Zicabange usanda kuqala ukuthatha umuthi omusha wesifo esithile. Ngemva kwesonto elilodwa noma amabili, uzizwa ungaphilile, sengathi usuzobanjwa umkhuhlane. Umzimba wakho uyaqaqamba, uzizwa ushisa, uyathuthumela... Bese kuthi ngokuzumayo, umzimba wakho uqale ukuvela amabala abomvu aphenduka kancane kancane abe amabhamuza amanzi, bese isikhumba sakho siqala ukuxebuka sengathi ushile. Lesi yisimo esesabekayo kakhulu, esibuhlungu, futhi esingasongela impilo. Namuhla sikhuluma ngalesi simo esiyingozi, okuyi -Toxic Epidermal Necrolysis (TEN) .
Kalula nje, iyini i-Toxic Epidermal Necrolysis (TEN)?
I-Toxic Epidermal Necrolysis, noma i-TEN ngamafuphi, iyisimo sesikhumba esibuhlungu kakhulu futhi esingasongela impilo. Sibangela ukuqhekeka nokuqhekeka kwezindawo ezinkulu zomzimba wakho, ngokuvamile okungenani ama-30% omzimba wakho. Lokhu kuqhekeka kungenzeka nasezindaweni ezinezimbotshana, njengomlomo, amehlo, kanye nezitho zangasese.
Lesi simo esiyingozi sivame ukwenzeka njengokusabela okukhulu kwemithi ethile esiyithathayo. Uma isikhumba sonakele kakhulu, kuba nengozi enkulu yokuphelelwa amanzi emzimbeni kanye nokutheleleka okukhulu.
Uma sikhuluma iqiniso, i-TEN uhlobo olubi kakhulu lwesinye isimo sesikhumba esibizwa ngokuthi i-Stevens-Johnson syndrome (SJS). Ku-SJS, isikhumba somzimba esingaphansi kuka-10% siyaphela. Uma umzimba u-10% kuya ku-30% uthintekile, sikubiza ngokuthi isimo sokugudlana kwe-SJS-TEN. Uma isikhumba esingaphezu kuka-30% siphela, kubhekwa njenge-TEN.
Ubani osengozini enkulu yokuthola lesi simo?
Abantu abanezinhlelo zokuzivikela ezibuthakathaka banamathuba amaningi okuthola i-Stevens-Johnson syndrome (SJS) noma i-TEN. Kunezizathu eziningana zokuthi kungani isimiso sokuzivikela somzimba singase sibe buthaka.
- Abantu abangenwe yigciwane lesandulela ngculaza (i-HIV).
- Abantu abanomdlavuza othile, njenge-lymphoma.
Ngaphezu kwalokho, izici zofuzo nazo zingadlala indima. Imizimba yabanye abantu ayikwazi ukuwohloka nokugaya imithi ethile ngendlela evamile. Lokhu kuyinto evela ezizakhini zabo zofuzo. Ezimweni ezinjalo, leyo mithi ingaqongelela emzimbeni futhi ibangele ukusabela okunzima njenge-SJS noma i-TEN. Futhi, ngenxa yezinguquko (ukuguqulwa kwezakhi zofuzo) kwezinye izakhi zofuzo, abanye abantu bangase babe namathuba amaningi okusabela emithini ethile.
Nakuba i-TEN ingenzeka kunoma yimuphi ubudala, ivame kakhulu kubantu abadala. Kodwa-ke, iyisimo esingavamile kakhulu .Kubalulekile ukukhumbula ukuthi emhlabeni jikelele, i-SJS ne-TEN zihlangene zithinta abantu ababalelwa esigidini esisodwa noma ezimbili ngonyaka.
Yiziphi izimbangela eziyinhloko ze-TEN?
Ezimweni eziningi, odokotela bakholelwa ukuthi imithi ethile iyimbangela eyinhloko ye-TEN. Ake sibheke ukuthi yimiphi imithi esengozini enkulu.
| Isigaba sezidakamizwa | Incazelo elula |
|---|---|
| I-Allopurinol | Umuthi osetshenziselwa ukwelapha izifo ezifana namatshe ezinso kanye ne-gout. |
| Imithi Yokuquleka | Uhlobo lwemithi olunikezwa ukulawula izimo ezifana nokuquleka. |
| Imithi yokulwa negciwane lengculazi | Ikakhulukazi imithi esetshenziswa ukwelapha ukutheleleka nge-HIV (isib. i-nevirapine). |
| Ama-Oxicam | Lezi yizinhlobo zemithi yokwelapha izinhlungu kanye nemithi yokulwa nokuvuvukala eyingxenye yeqembu lama-NSAID. |
| Ama-Sulfonamides | Lezi uhlobo lomuthi wama-antibiotic. |
Ngaphezu kwale mithi, akuvamile kakhulu ukuthi izifo ezithile noma imijovo ingabangela i-TEN. Kodwa lokhu akuvamile kakhulu. Ngezinye izikhathi, imbangela ye-TEN ayitholakali.
Ziyini izimpawu ze-TEN?
Izimpawu eziyishumi zivame ukuqala ukuvela zingakapheli amasonto ambalwa kusukela kuqalwe umuthi omusha. Ziqala ngezimpawu ezifana nomkhuhlane.
- Ubuhlungu bomzimba
- Ukukhwehlela
- Umkhuhlane kanye nokubanda
- Ikhanda elibuhlungu
- Ukubomvu kwamehlo nokuvuvukala
Ngemva kwalezi zimpawu zokuqala, amabala abomvu abuhlungu (amaqhubu) aqala ukuvela esikhumbeni. Lawa mabala akhula kancane kancane, aphenduke amabhamuza agcwele amanzi, futhi ekugcineni isikhumba siqala ukuqhekeka. Amanxeba akheka lapho isikhumba siqhekeka abizwa ngokuthi ama-erosions . Lawa amanxeba abuhlungu kakhulu, avulekile abukeka njengokusha okukhulu.
Lezi zilonda ziqala ukubonakala ebusweni nasesifubeni, bese zisakazekela kwezinye izingxenye zomzimba.
- Amehlo: Ingaphakathi leso (i-conjunctiva) kanye nengxenye engaphandle yeso elimnyama (i-cornea) kungalimala.
- Ulwelwesi lwamafinyila: Izilonda zingavela emlonyeni, ekhaleni, emphinjeni, nasendleleni yokuphefumula.
- Izindawo zomchamo, indunu, kanye nezitho zangasese: Lezi zindawo zingalimala kakhulu.
Lokhu kulimala kwenza ngisho nemisebenzi elula njengokudla, ukugwinya, ukuphefumula, ukuvala amehlo akho, nokuchama kube buhlungu kakhulu futhi kube nzima.
Izinkinga ezinkulu ezingase zenzeke ngenxa ye-TEN
I-TEN akuyona into okufanele ithathwe kalula. Ingabangela izinkinga ezinkulu nezisongela ukuphila.
- Ukutheleleka: Uma isikhumba siphuka, kunethuba elikhulu lokuthi amagciwane angene emzimbeni. Uma la magciwane engena egazini, kungavela isimo esiyingozi kakhulu esibizwa ngokuthi i-sepsis .
- Ukwehluleka kwezitho eziningi: Ukuvuvukala okukhulu kanye nokutheleleka emzimbeni kungabangela ukuthi izitho zangaphakathi njengezinso, isibindi namaphaphu zingasebenzi.
- I-pneumonia: Kukhona ingozi eyengeziwe yokutheleleka kwamaphaphu ngenxa yokulimala kwendlela yokuphefumula.
Ngenxa yokuthi kungenzeka kube nezinkinga ezinkulu kangaka, umuntu onezimpawu ze-TEN kufanele alaliswe esibhedlela futhi elashwe ngokushesha .
Odokotela basithola kanjani lesi sifo?
Udokotela oqeqeshiwe ngokuvamile angaxilonga i-TEN ngokuhlola isikhumba sakho nokubuza ngezimpawu zakho. Ngezinye izikhathi, kungadingeka i-biopsy yesikhumba ukuqinisekisa ukuxilongwa.
Lokhu kuhilela ukuthatha ingxenye encane kakhulu yesikhumba esilondeni sesikhumba ngaphansi kwe-anesthesia bese uyihlola ngaphansi kwe-microscope. Lokhu kuhlola kungabona ngokucacile ukuthi kukhona yini amangqamuzana esikhumba afile (amangqamuzana afile) nokuthi ngabe ungqimba olungaphezulu lwesikhumba (i-epidermis) luhlukene nongqimba olungezansi.
Yiziphi izindlela zokwelapha lokhu?
Okubaluleke kakhulu, i-TEN iyisimo esiphuthumayo sezokwelapha.Lesi akusona isifo esingelashwa ekhaya. Kufanele uye e-Emergency Treatment Unit (ETU) yesibhedlela ngokushesha nje lapho izimpawu ziqala.
Esibhedlela, isiguli sivame ukungeniswa egunjini lokunakekelwa okujulile (ICU) noma esikhungweni sokusha, njengoba lezi ziguli zidinga ukunakekelwa okukhethekile okufana nokunikezwa isiguli esishile.
Izindlela zokwelapha zingahlukaniswa zibe izingxenye ezimbili eziyinhloko.
| Izinketho zokwelapha ze-TEN | |
|---|---|
| Ukwelashwa okusheshayo | |
| Ukuyeka umuthi obangela | Yonke imithi okusolwa ukuthi ibangela i-TEN iyayekwa ngokushesha. |
| Ukulawulwa kwamazinga oketshezi lomzimba | Ukuxebuka kwesikhumba kubangela ukuthi kukhishwe inani elikhulu loketshezi emzimbeni. Ngakho-ke, usawoti (i-IV fluids) unikezwa ngemithambo ukuze kulawulwe amazinga oketshezi emzimbeni. |
| Ukuvimbela ukutheleleka | Ama-cream noma amafutha okulwa namagciwane asetshenziswa ezilonda ezivulekile. Ama-antibiotic anikezwa lapho kuvela izimpawu zokuqala zokutheleleka. |
| Ezinye izindlela zokwelapha ezithile | |
| I-immune globulin (IVIG) | Lolu uketshezi olunikezwa ngemithambo yegazi. Luqukethe ama-antibodies athathwe egazini labantu abaphilile. Lawa asiza ukulawula impendulo engemihle yomzimba yokuzivikela komzimba. |
| Izithiyo zokucindezela amasosha omzimba | Kunikezwa imithi yokuvimba amasosha omzimba ekuhlaseleni amangqamuzana awo, okwenza kube buthaka ukusebenza kwawo. |
| I-Plasmapheresis | Lokhu kuhilela ukuthumela igazi lesiguli emshinini okhethekile, ukuhlukanisa nokususa ama-antibodies ayingozi ku-plasma yegazi, nokubuyisela igazi elihlanziwe emzimbeni. |
Imiphumela yesikhathi eside ngemva kokululama
Abasindile ku-TEN bangase babe nemiphumela ethile yesikhathi eside. Ngisho noma isikhumba siphola ngokuphelele, kungase kuvele ezinye izinkinga.
- Isikhumba, izinwele nezinzipho: ukukhula noma ukuphuma kwezinzipho okungavamile, amabala esikhumba (amnyama noma amhlophe), ukulahleka kwezinwele kwezinye izindawo (i-alopecia areata), isikhumba esomile nesilumayo, ukujuluka ngokweqile.
- Amehlo: Ukuvuvukala noma ukubomvu kwamehlo isikhathi eside, amehlo omile, ukungajwayelekile kwamehlo, ukuzwela ekukhanyeni, ukubona okufiphele noma, ngokungavamile, ubumpumputhe.
- Umlomo, impumulo kanye nohlelo lokuphefumula: I-Bronchitis, izifo zamaphaphu ezifana ne-COPD, umlomo owomile, isifo sezinsini, ukulahlekelwa ukunambitheka nephunga, umonakalo wamaphaphu.
- Uhlelo lomchamo nokuzala: Ukulimala noma ukuvuvukala komchamo isikhathi eside, isitho sangasese sowesifazane, noma ipenisi, ubunzima bokuchama, ukoma kwesitho sangasese sowesifazane kwabesifazane.
Kubaluleke kakhulu ukukhuluma nodokotela wakho ngale miphumela yesikhathi eside bese ucela ukwelashwa okudingekayo.
Umlayezo Wokuya Nawe Ekhaya
- I-Toxic Epidermal Necrolysis (TEN) iyindlela yokusabela enzima kakhulu, esongela impilo emithini ethile.
- Kuqala ngezimpawu ezivamile njengomkhuhlane kanye nobuhlungu bomzimba, kodwa bese kuqhubekela phambili kube amabhamuza abuhlungu kanye nomuzwa wokushisa obangela ukuba isikhumba siqhekeke.
- Lesi yisimo esiphuthumayo sezokwelapha. Uma uhlangabezana nalezi zimpawu, kufanele uye e-Emergency Treatment Unit (ETU) yesibhedlela ngokushesha.
- Uma uhlaselwa ukuqubuka kwesikhumba, ukuqubuka kwamaqabunga, noma ezinye izimpawu ezingavamile ngemva kokuqala umuthi omusha, ungalokothi uzishaye indiva. Bona udokotela wakho ngokushesha.
- Uma uke waba nokungezwani komzimba nanoma yimuphi umuthi ngaphambilini, qiniseka ukuthi wazisa udokotela wakho ngalokhu noma nini lapho uya khona ukuyofuna umuthi.
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