Tsɔe be ɖeko nèdze atike yeye aɖe nono gɔme na dɔléle aɖe teti koe nye ema. Le abe kwasiɖa ɖeka alo eve ene megbe la, wò lãme megasẽna o, abe ɖe wòsusɔ vie dzame le fu ɖem na wò ene. Wò ŋutilã le veve sem, dzoxɔxɔ le ŋuwò, èʋuʋuna... Emegbe kasia, wò ŋutilã dzea dodo gɔme le teƒe dzĩ siwo trɔna vivivi zua tsi ƒe ʋuʋudedi, eye wò ŋutigbalẽ dzea ʋuʋu gɔme abe ɖe wotɔ dzo wò ene. Esia nye nɔnɔme si dzi ŋɔ ŋutɔ, si vea ame, eye ate ŋu ade ame ƒe agbe afɔku me. Egbea míele nu ƒom tso nɔnɔme sia si me afɔku le, si nye Toxic Epidermal Necrolysis (TEN) ŋu.
Kpuie ko la, nukae nye Toxic Epidermal Necrolysis (TEN)?
Toxic Epidermal Necrolysis, alo TEN kpuie, nye ŋutigbalẽ ƒe dɔléle si vea ame ŋutɔ eye ate ŋu ade ame ƒe agbe afɔku me. Enaa wò ŋutilã ƒe akpa gãwo, zi geɖe la, wò ŋutilã ƒe 30% ya teti , ʋuʋuna eye wòɖena. Ʋuʋudedi sia ate ŋu adzɔ le teƒe siwo lãkusiwo le abe nu, ŋku, kple vidzinuwo ene hã.
Zi geɖe la, nɔnɔme sia si me afɔku le la dzɔna abe atike aɖewo siwo míenona ƒe nuwɔna sesẽ ene. Ne ŋutigbalẽa gblẽ alea la, tsikuɖiɖi kple dɔlékui sesẽwo ƒe afɔku gã aɖe nɔa eme.
Ne míagblɔe tututu la, TEN ye nye ŋutigbalẽ ƒe dɔléle bubu si woyɔna be Stevens-Johnson syndrome (SJS) ƒe ƒomevi si nu sẽ wu. Le SJS me la, ŋutilã ƒe ŋutigbalẽ ƒe 10% mede 10% o. Ne ŋutilã ƒe 10% va ɖo 30% gblẽ nu le eŋu la, míeyɔnɛ be SJS-TEN ƒe ƒoƒo ɖekae ƒe nɔnɔme. Ne ŋutigbalẽa ƒe akpa si wu 30% kɔ la, wobua eŋu be enye EWO.
Amekae le afɔku me wu be wòaxɔ nɔnɔme sia?
Amesiwo ƒe dɔlélenutsiŋutete gbɔdzɔ la ate ŋu axɔ Stevens-Johnson ƒe dɔléle (SJS) alo TEN. Susu geɖewo li siwo tae dɔlélenutsiŋutete ate ŋu agbɔdzɔ ɖo.
- Ame siwo ŋu amegbetɔ ƒe dɔlélenutsiŋutete ƒe dɔlékui (HIV) le.
- Ame siwo ŋu kansa aɖewo le, abe ʋumenugbagbeviɣidɔ ene.
Tsɔ kpe ɖe eŋu la, domenyiŋusẽfianu hã ate ŋu awɔ akpa aɖe. Ame aɖewo ƒe ŋutilã mete ŋu gblẽna hewɔa atike aɖewo ƒe asitɔtrɔ le wo ɖokui ŋu le mɔ si sɔ nu o. Esia nye nane si tso woƒe domenyiŋusẽfianu me. Le nɔnɔme mawo me la, atike mawo ate ŋu aƒo ƒu ɖe ŋutilãa me eye woahe dɔléle sesẽwo abe SJS alo TEN ene vɛ. Azɔ hã, le tɔtrɔ (trɔtrɔ) siwo va domenyiŋusẽfianu aɖewo me ta la, ame aɖewo ate ŋu awɔ nu ɖe atike aɖewo ŋu bɔbɔe wu.
Togbɔ be TEN ate ŋu adzɔ le ƒe ɖesiaɖe me hã la, ebɔ ɖe ame tsitsiwo me wu. Gake enye nɔnɔme si mebɔ kura o .Ele vevie be míaɖo ŋku edzi be le xexeame katã la, SJS kple TEN ne wotsɔ wo ƒo ƒui la, ame siwo ade miliɔn ɖeka alo eve koe wògblẽa nu le ƒe sia ƒe.
Nukawo koŋue hea TEN vɛ?
Le go geɖe me la, ɖɔktawo xɔe se be atike aɖewo koŋ gbɔe TEN tsona. Mina míalé ŋku ɖe atike siwo ŋu afɔku le wu ŋu.
| Atikewo ƒe hatsotso | Numeɖeɖe bɔbɔe |
|---|---|
| Allopurinol ƒe atike | Atike si wozãna tsɔ daa dɔlélewo abe ayiku me kpewo kple gout ene. |
| Atike siwo tsia ʋuʋudedi nu | Atikewo ƒe hatsotso aɖe si wonana be woatsɔ aɖu nɔnɔmewo abe alɔ̃madɔmadɔ ene dzi. |
| Atike siwo tsia dɔlékuiwutikewo nu | Vevietɔ atike siwo wozãna tsɔ daa HIV dɔlékui (e.g. nevirapine). |
| Oxicams ƒe lãwo | Esiawo nye vevesesenutsitike kple atike siwo tsia dɔdzẽ nu ƒe hatsotso aɖe si le NSAID ƒe ƒuƒoƒoa me. |
| Sulfonamides ƒe atikewo | Esiawo nye dɔlékuiwutike ƒomevi aɖe. |
Tsɔ kpe ɖe atike siawo ŋu la, ƒã ŋutɔ la, dɔlékui aɖewo alo atikewɔmɔnu aɖewo hã ate ŋu ahe TEN vɛ. Gake esia mebɔ kura o. Ɣeaɖewoɣi la, womate ŋu ake ɖe nusi gbɔ TEN tso ŋu o.
Nukae nye TEN ƒe dzesiwo?
ZI geɖe la, dzesi ewo dzea egɔme dzena le kwasiɖa ʋɛ aɖewo megbe tso esime wodze atike yeye zazã gɔme. Edzea egɔme tso dzesi siwo le abe vuvɔ ene dzi.
- Ŋutilã ƒe vevesese
- Kpe
- Asrã kple vuvɔ
- Taɖuame
- Ŋkuwo ƒe biã kple dɔdzẽ
Le dzesi gbãtɔ siawo megbe la, teƒe dzĩ siwo le veve sem (ʋuʋudedi) dzea egɔme dzena le ŋutigbalẽa ŋu. Teƒe siawo lolona vivivi, wotrɔna zua ʋuʋudedi siwo me tsi yɔ fũ, eye mlɔeba ŋutigbalẽa tea ʋuʋu. Woyɔa abi siwo dona ne ŋutigbalẽa vuvu . Esiawo nye abi siwo le ʋuʋu ɖi siwo le veve sem ŋutɔ, siwo le abe dzobibi sesẽwo ene.
Abi siawo dzena le mo kple akɔta gbã, eye emegbe woate ŋu akaka ɖe ŋutilã ƒe akpa bubuwo.
- Ŋkuwo: Ŋku ƒe akpa si le eme (conjunctiva) kple ŋku yibɔa ƒe gota gome (cornea) ate ŋu agblẽ.
- Mucous membranes: Abi ate ŋu adzɔ le nu, ŋɔti, ŋɔti, kple gbɔgbɔtsixe me.
- Aɖuɖɔtoe, aɖuɖɔtoe, kple vidzinuwo: Teƒe siawo hã ate ŋu axɔ abi vevie.
Abi siawo nana dɔ bɔbɔewo abe nuɖuɖu, nu mimi, gbɔgbɔ, ŋku ƒoƒo, kple aɖuɖɔtoe ene gɔ̃ hã vea ame ŋutɔ eye wòsesẽna ŋutɔ.
Kuxi sesẽ siwo ate ŋu ado mo ɖa le TEN ta
TEN menye nɔnɔme si woabu nu tsɛe o. Ate ŋu ahe kuxi sesẽ siwo ate ŋu ade ame ƒe agbe afɔku me vɛ.
- Dɔlékuiwo: Ne ŋutigbalẽa gbã la, mɔnukpɔkpɔ geɖe li be dɔlékuiwo nage ɖe ŋutilãa me. Ne dɔlékui siawo ge ɖe ʋukawo me la, nɔnɔme aɖe si me afɔku le ŋutɔ si woyɔna be sepsis ate ŋu ado mo ɖa.
- Ŋutinu geɖe ƒe dɔmawɔmawɔ nyuie: Dzoxɔxɔ sesẽ kple dɔlékuiwo xɔxɔ le ŋutilãa me ate ŋu ana ŋutinu ememetɔwo abe ayiku, aklã, kple lãkusi ene nawɔ dɔ nyuie.
- Aklãdɔ: Afɔku si le lãkusi me dɔlékuiwo xɔxɔ me dzina ɖe edzi le abi siwo woxɔna le gbɔgbɔtsixe me ta.
Le kuxi sesẽ mawo ate ŋu ado mo ɖa ta la, ele be woaxɔ amesi ŋu TEN ƒe dzesiwo le la ɖe kɔdzi ahada dɔ nɛ enumake .
Aleke ɖɔktawo wɔa dea dzesi dɔléle siae?
Zi geɖe la, ɖɔkta bibi ate ŋu anya TEN ne edo wò ŋutigbalẽ kpɔ eye wòbia wò dzesiwo. Ɣeaɖewoɣi la, ahiã be woaɖe ŋutigbalẽ ƒe lãmenugbagbeviwo atsɔ aɖo kpe dɔlélea dzi.
Esia bia be woaɖe ŋutigbalẽ sue aɖe ŋutɔ tso ŋutigbalẽ ƒe abi aɖe me le atike si naa alɔ̃dɔdɔ ame me eye woadoe kpɔ le nusuekpɔmɔ̃ me. Dodokpɔ sia ate ŋu akpɔe kɔte be ŋutigbalẽmenugbagbevi kukuwo (lãmenugbagbevi siwo ƒu) li eye nenye be ŋutigbalẽa ƒe akpa si le etame (epidermis) ma tso akpa si le ete gbɔ.
Nukawoe nye atike siwo wozãna na esia?
Vevietɔ wu la, TEN nye atikewɔwɔ kpata.Esia menye dɔléle si woate ŋu ada le aƒeme o. Ele be nàyi kɔdzi ƒe Atikewɔwɔ Kpata (ETU) enumake ne dzesiawo dze egɔme ko.
Le kɔdzi la, woxɔa dɔnɔa ɖe dɔnɔdzikpɔƒe si wokpɔa dɔnɔwo gbɔ le vevie (ICU) alo afisi wotɔa dzoe zi geɖe, elabena dɔnɔ siawo hiã beléle tɔxɛ si sɔ kple esi wonaa dɔnɔ si ŋu dzo le.
Woate ŋu ama atikewɔwɔmɔnuawo ɖe akpa vevi eve me.
| Atikewɔwɔ ƒe tiatia siwo woate ŋu azã na TEN | |
|---|---|
| Atikewɔwɔ enumake | |
| Atike si hea dɔlélea vɛ la nu tsotso | Wodzudzɔa atike siwo katã wosusu be woawoe hea TEN vɛ la zazã enumake. |
| Ŋutilã me tsi ƒe agbɔsɔsɔ dzi ɖuɖu | Ŋutilã ƒe ʋuʋu nana tsi gbogbo aɖe dona le ŋutilãa me. Eyata wotsɔa saline (IV tsiwo) naa to ʋuka aɖe me be woatsɔ akpɔ ŋutilãa me tsi ƒe agbɔsɔsɔ dzi. |
| Mɔxexe ɖe dɔlékuiwo xɔxɔ nu | Wodea dɔlékuiwutikewo alo ami siwo wotsɔna ƒoa abi siwo le ʋuʋu ɖi. Wona dɔlékuiwutikewo le dɔlélea ƒe dzesi gbãtɔwo me. |
| Atikewɔwɔ tɔxɛ bubuwo | |
| Dɔlélenutsiŋutete ƒe globulin (IVIG) . | Esia nye tsi si wonana to ʋuka aɖe me. Dɔlékuiwutike siwo woɖe tso ame siwo le lãmesẽ me ƒe ʋumenugbagbeviɣi me la le eme. Esiawo kpena ɖe ame ŋu wòɖua ŋutilãa ƒe dɔlélenutsiŋutete ƒe ŋuɖoɖo gbegblẽ dzi. |
| Dɔlélenutsiŋutete ƒe atikewo | Wona atikewo be woatsɔ axe mɔ na ŋutilãa ƒe dɔlélenutsiŋutete be wòagadze eya ŋutɔ ƒe lãmenugbagbeviwo dzi o, si ana eƒe dɔwɔwɔ nagbɔdzɔ. |
| Plasmapheresis ƒe dɔwɔwɔ | Esia bia be woaɖo dɔnɔa ƒe ʋu ɖe mɔ̃ tɔxɛ aɖe me, ama dɔlékuiwutike siwo gblẽa nu le ame ŋu le ʋumenugbagbeviɣia me ahaɖe wo ɖa, eye woagbugbɔ ʋu si ŋu wokɔ la atrɔ ayi ŋutilãa me. |
Nusiwo dona tso eme ɣeyiɣi didi le hayahaya megbe
Amesiwo tsi agbe le TEN me ate ŋu akpɔ ŋusẽ aɖewo siwo anɔ anyi ɣeyiɣi didi. Ne ŋutigbalẽa haya keŋkeŋ gɔ̃ hã la, kuxi bubuwo ate ŋu ado mo ɖa.
- Ŋutilã, taɖa kple ɖa: ɖa ƒe tsitsi alo eƒe sisi si mesɔ o, ŋutigbalẽ ƒe teƒeteƒewo (yibɔ alo ɣi), ɖa ƒe vuvu le teƒe aɖewo (alopecia areata), ŋutigbalẽ si ƒu eye wòle ʋuʋum, fifia si gbɔ eme.
- Ŋkuwo: Ŋkuwo ƒe abi alo biã ɣeyiɣi didi, ŋkuwo ƒe ƒuƒu, ŋkume ƒe ʋuʋu, kekeli ƒe seselelãme, ŋku ƒe nukpɔkpɔ si me kɔ o alo ƒã hafi ŋkuagbã.
- Nu, ŋɔti kple gbɔgbɔtsixe ƒe ɖoɖo: Aɖuɖɔtoedɔléle, lãkusidɔ abe COPD, nu ƒe ƒuƒu, aɖudɔ, vivisese kple ʋeʋẽ ƒe bu, lãkusi ƒe gbegblẽ.
- Aɖuɖɔtoe kple vidzidzi ƒe ɖoɖo: Aɖuɖɔtoe, nyɔnu ƒe vidzidɔ, alo ŋutsu ƒe vidzinu ƒe abi alo dɔdzẽ ɣeyiɣi didi, aɖuɖɔtoe sesẽ, nyɔnuwo ƒe vidzidɔ ƒe ƒuƒu.
Ele vevie ŋutɔ be nàƒo nu tso nusiwo wògblẽna le ame ŋu ɣeyiɣi didi siawo ŋu na wò ɖɔkta eye nàdi atike si hiã.
Gbedasi si Wotsɔ Yi Aƒeme
- Toxic Epidermal Necrolysis (TEN) nye atike aɖewo zazã ƒe nuwɔna si nu sẽ ŋutɔ, si ate ŋu ade ame ƒe agbe afɔku me.
- Edzea egɔme tso dzesi siwo bɔ abe dzoxɔxɔ kple ŋutilã ƒe vevesese ene dzi, gake emegbe eyia edzi va zua ʋuʋudedi si me vevesese le kple ŋutigbalẽ si le ʋuʋum abe ɖe wòfiã ene.
- Esia nye atikewɔwɔ kpata. Ne èkpɔ dzesi siawo la, ele be nàyi kɔdzi ƒe Atikewɔwɔ Kpata ƒe Dɔwɔƒe (ETU) enumake.
- Ne ŋutigbalẽ ƒe ʋuʋu, ʋuʋudedi, alo dzesi bubu siwo mebɔ o va dze ŋuwò le atike yeye zazã gɔmedzedze megbe la, mègaŋe aɖaba ƒu edzi gbeɖe o. Kpɔ wò ɖɔkta enumake.
- Ne atike aɖe ƒe nulɔdɔ aɖe nɔ ŋuwò tsã la, kpɔ egbɔ be yena wò ɖɔkta nanya esia ɣesiaɣi si nèyi ɖaxɔ atike.
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