Ðe wò ŋutigbalẽ biãna zi ɖeka, ƒuna, eye wòɖea ɖaa? Mina míasrɔ̃ nu tso Stevens-Johnson ƒe Dɔléle (SJS) sia si me afɔku le ŋua?

Èkpɔe kpɔa, alo ɖe wòdzɔ ɖe dziwò be ʋuʋudedi kpata aɖe le wò ŋutilã ŋu si trɔna biã, wòdzena abe ʋuʋudedi ene, emegbe ʋuʋudediwo dona eye ŋutigbalẽa vuvua? Abi siawo ate ŋu adze le nu me, ŋkuwo, kple vidzinuwo hã me. Esia menye nu bɔbɔe o, eye ate ŋu anye nɔnɔme sesẽ aɖe si abia be woaxɔ ame ɖe kɔdzi enumake . Egbea, míaƒo nu tso nɔnɔme sia si woyɔna be Stevens-Johnson Syndrome (SJS) ŋu.

Nukae nye Stevens-Johnson ƒe Dɔléle (SJS)?

Kpuie ko la, Stevens-Johnson Syndrome (SJS) kple Toxic Epidermal Necrolysis (TEN) nye ŋutigbalẽ ƒe dɔléle eve siwo nu sẽ ŋutɔ. Nusi dzɔnae nye be kasia wò ŋutigbalẽa dzea ƒoƒoe siwo biã, siwo le ʋuʋum, siwo emegbe ʋuʋudediwo eye woɖea wo ɖa. Ate ŋu akpɔ ŋusẽ ɖe wò ŋkuwo, vidzinuwo, kple lãkusi siwo le wò nu me hã dzi. Ne nɔnɔme siawo va dze dziwò la, ahiã godoo be woaxɔ wò ɖe kɔdzi be woawɔ atike na wò.

Ðɔkta aɖewo bua SJS kple TEN be wonye dɔléle eve siwo to vovo, gake bubuwo gblɔ be dɔléle ɖeka ƒe akpa vovovowoe wonye. SJS nye dɔlélea ƒe ƒomevi aɖe si nu mesẽna vie wu TEN o. Le kpɔɖeŋu me, le SJS me la, ŋutigbalẽ si le ŋutilã bliboa dzi ƒe akpa si mede 10% o ate ŋu abu. Le TEN me la, ŋutigbalẽa ƒe akpa si wu 30% ate ŋu abu. Gake ele vevie be míaɖo ŋku edzi be nɔnɔme evea siaa ate ŋu ade ame ƒe agbe afɔku me .

Ŋkɔ bubu kawoe le SJS si?

Ẽ, wotsɔ ŋkɔ bubu geɖe nɛ. Le kpɔɖeŋu me:

• Lyell ƒe Dɔléle
• Stevens-Johnson ƒe dɔléle/aɖi ƒe ŋutigbalẽ ƒe kuku
• Stevens-Johnson ƒe dɔlélea ƒe aɖi le ŋutigbalẽ me kuku ƒe ɣeyiɣi ƒe didime

Ɣeaɖewoɣi la, ŋkɔa trɔna le nusi gbɔ wòtso nu. Ne atike aɖe gbɔe wòtso la, woateŋu ayɔe be ``atikewo ƒe Stevens-Johnson ƒe dɔléle'', eye ne dɔlékui aɖe si woyɔna be ``Mycoplasma'' gbɔe wòtso la, woateŋu ayɔe be ``mycoplasma-induced Stevens-Johnson syndrome''.

Amekae ate ŋu axɔ SJS wu?

Wokpɔa SJS zi geɖe le sɔhɛ siwo mexɔ ƒe 30 haɖe o kple ɖevi suewo me. Ke hã, ate ŋu adzɔ le ame siwo xɔ ƒe ɖesiaɖe me, vevietɔ ame tsitsiwo. Nyɔnuwo ate ŋu axɔ SJS wu ŋutsuwo.

Bu eŋu kpɔ, ne ɖevi sue aɖe xɔ dɔlékui aɖe abe aklãdɔ ene eye emegbe ŋutigbalẽ ƒe kuxi aɖe le eŋu abe esia ene... ateŋu anye SJS. Nusi koŋ gbɔ SJS tsona le ɖeviwo ŋue nye dɔlékuiwo abe aklãdɔ ene. Gake le ame tsitsiwo gome la, atike siwo wozãna gbɔe SJS/TEN tsona wu.

Nukawoe nye afɔku siwo ate ŋu ana SJS nadze ame dzi?

Menye nu ɖeka aɖeke meli si gbɔ dɔléle sia tso o, ke boŋ nu vovovowoe ƒo ƒu. Esiawo dometɔ vevitɔe nye domenyiŋusẽfianu ƒe nɔnɔme. Eyae nye be, wò domenyiŋusẽfianu ate ŋu akpɔ ŋusẽ aɖe ɖe ame dzi. Nutoa me nu aɖewo hã ate ŋu ana domenyiŋusẽfianu mawo nawɔ dɔ. Domenyiŋusẽfianu siawo dometɔ ɖekae nye míaƒe ŋutilã ƒe akpa tɔxɛ siwo woyɔna be `(Human Leukocyte Antigens - HLAs). Ame siwo si `(HLA)` siawo ƒe vovototo aɖewo le la le afɔku gã aɖe me be woaxɔ SJS alo TEN wu ame bubuwo.

Nukae nye SJS ƒe dzesiwo?

Dzesi geɖe li siwo ate ŋu ado mo ɖa le SJS me. Ele vevie be nànya nu tso esiawo ŋu:

• Vevesese sesẽ le ŋutigbalẽa ŋu: Gbã la, ŋutigbalẽa tea vevesese.
• Asrã: Asrã le ŋuwò.
• Ŋutilã ƒe vevesese: Ewɔna na wò abe ɖe wò ŋutilã bliboa le veve sem ene.
• Teƒe dzĩwo alo teƒeteƒewo le ŋutigbalẽa ŋu: Teƒe dzĩwo alo teƒeteƒewo dzena le ŋutigbalẽa ŋu.
• Kpe.
• Ʋuʋudedi kple abi: Menye ŋutigbalẽa ɖeɖeko dzie ʋuʋudedi kple abi ate ŋu adzɔ o, ke boŋ le lãkusi siwo le teƒewo abe nu, ŋɔti, ŋku, vidzinuwo, kple dɔgbo hã dzi. Bu eŋu kpɔ, abi siwo le nu me nana be menye nuɖuɖu koe wòsesẽna o, ke esesẽna na nuƒoƒo hã.
• Ŋutilãa ƒe ʋuʋu: Ŋutilãa ʋuna le ʋuʋudediawo me.
• Aɖuɖɔɖɔɖɔ: Le nu me ƒe abi ta la, aɖuɖɔ dona ne mète ŋu tsi nu o.
• Ŋku ƒe vuvu: Ʋuʋu kple vuvu le ŋkuwo me nana ŋkuwo vuvu ale gbegbe be womate ŋu aʋu o.
• Vevesese le aɖuɖɔtoeme: Ʋuʋudedi siwo le lãkusiwo me nana ame sea veve vevie le aɖuɖɔtoe me.

Tsɔe be èdze atike yeye aɖe zazã gɔme, eye le ŋkeke ʋee aɖewo megbe la, èse le ɖokuiwò me be yeƒe lãme mekɔ o, dzoxɔxɔ le ŋuwò, eye nèle veve sem, eye kasia teƒe dzĩwo dona le wò ŋutigbalẽ ŋu eye ʋuʋudediwo dona... Ɣemaɣie wòle be nàdze ɖikeke gɔme be SJS ye nye esia.

Nukae hea SJS vɛ?

Nu vevi geɖewo li siwo gbɔ SJS tsona:

• Atike aɖe ƒe nulɔdɔ: Esia koŋ gbɔe SJS akpa gãtɔ kple TEN dɔléleawo katã tsona. Esia ate ŋu adzɔ ne atike aɖe si nèzãna ƒe agbɔsɔsɔme aɖe to ŋuwò.
• Dɔlékuiwo: Le kpɔɖeŋu me, dɔlékuiwo abe Mycoplasma pneumonia, Herpes virus, kple Hepatitis A ene.
• Graft-versus-host disease: Esia nye nɔnɔme si ate ŋu adzɔ, vevietɔ le ƒumeŋuɖui dodo vɔ megbe.
• Womekpɔ nusi gbɔ wòtso o: Ɣeaɖewoɣi la, SJS ate ŋu adzɔ evɔ womekpɔ nusi gbɔ wòtso si dze ƒã o.

Ne SJS le ŋuwò le atike aɖe ta la, zi geɖe la, dzesiawo dzea egɔme le kwasiɖa ɖeka, eve, alo etɔ̃ me tso esime nèdze atikea zazã gɔme. Àte ŋu adze egɔme kple asrã, kɔdzi, kple taɖuame, eye ŋutigbalẽa ƒe ʋuʋu kple ŋutigbalẽ ƒe ʋuʋu akplɔe ɖo. Le ame aɖewo siwo ŋu TEN le gome la, taɖa kple ɖa ate ŋu adze gɔ̃ hã. Ƒã ŋutɔ hafi woka nya ta be atike si wodo nɛ nyitsɔ laa gbɔe SJS tso.

Atike kawoe ate ŋu ahe SJS vɛ wu?

Atike aɖewo li siwo me afɔku le wu be woahe SJS vɛ. Esiawo dometɔ aɖewoe nye:

• Sulfa ƒe atike siwo wua dɔlékuiwo.
• Atike siwo tsia asrãdɔ nu: Kpɔɖeŋu aɖewoe nye Phenytoin (Dilantin®), Carbamazepine (Tegretol®), Lamotrigine (Lamictal®), kple Phenobarbital (Luminal®).
• `(Allopurinol (Aloprim®, Zyloprim®))`: Esia nye atike si wozãna na gout kple ayiku me kpewo.
• Atike siwo me steroid mele o (NSAIDs): Kpɔɖeŋu aɖewoe nye Piroxicam (Feldene®), Nevirapine (Viramune®), kple Diclofenac (Cambia®, Flector®).
• Dɔlékuiwutike bubuwo.

Vevietɔ: Esia mefia be amesiame si noa atike siawo la axɔ SJS o. Gake wokpɔe be atike siawo do ƒome kple afɔku si le SJS xɔxɔ me ƒe dzidziɖedzi.

Ðe nu bubu aɖewo li siwo nana SJS xɔxɔ ƒe afɔkua dzina ɖe edzia?

Ẽ, nɔnɔme bubu aɖewo li siwo dzia afɔku si le SJS xɔxɔ me ɖe edzi. Woawoe nye:

• Esi wodo ƒumeŋuɖui na wo ta.
• Dɔléle siwo dɔlélenutsiŋutete wɔna abe `(Systemic lupus erythematosus - SLE)` ene ƒe amesinɔnɔ.
• Amegbetɔ ƒe dɔlélenutsiŋutete ƒe dɔlékui (HIV) dɔlékui.
• Dɔléle bubu siwo nɔa anyi didi le ƒunukpeƒewo kple kadodoŋusẽ ŋu.
• Kansa.
• Dɔlélenutsiŋutete si gbɔdzɔ ƒe amesinɔnɔ.
• Ne ame aɖe le wò ƒomea me xɔ SJS (ƒome ŋutinya) va yi.
• Domenyiŋusẽfianu tɔxɛ aɖe ƒe tɔtrɔ aɖe si woyɔna be ``Human Leukocyte Antigen-B - HLA-B'' ƒe amesinɔnɔ.

Aleke ɖɔktawo wɔa dea dzesi SJS ƒe dɔléle siae?

Ðɔktawo dea dzesi SJS kple TEN to nu siawo ŋu bubu me:

• Ŋutilã si ŋu dɔlélea le kple lãkusi siwo ŋu dɔlélea le me dzodzro: Zi geɖe la, lãkusi eve ya teti ŋue wògblẽa nu le.
• Le vevesese si nèsena le ɖokuiwò me nu.
• Le alesi wògblẽ nu le wò ŋutigbalẽ ŋu kabakabae nu.
• Le alesi gbegbe wò ŋutigbalẽa gblẽ nu le eŋu nu.
• Ŋutilã ƒe lãmenugbagbeviwo ɖeɖe: Ɣeaɖewoɣi la, woɖea ŋutigbalẽ sue aɖe hedoa wo kpɔ le nusuekpɔmɔ̃ me tsɔ ɖoa ​​kpe dɔlélea dzi.

Aleke wowɔa nu ɖe ​​SJS ŋui?

SJS nye dɔléle si hiã be woaxɔ ame ɖe kɔdzi enumake ahadae. Agbagbadzedze be woadae le aƒeme ate ŋu ana nɔnɔmea nagagblẽ ɖe edzi. Dɔdamɔnuawo dometɔ aɖewoe nye esiawo:

• Dzudzɔ atike si wosusu be eyae le kuxia hem vɛ enumake: Esiae nye nu gbãtɔ si nàwɔ.
• Tsi siwo wodona ɖe ʋuka me (IV) be woatsɔ agbugbɔ elektrikŋusẽ aɖo ame me: Wowɔa esia be woatsɔ akpɔ tsi si bu le ŋutilãa me ne ŋutigbalẽa le ʋuʋum la dzi.
• Atike siwo meléna ɖe nu ŋu o sisi ɖe ŋutigbalẽ si ŋu dɔlélea le ŋu.
• Nuɖuɖu siwo me nunyiame sɔ gbɔ ɖo nana be wòahaya kabakaba: Ɣeaɖewoɣi la, ate ŋu ahiã be woana nuɖuɖu ame to mɔ̃ me.
• Dɔlékuiwutikewo nana ne ehiã be woaxe mɔ ɖe dɔlékuiwo xɔxɔ nu.
• Vevesesenutsitikewo nana.
• Atikewɔwɔ le kɔdzi, ɖewohĩ le Dɔnɔdzikpɔƒe si Kpɔa Dɔléle Sesẽwo Gbɔ (ICU) alo Dzobibi ƒe Dɔwɔƒe.
• Kpekpeɖeŋu didi tso eŋutinunyalawo ƒe ƒuƒoƒowo abe Dermatology kple Ophthalmology (ne ŋkuwo ŋue wògblẽ nu le) gbɔ.
• Le go aɖewo me la, woate ŋu ana atike tɔxɛwo abe IV immunoglobulin, cyclosporine, IV steroids, alo amniotic membrane grafts (na ŋkuwo) ene.

Nukawoe nye kuxi siwo ate ŋu ado tso SJS me?

Esi wònye be SJS kple TEN nye nɔnɔme sesẽwo ta la, kuxiawo ate ŋu asẽ ŋutɔ.

• Ku: Esiae nye kuxi sesẽtɔ kekeake. Dɔnɔ siwo ŋu SJS le ƒe 10% kple dɔnɔ siwo ŋu TEN le ƒe 50% ate ŋu aku.
• Aklãdɔléle.
• Sepsis: Esia nye dɔlékuiwo ƒe dɔléle sesẽ aɖe, si sɔ kple aɖi si le ʋu me.
• Dzidziƒoame ƒe nɔnɔme `(Shock)`.
• Ŋutinu geɖe ƒe dɔmawɔmawɔ nyuie.

Kuxi sesẽ siawo tae SJS/TEN ƒe nɔnɔmewo hiã be woaxɔ ame ɖe kɔdzi enumake.

Ðe woate ŋu axe mɔ ɖe SJS nua?

Le nyateƒe me la, zi geɖe la, womate ŋu axe mɔ ɖe SJS nu o. Esi wònye be zi geɖe la, atike aɖe ƒe nuwɔna si womele mɔ kpɔm na o gbɔe wòtsona ta la, mɔ aɖeke meli si dzi woato anya ne esia adzɔ hafi ano atike o.

Gake ne wokpɔ dɔléle aɖe si atikewo hena vɛ le ŋuwò la, nu vevitɔ kekeakee nye be màgazã atike ma alo atike ƒomevi ma tɔgbe gbeɖe o. Ele vevie ŋutɔ be nàna wò ɖɔkta nanya nu tso esia ŋu eye nàŋlɔe ɖe wò atikewɔwɔ ŋuti nuŋlɔɖiwo me.

Nukae nye mɔkpɔkpɔ na amesi ŋu SJS le? (Nukpɔsusu) .

Menye amesiame si ŋu SJS le ye kpɔa dzesi mawo ke o. Ame aɖewo hayana le kwasiɖa ʋɛ aɖewo megbe. Gake ne dzesiawo nu sẽ la, ate ŋu axɔ ɣleti geɖe hafi ahaya keŋkeŋ. Ame aɖewo ate ŋu akpɔ ŋusẽ ɖe ame dzi ɣeyiɣi didi. Le kpɔɖeŋu me:

• Ŋutilã: Ŋutilã si ƒu, ʋuʋudedi, ŋutigbalẽ ƒe amadede ƒe tɔtrɔ.
• Ŋkuwo: Ʋuʋudedi kple/alo ƒuƒu enuenu, ŋku ƒe vuvu enuenu, ŋku ƒe nukpɔkpɔ si me kɔ o, kekeli ƒe seselelãme (fotophobia).
• Fifia si gbɔ eme.
• Aklã ƒe gbegblẽ: Nɔnɔmewo abe aklãdɔ si xea mɔ na dɔléle si nɔa anyi didi (COPD), asrã ene.
• ɖa siwo le gegem alo woƒe lãme gblẽ.
• Taɖa ƒe ŋeŋe (Alopecia).
• Lãmetsiŋusẽ ƒe ƒuƒu: Esia ate ŋu ana nuwo abe aɖuɖɔtoe nasesẽ.
• Ðeɖiteameŋu si nɔa anyi didi ƒe dɔléle.
• Tɔtrɔ siwo vaa vivisese me.

Vevietɔ la, dɔlélea ate ŋu agadzɔ ne amea gade atike si he SJS vɛ le gɔmedzedzea me la me ake. Ne edzɔ alea la, zi geɖe la, dzesiawo nu sẽna ɖe edzi zi evelia.

SJS dɔnɔ siwo ade 10% kple TEN dɔnɔwo ƒe 30% kuna, vevietɔ le sepsis, acute respiratory distress syndrome (ARDS), kple ŋutinu geɖe ƒe dɔmawɔmawɔ nyuie ta.

Nusiwo dzi wòle be nàɖo ŋkui tso nusiwo ŋu míeƒo nu tsoe me (Take-Home Message) dometɔ aɖewoe nye esi:

Enyo, eyata míeƒo nu geɖe tso nɔnɔme sia si me afɔku le si woyɔna be SJS ŋu. Nusiwo dzi wòle be nàɖo ŋkui dometɔ aɖewoe nye esi:

• Stevens-Johnson Syndrome (SJS) kple Toxic Epidermal Necrolysis (TEN) nye ŋutigbalẽ ƒe dɔléle siwo nu sẽ ŋutɔ, siwo ate ŋu ade ame ƒe agbe afɔku me gɔ̃ hã.
• Ne dzesiwo abe ŋutigbalẽ ƒe vevesese, teƒe dzĩwo, ʋuʋudedi, ŋutigbalẽ ƒe ʋuʋu, alo nu me alo ŋku ƒe abi le ŋuwò le atike yeye zazã gɔmedzedze megbe, vevietɔ le kwasiɖa ɖeka alo eve me la, di atikewɔlawo ƒe aɖaŋuɖoɖo enumake. Ate ŋu anye SJS.
• Gblɔe na wò ɖɔkta ɣesiaɣi ne atike aɖe ƒe nulɔdɔ alo nugbegblẽ le ŋuwò vevie do ŋgɔ.
• Mègazã atike alo atike ma tɔgbe si wokpɔ be ehe SJS vɛ gbeɖe o.**
• Ne èsusu be nɔnɔme sia le ŋuwò la, mègatsi aƒeme o, yi kɔdzi enumake. Atikewɔwɔ kabakaba ate ŋu axɔ wò agbe.

Mele mɔ kpɔm be nyatakaka sia aɖe vi na wò. Nɔ lãmesẽ me!

` Stevens-Johnson Syndrome, SJS, Toxic Epidermal Necrolysis, TEN, Ŋutilãmedɔlélewo, Nulɔdɔ, Atikewo ƒe nugbegblẽ le ame ŋu, Ʋuʋudedi, Ŋutilã ƒe ʋuʋudedi, Ŋutilã ƒe dɔlélewo