Ingabe isikhumba sakho siphenduka sibe bomvu ngokuzumayo, sibe amabala, futhi siqhekeke? Ake sifunde ngalesi sifo esiyingozi iStevens-Johnson Syndrome (SJS)?

Wake wabona, noma wake wakubona, ukuqubuka okungazelelwe emzimbeni wakho okuphenduka kube bomvu, kubukeke njengokuqubuka, bese kuvela amabhamuza bese isikhumba siphuma? Lezi zilonda zingavela nangaphakathi emlonyeni, emehlweni, nasendaweni yokuzala. Lokhu akuyona into elula, futhi kungaba yisimo esibi esidinga ukulaliswa esibhedlela ngokushesha . Namuhla, sizoxoxa ngalesi simo esibizwa ngokuthi iStevens-Johnson Syndrome (SJS).

Iyini i-Stevens-Johnson Syndrome (SJS)?

Kalula nje, i-Stevens-Johnson Syndrome (SJS) kanye ne-Toxic Epidermal Necrolysis (TEN) yizimo ezimbili zesikhumba ezibucayi kakhulu. Okwenzekayo ukuthi isikhumba sakho siqala ngokuzumayo ukuba namaqhubu abomvu, alumayo, abese eqhuma futhi aqhekeke. Kungathinta namehlo akho, izitho zangasese, kanye nolwelwesi lwamafinyila emlonyeni wakho. Uma uba nalezi zimo, kuzodingeka nakanjani ulaliswe esibhedlela ukuze uthole ukwelashwa.

Abanye odokotela babheka i-SJS ne-TEN njengezifo ezimbili ezihlukene, kanti abanye bathi ziyizigaba ezahlukene zesifo esifanayo. I-SJS iwuhlobo lwesifo olungelubi kangako kune-TEN. Isibonelo, ku-SJS, ngaphansi kuka-10% wesikhumba emzimbeni wonke kungalahleka. Ku-TEN, ngaphezu kuka-30% wesikhumba kungalahleka. Kodwa-ke, kubalulekile ukukhumbula ukuthi zombili lezi zimo zingaba yingozi empilweni .

Yimaphi amanye amagama anawo i-SJS?

Yebo, ibizwa ngamanye amagama amaningana. Isibonelo:

• Isifo sikaLyell
• Isifo sikaStevens-Johnson/i-toxic epidermal necrolysis
• Isifo sikaStevens-Johnson i-toxic epidermal necrolysis spectrum

Ngezinye izikhathi, igama liyashintsha kuye ngokuthi imbangela iyini. Uma kubangelwa umuthi othile, kungabizwa ngokuthi ``i-drug-induced Stevens-Johnson syndrome'', futhi uma kubangelwa ukutheleleka okubizwa ngokuthi ``i-Mycoplasma'', kungabizwa ngokuthi ``i-mycoplasma-induced Stevens-Johnson syndrome''.

Ubani onamathuba amaningi okuthuthukisa i-SJS?

I-SJS ivame ukubonakala kakhulu entsheni engaphansi kweminyaka engama-30 kanye nasezinganeni ezincane. Kodwa-ke, ingenzeka kubantu banoma yimuphi ubudala, ikakhulukazi asebekhulile. Abesifazane banamathuba amaningi okuthola i-SJS kunabesilisa.

Cabanga nje, uma ingane encane ithola ukutheleleka okufana ne-pneumonia bese iba nenkinga yesikhumba efana nale... kungaba yi-SJS. Imbangela eyinhloko ye-SJS ezinganeni ukutheleleka okufana ne-pneumonia. Kodwa kubantu abadala, i-SJS/TEN ibangelwa kakhulu yimithi abayiphuzayo.

Yiziphi izici eziyingozi zokuthuthukisa i-SJS?

Akukho imbangela eyodwa yalesi sifo, kodwa inhlanganisela yezici. Okubaluleke kakhulu kulezi ukuthambekela kwezakhi zofuzo. Okusho ukuthi, izakhi zofuzo zakho zingase zibe nethonya elithile. Izici ezithile zemvelo nazo zingavuselela lawo ma-gene. Esinye salezi zici zofuzo yizingxenye ezikhethekile zomzimba wethu ezibizwa ngokuthi `(Human Leukocyte Antigens - HLAs). Abantu abanezinhlobo ezithile zalezi `(HLAs)` basengozini enkulu yokuthola i-SJS noma i-TEN kunezinye.

Ziyini izimpawu ze-SJS?

Kunezimpawu eziningana ezingase zivele ku-SJS. Kubalulekile ukuqaphela lezi:

• Ubuhlungu obukhulu esikhumbeni: Okokuqala, isikhumba siqala ukubuhlungu.
• Umkhuhlane: Unomkhuhlane.
• Ubuhlungu bomzimba: Kuzwakala sengathi umzimba wakho wonke ubuhlungu.
• Amabala abomvu noma amabala esikhumbeni: Amabala abomvu noma amabala avela esikhumbeni.
• Ukukhwehlela.
• Amaqhubu nezilonda: Amaqhubu nezilonda kungenzeka hhayi esikhumbeni kuphela, kodwa futhi nasezingxeni zolwelwesi ezindaweni ezifana nomlomo, umphimbo, amehlo, izitho zangasese kanye ne-rectum. Cabanga nje, izilonda emlonyeni zenza kube nzima hhayi ukudla kuphela kodwa nokukhuluma.
• Ukuxebuka kwesikhumba: Isikhumba siyaxebuka emaqakaleni.
• Ukuvuza amathe: Ngenxa yezilonda emlonyeni, amathe ayaphuma uma ungakwazi ukuvala umlomo wakho.
• Ukuvuvukala kwamehlo: Amaqhubu nokuvuvukala kwamehlo kubangela ukuthi amehlo avuvuke kakhulu kangangokuthi awakwazi ukuvulwa.
• Ubuhlungu ngesikhathi sokuchama: Amaqhubu olwelwesini lwamafinyila abangela ubuhlungu obukhulu ngesikhathi sokuchama.

Cabanga ukuthi uqale umuthi omusha, bese kuthi phakathi nezinsuku ezimbalwa uzizwe ungaphilile, ube nomkhuhlane, nezinhlungu, bese kuthi ngokuzumayo kuvele amabala abomvu esikhumbeni sakho bese kuvela amabhamuza... Yilapho-ke okufanele uqale khona ukusola ukuthi lokhu kuyi-SJS.

Yini ebangela i-SJS?

Kunezimbangela eziningana eziyinhloko ze-SJS:

• Ukusabela kokungezwani komzimba nomuthi: Lena yimbangela eyinhloko yezifo eziningi ze-SJS kanye nazo zonke izimo ze-TEN. Lokhu kungenzeka uma uphuthelwa umthamo womuthi owuthathayo.
• Ukutheleleka: Isibonelo, ukutheleleka okufana ne-Mycoplasma pneumonia, i-Herpes virus, kanye ne-Hepatitis A.
• Isifo se-graft-versus-host: Lesi yisimo esingaba khona, ikakhulukazi ngemva kokufakelwa umnkantsha.
• Akukho sizathu esitholiwe: Ngezinye izikhathi i-SJS ingavela ngaphandle kwesizathu esisobala.

Uma une-SJS ngenxa yomuthi, izimpawu zivame ukuqala ukubonakala zingakapheli isonto elilodwa, amabili, noma amathathu uqale umuthi. Ungase uqale ngomkhuhlane, ukukhwehlela, kanye nekhanda elibuhlungu, kulandelwe ukuqubuka kwesikhumba kanye nokuqhekeka. Kwabanye abantu abane-TEN, izinwele nezinzipho zingase ziphume. Akuvamile kakhulu, i-SJS ibikwe ukuthi ibangelwa ukugonywa muva nje.

Yimiphi imithi evame ukubangela i-SJS?

Kunemithi ethile enengozi enkulu yokubangela i-SJS. Lokhu kufaka phakathi:

• Imithi ye-sulfa elwa namagciwane.
• Imithi yokulwa nesifo sokuwa: Izibonelo zifaka phakathi iPhenytoin (Dilantin®), iCarbamazepine (Tegretol®), iLamotrigine (Lamictal®), kanye nePhenobarbital (Luminal®).
• `(I-Allopurinol (I-Aloprim®, I-Zyloprim®))`: Lona umuthi osetshenziselwa i-gout namatshe ezinso.
• Imithi engeyona i-steroidal elwa nokuvuvukala (ama-NSAID): Izibonelo zifaka phakathi i-Piroxicam (i-Feldene®), i-Nevirapine (i-Viramune®), kanye ne-Diclofenac (i-Cambia®, i-Flector®).
• Amanye ama-antibiotic.

Okubalulekile: Lokhu akusho ukuthi wonke umuntu othatha le mithi uzoba ne-SJS. Kodwa-ke, le mithi itholakale ihlotshaniswa nengozi eyengeziwe yokuthola i-SJS.

Ingabe zikhona ezinye izinto ezandisa ingozi yokuthola i-SJS?

Yebo, kunezinye izimo ezandisa ingozi yokuthola i-SJS. Lezi yizi:

• Njengoba ngifakelwe umnkantsha.
• Ukuba nezifo zokuzivikela komzimba ezifana ne-`(Systemic lupus erythematosus - SLE)`.
• Ukutheleleka ngegciwane le-HIV (i-Human immunodeficiency virus).
• Ezinye izifo ezingamahlalakhona zamalunga nezicubu ezixhumeneyo.
• Umdlavuza.
• Ukuba nesimiso somzimba esibuthakathaka.
• Uma othile emndenini wakho esevele enesifo i-SJS (umlando womndeni).
• Ukuba nohlobo oluthile lwesakhi sofuzo esibizwa ngokuthi ``Human Leukocyte Antigen-B - HLA-B''.

Odokotela bakuthola kanjani lesi simo se-SJS?

Odokotela baxilonga i-SJS ne-TEN ngokucabangela lezi zici:

• Ukuhlolwa kwesikhumba esithintekile kanye nolwelwesi lwamafinyila: Ngokuvamile kuthinteka okungenani ulwelwesi lwamafinyila olubili.
• Kuye ngezinga lobuhlungu obuzwayo.
• Kuye ngokuthi isikhumba sakho sithinteke ngokushesha kangakanani.
• Kuye ngokuthi isikhumba sakho sithinteke kangakanani.
• I-biopsy yesikhumba: Ngezinye izikhathi, kuthathwa isampula encane yesikhumba bese ihlolwa ngaphansi kwe-microscope ukuqinisekisa ukuxilongwa.

Iphathwa kanjani i-SJS?

I-SJS yisimo esidinga ukulaliswa esibhedlela ngokushesha kanye nokwelashwa. Ukuzama ukuyelapha ekhaya kungenza isimo sibe sibi kakhulu. Nazi ezinye zezindlela zokwelapha:

• Yeka ngokushesha umuthi okucatshangwa ukuthi ubangela inkinga: Lena yinto yokuqala okufanele uyenze.
• Uketshezi olufakwa emthanjeni (IV) ukuze kubuyiselwe ama-electrolyte: Lokhu kwenzelwa ukulawula ukulahleka koketshezi emzimbeni njengoba isikhumba siqala ukuxebuka.
• Ukufaka amabhandeshi anganamatheli esikhumbeni esithintekile.
• Ukunikeza ukudla okunama-calorie amaningi ukuze kusheshiswe ukululama: Ngezinye izikhathi, kungadingeka ukuncelisa ngethubhu.
• Ukunikeza ama-antibiotic uma kudingeka ukuvimbela ukutheleleka.
• Ukunikeza imithi yokwelapha izinhlungu.
• Ukwelashwa esibhedlela, mhlawumbe eYunithi Yokunakekela Abagula Kakhulu (ICU) noma eYunithi Yokushisa.
• Ukufuna usizo emaqenjini ochwepheshe njenge-Dermatology kanye ne-Ophthalmology (uma amehlo ethintekile).
• Kwezinye izimo, ukwelashwa okuqondile okufana ne-IV immunoglobulin, i-cyclosporine, i-IV steroids, noma i-amniotic membrane grafts (yamehlo) kunganikezwa.

Yiziphi izinkinga ezingaba khona ze-SJS?

Ngenxa yokuthi i-SJS ne-TEN ziyizimo ezibucayi, izinkinga zingaba zimbi kakhulu.

• Ukufa: Lena yinkinga enkulu kakhulu. Cishe u-10% weziguli ezine-SJS kanye no-50% weziguli ezine-TEN bangafa.
• Inyumoniya.
• I-Sepsis: Lokhu ukutheleleka okubangelwa amagciwane okukhulu, okufana noshevu wegazi.
• Isimo sokushaqeka `(Ukushaqeka)`.
• Ukwehluleka kwezitho eziningi.

Kungenxa yalezi zinkinga ezinkulu ukuthi izimo ze-SJS/TEN zidinga ukulaliswa esibhedlela ngokushesha.

Ingabe i-SJS ingavinjelwa?

Eqinisweni, ezimweni eziningi, i-SJS ayinakuvinjelwa. Ngenxa yokuthi ivame ukubangelwa ukusabela okungalindelekile emuthini, ayikho indlela yokwazi ukuthi lokhu kuzokwenzeka yini ngaphambi kokuthatha umuthi.

Kodwa-ke, uma kutholakala ukuthi unesifo esibangelwa izidakamizwa, into ebaluleke kakhulu ukuthi ungaphinde usebenzise lowo muthi noma uhlobo olufanayo lwezidakamizwa. Kubaluleke kakhulu ukwazisa udokotela wakho ngalokhu nokukubhala phansi kumarekhodi akho ezokwelapha.

Uyini umbono womuntu one-SJS? (I-Outlook)

Akuwona wonke umuntu one-SJS obhekana nezimpawu ezifanayo. Abanye abantu bayalulama phakathi namasonto ambalwa. Kodwa-ke, uma izimpawu zinzima, kungathatha izinyanga ukululama ngokuphelele. Abanye abantu bangase babe nemiphumela yesikhathi eside. Isibonelo:

• Isikhumba: Isikhumba esomile, ukulunywa, ukushintsha kombala wesikhumba.
• Amehlo: Ukuvuvukala njalo kanye/noma ukoma, ukuvuvukala njalo kwamehlo, ukubona okufiphele, ukuzwela ukukhanya (i-photophobia).
• Ukujuluka ngokweqile.
• Ukulimala kwamaphaphu: Izimo ezifana nesifo samaphaphu esingamahlalakhona (COPD), i-asthma.
• Izinzipho ziyawa noma ziyaguquguquka.
• Ukulahlekelwa izinwele (i-Alopecia).
• Ukoma kolwelwesi lwamafinyila: Lokhu kungabangela izinto ezifana nobunzima bokuchama.
• Isifo sokukhathala okungapheli.
• Izinguquko ekunambithekeni.

Okubalulekile, lesi sifo singaphinde sibuye uma umuntu ephinde wachayeka emuthini owabangela i-SJS kwasekuqaleni. Uma lokho kwenzeka, izimpawu zivame ukuba zimbi kakhulu okwesibili.

Cishe iziguli eziyi-10% ze-SJS kanye neziguli ezingama-30% ze-TEN ziyafa, ikakhulukazi ngenxa ye-sepsis, i-acute respiratory distress syndrome (ARDS), kanye nokwehluleka kwezitho eziningi.

Nazi ezinye izinto okufanele uzikhumbule kulokho esikhulume ngakho (Umyalezo Wokuya Ekhaya):

Kulungile, ngakho-ke sesikhulume kakhulu ngalesi simo esiyingozi esibizwa ngokuthi i-SJS. Nazi ezinye izinto okudingeka uzikhumbule:

• I-Stevens-Johnson Syndrome (SJS) kanye ne-Toxic Epidermal Necrolysis (TEN) ziyizimo zesikhumba eziyingozi kakhulu, ngisho nezisongela ukuphila.
• Uma uba nezimpawu ezifana nobuhlungu besikhumba, amabala abomvu, amabhamuza, isikhumba esixebukayo, noma izilonda zomlomo noma zamehlo ngemva kokuqala umuthi omusha, ikakhulukazi phakathi nesonto noma amabili, funa iseluleko sezokwelapha ngokushesha. Kungaba yi-SJS.
• Tshela udokotela wakho njalo uma uke waba nokungezwani komzimba noma ukusabela okubi kakhulu ngemithi ngaphambili.
• Ungalokothi usebenzise umuthi noma imithi efanayo etholakale ibangela i-SJS futhi.**
• Uma usola lesi simo, ungahlali ekhaya, hamba uye esibhedlela ngokushesha. Ukwelashwa okusheshayo kungasindisa impilo yakho.

Ngiyethemba ukuthi lolu lwazi luwusizo kuwe. Hlala uphilile!

Isifo sikaStevens -Johnson, i-SJS, i-Toxic Epidermal Necrolysis, i-TEN, Izifo zesikhumba, Ukungezwani komzimba, Imiphumela emibi yemithi, Ama-blisters, Ukuqubuka kwesikhumba, Izifo zesikhumba