaneous Drug Reactions in HIV Positive
More informationallergy Asia Pacific Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from
pissn -876 eissn -868 Original Article Asia Pac Allergy 6;6:-7 Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 9 Oki Suwarsa *, Wulan
More informationTo update the use of IVIG and CORTICOIDS IN management of SJS/ TEN To remind Doctors being careful when giving
Present : Dr Pham Thi Minh Rang Internal Department No2-Hospital for children No2 AIMS To update the use of IVIG and CORTICOIDS IN management of SJS/ TEN To remind Doctors being careful when giving To
More informationDERMATOLOGICAL EMERGENCIES. DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE
DERMATOLOGICAL EMERGENCIES DR. Ian Hoyle MBBS DIP IMC RCS (Ed), DA (UK),FRACGP,FACRRM,DIP DERM(Wales) TASMANIAN SKIN AND BODY CENTRE Dermatological Emergencies INFECTIONS ERYTHRODERMA DRUG ERUPTIONS STEVENS-JOHNSON
More informationCase Report Cephazolin-Induced Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin and N-Acetylcysteine
Case Reports in Immunology Volume 2012, Article ID 931528, 4 pages doi:10.1155/2012/931528 Case Report Cephazolin-Induced Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin and N-Acetylcysteine
More informationEmergency Dermatology Dr Melissa Barkham
Emergency Dermatology Dr Melissa Barkham Spotlight Seminar 30 th September 2010 Why is this important? Urgent recognition and treatment of dermatologic emergencies can be life saving and prevent long term
More informationA Middle-Aged Man with Newly Diagnosed HIV Infection and Rash
CLINICAL CASE OF THE MONTH A Middle-Aged Man with Newly Diagnosed HIV Infection and Rash Patrick Njoku, MD; Temeka Tate, MD; Sousan Zadeh, MD; Erin Hauck, MD; Anila Chaudhry, MD; Betty Lo-Blais, MD; Lee
More informationDilantin (phenytoin) ROBERT A. SCHWARTZ
Dilantin (phenytoin) ROBERT A. SCHWARTZ Bailey & Galyen Attorney in Charge, Mass Tort Litigation Managing Attorney, Houston 18333 Egret Bay Blvd., Suite 120 Houston, Texas 77058 Toll Free: (866) 715-1529
More informationStevens-Johnson s Syndrome / Toxic Epidermal Necrolysis: An update
Stevens-Johnson s Syndrome / Toxic Epidermal Necrolysis: An update Robert G. Micheletti, MD Assistant Professor of Dermatology and Medicine Director, Cutaneous Vasculitis Clinic, Penn Vasculitis Center
More informationPediatric Dermatology
Pediatric Dermatology --------- Emergencies & Urgencies Nicholas V. Nguyen, M.D. Director, Pediatric Dermatology Disclosures In the past 12 months, I have had the following financial relationships with
More informationAutoimmune Diseases with Oral Manifestations
Autoimmune Diseases with Oral Manifestations Martin S. Greenberg DDS, FDS RCSEd Professor Emeritus Department of Oral Medicine University of Pennsylvania Disclosure Statement I have no actual or potential
More informationCARBAMAZEPINE INDUCED STEVENS JOHNSON SYNDROME- A CASE STUDY
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Ragesh SJIF Impact Factor 2.786 Volume 3, Issue 6, 1599-1604. Case Study ISSN 2278 4357 CARBAMAZEPINE INDUCED STEVENS JOHNSON SYNDROME- A CASE STUDY
More informationCase No. 5; Slide No. B13/8956/2
Interface diseases Case No. 5; Slide No. B13/8956/2 Histological findings Severe hydropic vacuolation of epidermal and follicular basal cells/ interface dermatitis Multifocally apoptotic keratinocytes
More informationDepartment of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea 2
pissn: 1011-8942 eissn: 2092-9382 Korean J Ophthalmol 2013;27(5):331-340 http://dx.doi.org/10.3341/kjo.2013.27.5.331 Original Article Effect of Age and Early Intervention with a Systemic Steroid, Intravenous
More informationGOOD MORNING! AUGUST 5, 2014
GOOD MORNING! AUGUST 5, 2014 PREP QUESTION During the health supervision visit of a term newborn boy, his mother relates that a cousins child died at age 4 months from sudden infant death syndrome. She
More informationOral Manifestation in Patients diagnosed with Dermatological Diseases
JCDP ORIGINAL RESEARCH Oral Manifestation in Patients diagnosed 10.5005/jp-journals-10024-2191 with Dermatological Diseases Oral Manifestation in Patients diagnosed with Dermatological Diseases 1 Sanjay
More informationMedical History. Oral Medicine and General Medicine
Medical History Oral Medicine and General Medicine Gingivitis herpetica acuta NECROTIZÁLÓ SIALOMETAPLASIA SOOR Medical History The life expectancy has recently increased and increasing By dental prevention
More informationStevens-Johnson Syndrome : A Case Report
https://doi.org/10.5933/jkapd.2017.44.4.455 J Korean Acad Pediatr Dent 44(4) 2017 ISSN (print) 1226-8496 ISSN (online) 2288-3819 Stevens-Johnson Syndrome : A Case Report Yongho Song, Nanyoung Lee, Sangho
More informationFive things not to miss in Dermatology. Dr Judy Wismer Associate Clinical Professor Michael G DeGroote School of Medicine
Five things not to miss in Dermatology Dr Judy Wismer Associate Clinical Professor Michael G DeGroote School of Medicine Key Descriptives Fever, skin pain Purpura, necrosis Bullae, Mucosal, Skin sloughing
More informationCutaneous Adverse Drug Reactions in Domestic Animals. Katherine Doerr, DVM, Dip. ACVD. Veterinary Dermatology Center
Cutaneous Adverse Drug Reactions in Domestic Animals Katherine Doerr, DVM, Dip. ACVD Veterinary Dermatology Center Maitland, Rockledge, Waterford Lakes, FL Not highly studied in veterinary medicine Unknown
More informationOral Health & HIV. Professor Sudeshni Naidoo Department of Community Dentistry University of the Western Cape
Oral Health & HIV Professor Sudeshni Naidoo Department of Community Dentistry University of the Western Cape Importance & relevance of Oral HIV Lesions >70% of HIV+ve patients present with oral manifestations
More informationOral Medicine. Dr. Qianming Ian CHEN
Oral Medicine Dr. Qianming Ian CHEN ORAL MEDICINE Oral medicine is the specialty of dentistry that is concerned with the oral health care of medically compromised patients and with the diagnosis and nonsurgical
More informationClassification: 1. Infective: 2. Traumatic: 3. Idiopathic: Recurrent Aphthous Stomatitis (RAS) 4. Associated with systemic disease:
Classification: 1. Infective: 2. Traumatic: 3. Idiopathic: Recurrent Aphthous Stomatitis (RAS) 4. Associated with systemic disease: Hematological GIT Behcet s HIV 5. Associated with dermatological diseases:
More information건강한성인에서의오진하기쉬운포도구균성열상피부증후군의치험례. Staphylococcal Scalded Skin Syndrome in a Healthy Adult: Easy to Misdiagnose
Archives of Hand and Microsurgery Arch Hand Microsurg 2018;23(4):271-276. https://doi.org/10.12790/ahm.2018.23.4.271 pissn 2586-3290 eissn 2586-3533 Case Report 건강한성인에서의오진하기쉬운포도구균성열상피부증후군의치험례 김홍일ㆍ곽찬이ㆍ박언주
More informationSKIN REACTIONS WITH PSYCHOTROPICS: A SYSTEMATIC REVIEW
SKIN REACTIONS WITH PSYCHOTROPICS: A SYSTEMATIC REVIEW *Anderson Isaac, PharmD Candidate, 2019 Pooja Patel, PharmD Candidate, 2019 Katelyn Thomasson, PharmD Candidate, 2019 Erika Tillery, PharmD, BCPP,
More informationDrug Allergy A Guide to Diagnosis and Management
Drug Allergy A Guide to Diagnosis and Management (Version 1 April 2015 updated April 2018) Author: Jed Hewitt Chief Pharmacist, Governance & Professional Practice Date of Preparation: April 2015 Updated:
More informationSTEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS IN CHILDREN: A LITERATURE REVIEW OF CURRENT TREATMENTS
STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS IN CHILDREN: A LITERATURE REVIEW OF CURRENT TREATMENTS *Blanca R. Del Pozzo-Magaña, 1 Alejandro Lazo-Langner 2,3 1. Department of Pediatrics, University
More informationA Rare case of Tubercular Gingivitis Case Report
Case Report A Rare case of Tubercular Gingivitis Case Report *Dr. Ansh Chugh 1, Dr. Firoz A Hakkim 2, Dr. Rajesh. V 3, Dr. Raghava Sharma 4 1: JUNIOR RESIDENT IN GENERAL MEDICINE 2: SENIOR RESIDENT IN
More informationPACIFIC JOURNAL OF MEDICAL SCIENCES {Formerly: Medical Sciences Bulletin} ISSN:
PACIFIC JOURNAL OF MEDICAL SCIENCES {Formerly: Medical Sciences Bulletin} ISSN: 2072 1625 Pac. J. Med. Sci. (PJMS) www.pacjmedsci.com. Email: pacjmedsci@gmail.com. EROSIVE LICHEN PLANUS A CASE REPORT *Prathima
More informationDrug-induced stevens-johnson syndrome : Experience from a tertiary care hospital
Original article: Drug-induced stevens-johnson syndrome : Experience from a tertiary care hospital *Arjun R 1,Mahalingeshwara Bhat K P 2, Sara C 1 1 PG student in General Medicine, KS Hegde Medical Acadamy,
More informationSEVERE CUTANEUS ADVERSE DRUGS EFFECTS MANIFESTED AS TOXIC EPIDERMAL NECROLYSIS (TEN) DUE TO ORAL ANTITUBERCULOSIS DRUGS AND REVIEW OF THE LITERATURE
SEVERE CUTANEUS ADVERSE DRUGS EFFECTS MANIFESTED AS TOXIC EPIDERMAL NECROLYSIS (TEN) DUE TO ORAL ANTITUBERCULOSIS DRUGS AND REVIEW OF THE LITERATURE * HM Nataprawira, ** M Soepriadi * Respirology Division,
More informationCutaneous Drug Reactions
Cutaneous Drug Reactions Andrei Metelitsa, MD, FRCPC, FAAD Co-Director, Institute for Skin Advancement Clinical Associate Professor, Dermatology University of Calgary, Canada Copyright 2017 by Sea Courses
More informationA Case Report on Amoxicillin Induced Stevens- Johnson Syndrome
Open Journal of Clinical & Medical Case Reports Volume 2 (2016) Issue 11 A Case Report on Amoxicillin Induced Stevens- Johnson Syndrome Rajendra Singh Airee*; Aastha Rawal; Binu Mathew; H. Doddayya Abstract
More informationالسكري للداء مرافقة فقاعات diabeticorum= Bullosis
1 / 6 Bullosis diabeticorum Bullous disease of diabetes (bullosis diabeticorum) is a distinct, spontaneous, noninflammatory, blistering condition of acral skin unique to patients with diabetes mellitus.
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationCitation The Journal of Dermatology, 37(8), available at
NAOSITE: Nagasaki University's Ac Title Two cases of blaschkitis with promi Author(s) Utani, Atsushi Citation The Journal of Dermatology, 37(8), Issue Date 2010-08 URL Right http://hdl.handle.net/10069/25634
More informationCorrespondence should be addressed to Wanjarus Roongpisuthipong; rr
Dermatology Research and Practice, Article ID 237821, 5 pages http://dx.doi.org/10.1155/2014/237821 Research Article Retrospective Analysis of Corticosteroid Treatment in Stevens-Johnson Syndrome and/or
More informationGenetic susceptibility for Stevens-Johnson syndrome/toxic epidermal necrolysis with mucosal involvements
249 Special Issue: Inflammation in Ophthalmology Review Article Genetic susceptibility for Stevens-Johnson syndrome/toxic epidermal necrolysis with mucosal involvements 1, 2, ) Mayumi Ueta 1) Department
More informationStevens-Johnson Syndrome in patients receiving cranial irradiation and concomitant diphenylhydantoin
Turkish Journal of Cancer Vol. 32/ No. 4/2002 Stevens-Johnson Syndrome in patients receiving cranial irradiation and concomitant diphenylhydantoin ERKAN TOPKAN, FARUK ZORLU, MURAT GÜRKAYNAK Hacettepe University
More informationCUTANEOUS DRUG REACTIONS OR I WOULDN T HAVE SEEN IT, IF I HADN T BELIEVED IT Edmund J. Rosser Jr., DVM, DACVD
CUTANEOUS DRUG REACTIONS OR I WOULDN T HAVE SEEN IT, IF I HADN T BELIEVED IT Edmund J. Rosser Jr., DVM, DACVD DERMATOLOGY Pathogenesis Immunologic: can involve Type I, II, III, IV hypersensitivity reactions.
More informationThat. Name QUIZ. 60 SEPTEMBER 2017 // dentaltown.com
QUIZ Name That General dentists are first in the line of practitioners that patients see for an oral lesion evaluation; therefore, a sound understanding of oral mucosal diseases and their clinical presentation
More informationEXANTHEMATOUS ILLNESS. IAP UG Teaching slides
EXANTHEMATOUS ILLNESS 1 DEFINITIONS Exanthema eruption of the skin Exanthema eruption of mucosae Macule flat nonpalpable lesion Papule small palpable lesion Nodule large palpable lesion Vesicle small fluid
More informationVIRUS. Viral infection causing, or associated with diseases of the oral mucosa : Herpes Simpleks 1 & 2
VIRUS Viral infection causing, or associated with diseases of the oral mucosa : VIRUS Herpes Simpleks 1 & 2 Varicella - Zoster Coxsakie A PENYAKIT Primary Gingivostomatitis Herpetica Herpes Labialis Recurrent
More informationPigmented lesions of the Oral cavity
Oral medicine أ.م.د احسان عبد هللا كميل Pigmented lesions of the Oral cavity Pigmented oral lesions are a large group of disorders in which the dark or brown color is the essential clinical characteristic.
More informationDepartment of Dermatology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo , Japan 2
Dermatology Research and Practice Volume 2010, Article ID 931340, 5 pages doi:10.1155/2010/931340 Case Report Paraneoplastic Pemphigus Presenting as Mild Cutaneous Features of Pemphigus Foliaceus and Lichenoid
More informationFluconazole erythema multiforme
Fluconazole erythema multiforme Search 1. Eur J Dermatol. 2012 Sep-Oct;22(5):693-4. doi: 10.1684/ejd.2012.1806. Fluconazoleinduced fixed drug eruption imitating herpes labialis with erythema multiforme.
More informationOXCARBAZEPINE-INDUCED STEVENS-JOHNSON SYNDROME: A CASE REPORT
OXCARBAZEPINE-INDUCED STEVENS-JOHNSON SYNDROME: A CASE REPORT Lung-Chang Lin, 1,2 Ping-Chin Lai, 3 Sheau-Fang Yang, 4 and Rei-Cheng Yang 1,5 Departments of 1 Pediatrics and 4 Pathology, Kaohsiung Medical
More informationDexamethasone Pulse Therapy for Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis
Acta Derm Venereol 2007; 87: 144 148 CLINICAL REPORT Dexamethasone Pulse Therapy for Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis Sylvia H. Kardaun and Marcel F. Jonkman Center for Blistering Diseases,
More informationIn the past few years, beta-lactam-resistant gram-positive
Early Diagnosis Is Key in Vancomycin-Induced Linear IgA Bullous Dermatosis and Stevens-Johnson Syndrome Douglas H. Jones, MS Michael Todd, MD Timothy J. Craig, DO Background: With the emergence of highly
More informationVARICELLA. Infectious and Tropical Pediatric Division, Department of Child Health, Medical Faculty, University of Sumatera Utara
VARICELLA (Chicken pox) Infectious and Tropical Pediatric Division, Department of Child Health, Medical Faculty, University of Sumatera Utara Definition : Varicella is a common contagious disease caused
More informationConflicts. Objectives. University of Texas Health Science Center at San Antonio. Pediatrics Grand Rounds 24 August Pediatric Dermatology 101
Pediatric Dermatology 101 John C. Browning, MD, FAAD, FAAP Conflicts Investigator: ViroXis Advisor: ViroXis Advisory Board: TopMD Speaker: Galderma Objectives Understand the meaning and importance of cutaneous
More informationIN THE NAME OF GOD. Dr.kheirandish DDS,MSC Oral and maxillofacial pathology
IN THE NAME OF GOD Dr.kheirandish DDS,MSC Oral and maxillofacial pathology Dermatologic Diseases Chapter 16 ECTODERMAL DYSPLASIA o Two or more ectodermally derived anatomic structures fail to develop o
More informationDOI /j x
TOPICAL REVIEW DOI 10.1111/j.1365-2133.2005.06721.x Toxic epidermal necrolysis: current evidence, practical management and future directions T.A. Chave, N.J. Mortimer, M.J. Sladden, A.P. Hall* and P.E.
More informationStevens Johnson Syndrome: How Diagnosis Impacts Disease Course
Southern Adventist Univeristy KnowledgeExchange@Southern Graduate Research Projects Nursing 12-4-2015 Stevens Johnson Syndrome: How Diagnosis Impacts Disease Course Sharon K. Hart Southern Adventist University,
More informationAllergic contact stomatitis is a rare disorder,
Allergic Contact Stomatitis: A Case Report and Review of Literature P Lokesh, T Rooban, Joshua Elizabeth, K Umadevi, K Ranganathan Abstract Allergic contact stomatitis is a well-recognized entity, which
More informationAPHTHOUS STOMATITIS ADULT & PEDIATRIC
DEFINITION Aphthous stomatitis or canker sores are described as ulcers and inflammation of the tissues of the mouth, including the lips, buccal mucosa, tongue, gingiva, and posterior pharyngeal wall. These
More informationREASON FOR REFERRAL Referred for blisters and rash of mucous membranes and skin.
Report 1 Listen to the audio to fill in the blanks. Name: DERMATOLOGY CONSULTATION REPORT REASON FOR REFERRAL Referred for blisters and rash of mucous membranes and skin. HISTORY OF PRESENT ILLNESS Rash
More informationErythema Multiforme with Reference to Atypical Presentation in an HIV-Positive Patient Following Antiretroviral Therapy Discontinuation
2009;17(1):9-15 CLINICAL ARTICLE Erythema Multiforme with Reference to Atypical Presentation in an HIV-Positive Patient Following Antiretroviral Therapy Discontinuation Liborija Lugović Mihić, Marija Buljan,
More informationSevere Desquamating Disorder After Liver Transplant: Toxic Epidermal Necrolyis or Graft Versus Host Disease?
Severe Desquamating Disorder After Liver Transplant: Toxic Epidermal Necrolyis or Graft Versus Host Disease? John T. Schulz III, MD, PhD, FACS, and Robert L. Sheridan, MD, FACS Bridgeport Hospital, Bridgeport,
More informationWorld Articles of Ear, Nose and Throat Page 1
World Articles of Ear, Nose and Throat ---------------------Page 1 Primary Malignant Melanoma of the Tongue: A Case Report Authors: Nanayakkara PR*, Arudchelvam JD** Ariyaratne JC*, Mendis K*, Jayasekera
More informationBenign Oral cavity lesions. Mohammed ALESSA MBBS,FRCSC Assistant Professor Consultant Otolaryngology, Head & Neck Surgery
Benign Oral cavity lesions Mohammed ALESSA MBBS,FRCSC Assistant Professor Consultant Otolaryngology, Head & Neck Surgery Anatomy Histology Physiology Pathology Clinical cases Introduction The oral cavity
More informationSyndrome de Lyell Approche diagnostique. seminaires iris. Veronique del Marmol Alexandre Chamoun Service de Dermatologie Hôpital Erasme.
Syndrome de Lyell Approche diagnostique Veronique del Marmol Alexandre Chamoun Service de Dermatologie Hôpital Erasme Serge Jennes Hôpital Militaire Rash benign Pustulose exanthematique Aigue et généralisée
More informationEM minor EM major SJS SJS-TEN TEN
North American study of pediatric SJS and TEN: Setting diagnostic criteria, systematic review and retrospective cohort analysis comparing outcomes of common treatments Michele Ramien, MDCM, FRCPC Dermatology,
More informationToxic Epidermal Necrolysis - A Case Report
The Journal of Critical Care Medicine 2017;3(1):29-33 CASE REPORT Toxic Epidermal Necrolysis - A Case Report Laura Stătescu¹, Magda Constantin², Horia Silviu Morariu³ *, Laura Gheucă Solovăstru¹ ¹ Dermatology
More informationHEMORRHAGIC BULLOUS HENOCH- SCHONLEIN PURPURA: A CASE REPORT
HEMORRHAGIC BULLOUS HENOCH- SCHONLEIN PURPURA: A CASE REPORT Nirmala Ponnuthurai, Sabeera Begum, Lee Bang Rom Paediatric Dermatology Unit, Institute of Paediatric, Hospital Kuala Lumpur, Malaysia Abstract
More informationDiseases of Immunity 2017 CL Davis General Pathology. Paul W. Snyder, DVM, PhD Experimental Pathology Laboratories, Inc.
Diseases of Immunity 2017 CL Davis General Pathology Paul W. Snyder, DVM, PhD Experimental Pathology Laboratories, Inc. Autoimmunity Reflects a loss of immunologic tolerance Mechanisms Auto-antibodies
More informationDermatopathology: The tumor is composed of keratinocytes which show atypia, increase mitoses and abnormal mitoses.
Squamous cell carcinoma (SCC): A common malignant tumor of keratinocytes arising in the epidermis, usually from a precancerous condition: 1- UV induced actinic keratosis, usually of low grade malignancy.
More informationOral Erythema Multiforme: Laboratory findings in monitoring Herpes Simplex Virus involvement (A case report)
Oral Erythema Multiforme: Laboratory findings in monitoring Herpes Simplex Virus involvement (Maria Leny Raiyon et al.) Oral Erythema Multiforme: Laboratory findings in monitoring Herpes Simplex Virus
More informationAmmara ismail, Fatima Javed, Memoona Ismail
International Journal of Scientific & Engineering Research Volume 9, Issue 4, April-2018 1542 Oral manifestations of exam/prof induced stress ABSTRACT Ammara ismail, Fatima Javed, Memoona Ismail Stress
More informationErythema gyratumrepens-like eruption in a patient with epidermolysisbullosaacquisita associated with ulcerative colitis
Erythema gyratumrepens-like eruption in a patient with epidermolysisbullosaacquisita associated with ulcerative colitis A. España C. Sitaru* M. Pretel L. Aguado J. Jimenez# Department of Dermatology, University
More informationImportant Decisions in Dermatopathology: The Clinico- Pathologic Correlation. Dermatopathology Specialists Needed. Changing Trends
Important Decisions in Dermatopathology: The Clinico- Pathologic Correlation Uma Sundram, MD, PhD Departments of Pathology and Dermatology Stanford University May 29, 2008 Dermatopathology Specialists
More informationEFAVIRENZ ASSOCIATED STEVENS-JOHNSON SYNDROME
EFAVIRENZ ASSOCIATED STEVENS-JOHNSON SYNDROME To the Editor: Persons with human immunodeficiency virus (HIV) infection are highly susceptible to adverse dermatological reactions to specific medications
More information=ﻰﻤاﻤﺤﻠا ﺔﻴﻘﻠﺤﻠا ﺔذﺒاﻨﻠا
1 / 15 Erythema Annulare Centrifugum and Other Figurate Erythemas The figurate erythemas include a variety of eruptions characterized by annular and polycyclic lesions. Classification of this group has
More informationThursday, 21 October :53 - Last Updated Thursday, 11 November :27
1 / 15 2 / 15 3 / 15 4 / 15 Pityriasis Alba Background Pityriasis alba is a nonspecific dermatitis of unknown etiology that causes erythematous scaly patches. These resolve and leave areas of hypopigmentation
More informationPrevention of severe cutaneous adverse drug reactions: the emerging value of pharmacogenetic screening
CMAJ Cases Prevention of severe cutaneous adverse drug reactions: the emerging value of pharmacogenetic screening Suran L. Fernando MB BS PhD, Andrew J. Broadfoot MB BS Previously published at www.cmaj.ca
More informationDifferential Diagnosis of Oral Lesions. An Interactive Lecture Using Audience Response Polling. John L. Alonge, MS, DDS
Differential Diagnosis of Oral Lesions An Interactive Lecture Using Audience Response Polling John L. Alonge, MS, DDS Goals 1. Review the diagnostic process needed to formulate a differential diagnosis
More informationWhat's New in Oncodermatopathology: Immunotherapy Reactions
What's New in Oncodermatopathology: Immunotherapy Reactions Emily Y. Chu, M.D., Ph.D. Assistant Professor of Dermatology & Pathology and Laboratory Medicine Hospital of the University of Pennsylvania March
More informationSEVERE CUTANEOUS ADVERSE DRUG REACTIONS: STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSISA, A REPORT OF 4 CASES SEEN AT UMMC
SEVERE CUTANEOUS ADVERSE DRUG REACTIONS: STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSISA, A REPORT OF 4 CASES SEEN AT UMMC Shasha Khairullah, Rokiah Che Ismail Department of Medicine, Faculty
More informationAnalysis of causation of Stevens Johnson Syndrome in a patient of rheumatoid arthritis with increased dose of methotrexate
Original Research Article Analysis of causation of Stevens Johnson Syndrome in a patient of rheumatoid arthritis with increased dose of methotrexate Manab Nandy 1, Sangeeta De 2*, Mustafa Asad 2, Nirmal
More informationSevere cutaneous reactions caused by barbiturates in seven Iranian children
Pharmacology and therapeutics Severe cutaneous reactions caused by barbiturates in seven Iranian children Setareh Mamishi, MD, Fatemeh Fattahi, MD, Zahra Pourpak, MD, PhD, Farzaneh Mirza Aghaee, MD, Zeinab
More informationEndocarditis. By : Mehrnoush. dianatkhah
Endocarditis By : Mehrnoush. dianatkhah Case 5.31, 31 years old woman CC : Fever, dyspnea, 3 days postpartum PMH : Mitral prolapse Fever 38.5 WBC : 8900 ESR : 84 CRP : 10.4 Cr : 0.6 NT Pro BNP: 5469 Physical
More informationDiagnosis and management of COMMON NON-VIRAL ORAL ULCERATIONS
and management of COMMON NON-VIRAL ORAL ULCERATIONS Van Heerden WFP, BChD, MChD (Oral Path), FC Path(SA) Oral Path, PhD, DSc Department of Oral Pathology, University of Pretoria Boy SC, BChD, MChD (Oral
More informationMEASLES (campak, rubeola, gabak, kerumut) Infectious and Tropical Pediatric Division Department of Child Health, Medical Faculty, University of Sumate
MEASLES (campak, rubeola, gabak, kerumut) Infectious and Tropical Pediatric Division Department of Child Health, Medical Faculty, University of Sumatera Utara 1 Maculapapular eruption : 1. Measles 2. Atypical
More informationIMACS FORM 07b: MYOSITIS DISEASE ACTIVITY ASSESSMENT TOOL, Version
IMACS FORM 07b: MYOSITIS ASSESSMENT TOOL, Version 2 2005 Subject s IMACS number: ASSESSOR: Date Assessed: Assessment number: The clinical features recorded are based upon the previous 4 weeks and the judgment
More informationDifferential Diagnosis of Oral Ulcerations
Differential Diagnosis of Oral Ulcerations Dr. Nagamani Narayana Department of Oral Biology University of Nebraska Medical Center College of Dentistry Objectives Differential diagnosis of oral ulcerations
More informationالمركب النموذج--- سبيتز وحمة = Type Spitz's Nevus, Compound SPITZ NEVUS 1 / 7
SPITZ NEVUS 1 / 7 Epidemiology An annual incidence rate of 1.4 cases of Spitz nevus per 100,000 individuals has been estimated in Australia, compared with 25.4 per 100,000 individuals for cutaneous melanoma
More informationExtensive Kaposi's sarcoma in a HIV positive patient: A case report
ISPUB.COM The Internet Journal of Infectious Diseases Volume 7 Number 1 Extensive Kaposi's sarcoma in a HIV positive patient: A case report G Lopez, Y Graza Citation G Lopez, Y Graza.. The Internet Journal
More informationJournal of Global Trends in Pharmaceutical Sciences
An Elsevier Indexed Journal ISSN-2230-7346 Journal of Global Trends in Pharmaceutical Sciences A CASE STUDY ON HERBAL THERAPY INDUCED ERYTHEMA MULTIFORME S. Showkath Ali * 1, S. Priyanka 2, Bandla Aswani
More informationParaneoplastic Pemphigus in A Patient with Chronic Lymphocytic Leukemia: A Case Report
Case Report Paraneoplastic Pemphigus in A Patient with Chronic Lymphocytic Leukemia: A Case Report Arif Kuş 1, Abdulkerim Yıldız 2*, Betül Erdem 3, Murat Albayrak 2, Çiğdem Pala Öztürk 2, Müzeyyen Gönül
More informationHerbal and homeopathic products, often considered natural and non-toxic, can also cause adverse drug reactions.
Idiosyncratic and potentially serious cutaneous adverse drug reactions (CADRs), although relatively rare, account for significant morbidity and mortality. RANNAKOE J LEHLOENYA, BSc, MB ChB, FCDerm (SA)
More information