Yini i-Toxic Epidermal Necrolysis (TEN)?

-Delile

• Izimbangela
• Imithi
• Izifo
• Izimpawu
• Izibonelo ezibonakalayo
• Ukuxhuma ne-Stevens-Johnson syndrome
• Izici zobungozi
• Ukuxilongwa
• Ukwelashwa
• Umbono
• Ukudla okudlela endlini

I-epidermal necrolysis enobuthi (TEN) yisimo sesikhumba esingandile futhi esibi. Imvamisa, kubangelwa ukusabela okungafanele emithini efana nama-anticonvulsants noma ama-antibiotics.

Uphawu oluyinhloko ukuxebuka okukhulu kwesikhumba nokuxebuka. Ukukhula kuqhubeka ngokushesha, kuphumele ezindaweni ezinkulu ezingavuthiwe ezingakhala noma zikhale. Iphinde ithinte nolwelwesi lwamafinyila, kufaka phakathi umlomo, umphimbo, amehlo, nesifunda sangasese.

Njengoba i-TEN ikhula ngokushesha, kubalulekile ukuthola usizo ngokushesha okukhulu. I-TEN yisimo esiphuthumayo esisongela impilo esidinga ukwelashwa ngokushesha.

Funda ukuze uhlole izimbangela nezimpawu ze-TEN, kanye nokuthi iphathwa kanjani.

Izimbangela

Ngoba i-TEN ayivelakancane, ayiqondakali ngokuphelele. Ngokuvamile kubangelwa ukusabela okungavamile emithini. Kwesinye isikhathi, kunzima ukukhomba imbangela eyisisekelo ye-TEN.

Imithi

Isizathu esivame kakhulu se-TEN ukusabela okungajwayelekile emithini. Kuyaziwa nangokuthi uhlobo oluyingozi lokuqubuka kwezidakamizwa, futhi lubhekene namaphesenti angama-95 wamacala we-TEN.

Imvamisa, isimo sakha ngaphakathi kwamasonto ayisishiyagalombili okuqala wokuthatha lesi sidakamizwa.

Imithi elandelayo ijwayele ukuhlotshaniswa ne-TEN:

• ama-anticonvulsants
• ama-oxicams (izidakamizwa ezingezona ukuvuvukala)
• ama-antibiotic e-sulfonamide
• i-allopurinol (ye-gout nokuvimbela amatshe ezinso)
• i-nevirapine (umuthi olwa ne-HIV)

Izifo

Ezimweni ezingavamile kakhulu, ukugula okufana ne-TEN kuxhumene nokutheleleka ngegciwane elaziwa njenge I-Mycoplasma pneumoniae, okubangela ukutheleleka okuphefumula.

Izimpawu

Izimpawu ze-TEN zihlukile kumuntu ngamunye. Ezigabeni zokuqala, kuvame ukudala izimpawu ezifana nomkhuhlane. Lokhu kungafaka:

• imfiva
• Ubuhlungu bomzimba
• amehlo abomvu, ahlabayo
• ubunzima bokugwinya
• ikhala eligijimayo
• ukukhwehlela
• Umphimbo obuhlungu

Ngemuva kwezinsuku ezi-1 kuya kwezingu-3, ​​isikhumba siyaxebuka noma ngaphandle kokushaya. Lezi zimpawu zingathuthuka kungakapheli amahora amaningi noma izinsuku.

Ezinye izimpawu zifaka:

• amabala abomvu, abomvana, noma ansomi
• isikhumba esibuhlungu
• izindawo ezinkulu, eziluhlaza zesikhumba (ukuguguleka)
• izimpawu zisakazeka emehlweni, emlonyeni nasezitho zangasese

Izibonelo ezibonakalayo

Uphawu oluyinhloko lwe-TEN ukuxebuka okubuhlungu kwesikhumba. Njengoba isimo siqhubeka, ukuxebuka kusakazeka ngokushesha emzimbeni wonke.

Ngezansi kunezibonelo ezibonakalayo ze-TEN.

Ukuxhuma ne-Stevens-Johnson syndrome

I-Stevens-Johnson syndrome (i-SJS), njenge-TEN, yisimo esibi sesikhumba esibangelwa umuthi noma, kuyaqabukela, sihambisana nokutheleleka. Lezi zimo zombili zisezingeni elifanayo lesifo futhi ziyehluka ngokuya ngesikhumba esithintekayo.

I-SJS ayinzima kangako. Isibonelo, ku-SJS, ngaphansi kwamaphesenti ayishumi omzimba kuthinteka ukuxebuka kwesikhumba. Ku-TEN, amaphesenti angaphezu kwama-30 athintekile.

Kodwa-ke, i-SJS isesimweni esibucayi. Kudinga nokunakekelwa kwezimo eziphuthumayo ngokushesha.

I-SJS ne-TEN zivame ukuhlangana, ngakho-ke izimo kwesinye isikhathi kuthiwa yiStevens-Johnson syndrome / i-toxic epidermal necrolysis, noma i-SJS / TEN.

Izici zobungozi

Yize noma ngubani ophuza umuthi angahlakulela i-TEN, abanye abantu basengozini enkulu.

Izici ezingaba yingozi zifaka:

• Ukuguga. I-TEN ingathinta abantu bayo yonke iminyaka, kodwa kungenzeka ukuthi ithinte abantu abadala asebekhulile.
• Ubulili. Abesifazane bangaba nengozi ephezulu ye-TEN.
• Amasosha omzimba abuthakathaka. Abantu abanamasosha omzimba abuthakathaka amathuba okuthi bahlakulele i-TEN. Lokhu kungenzeka ngenxa yezimo ezinjengomdlavuza noma i-HIV.
• Ingculaza. I-SJS ne-TEN zivame kakhulu izikhathi ezingama-1 000 kubantu abane-AIDS.
• Izakhi zofuzo. Ingozi iphezulu uma une-HLA-B * 1502 allele, evame kakhulu kubantu baseNingizimu-mpumalanga ye-Asia, amaShayina, kanye nozalo lwamaNdiya. Isakhi sofuzo singandisa ingozi yakho ye-TEN lapho usebenzisa umuthi othile.
• Umlando womndeni. Ungahle ube namathuba okuthuthukisa i-TEN uma isihlobo esiseduze sibe nalesi simo.
• Ukusabela kwezidakamizwa ezedlule. Uma usuhlakulele i-TEN ngemuva kokuthatha umuthi othile, unengozi eyengeziwe uma uphuza umuthi ofanayo.

Ukuxilongwa

Udokotela uzosebenzisa izivivinyo ezahlukahlukene ukuthola izimpawu zakho. Lokhu kungafaka:

• Ukuhlolwa ngokomzimba. Ngesikhathi sokuhlolwa komzimba, udokotela uzohlola isikhumba sakho ukuthi siyaxebuka, ukuthamba, ukuzibandakanya kwe-mucosal, kanye nokutheleleka.
• Umlando wezokwelapha. Ukuqonda impilo yakho yonke, udokotela uzokubuza ngomlando wakho wezokwelapha. Bazophinde bafune ukwazi ukuthi imiphi imishanguzo oyiphuzayo, kufaka phakathi noma imiphi imithi emisha ethathwe ezinyangeni ezimbili ezedlule, kanye nanoma yikuphi ukungezwani komzimba onakho.
• Isikhumba biopsy. Ngesikhathi sokuhlolwa kwesikhumba, isiqeshana sesampula sezicubu zesikhumba esithintekile siyasuswa emzimbeni wakho bese sithunyelwa elebhu. Uchwepheshe uzosebenzisa isibonakhulu ukuhlola izicubu bese ebheka izimpawu ze-TEN.
• Ukuhlolwa kwegazi. Ukuhlolwa kwegazi kungasiza ekuboneni izimpawu zokutheleleka noma ezinye izinkinga ngezitho zangaphakathi.
• Amasiko. Udokotela futhi angafuna ukutheleleka ngoku-oda isiko legazi noma lesikhumba.

Ngenkathi udokotela ngokuvamile ekwazi ukuxilonga i-TEN ngokuhlolwa komzimba kuphela, i-biopsy yesikhumba ivame ukwenziwa ukuqinisekisa ukuxilongwa.

Ukwelashwa

Kuzo zonke izimo, ukwelashwa kufaka ukuyeka isidakamizwa esidale ukusabela kwakho.

Ezinye izinhlobo zokwelashwa zixhomeke ezicini eziningana, njenge:

• iminyaka yakho
• umlando wakho jikelele wezempilo nowezokwelapha
• ubunzima besimo sakho
• izindawo zomzimba ezithintekile
• ukubekezelela kwakho izinqubo ezithile

Ukwelashwa kuzobandakanya:

• Ukulaliswa esibhedlela. Wonke umuntu one-TEN udinga ukunakekelwa kuphiko lokusha.
• Amafutha namabhandeshi. Ukunakekelwa okuyisilonda okufanele kuzovimbela ukuqhubeka kokulimala kwesikhumba futhi kuvikele isikhumba esiluhlaza ekulahlekelweni uketshezi nasekuthelelekeni. Ukuvikela isikhumba sakho, iqembu lakho lasesibhedlela lizosebenzisa amafutha okugcoba ngezihloko nokugqokwa kwamanxeba.
• Intravenous (IV) uketshezi nama-electrolyte. Ukulahleka okukhulu kwesikhumba okushisayo, ikakhulukazi ku-TEN, kuholela ekulahlekelweni uketshezi nokungalingani kwe-electrolyte. Uzonikezwa i-IV fluid nama-electrolyte ukunciphisa ubungozi. Ithimba lakho lasesibhedlela lizobheka ngokucophelela ama-electrolyte akho, isimo sezitho zakho zangaphakathi, kanye nesimo sakho soketshezi jikelele.
• Ukuzihlukanisa. Njengoba ukulimala kwesikhumba kwe-TEN kwandisa ubungozi bokutheleleka, uzohlukaniswa nabanye kanye nemithombo engaba khona yokutheleleka.

Imithi esetshenziselwa ukwelapha i-TEN ifaka:

• Imithi elwa namagciwane. Cishe wonke umuntu one-TEN unikezwa ama-antibiotic ukuvimbela noma ukwelapha noma yikuphi ukutheleleka.
• I-immunoglobulin G (IVIG) efakwa ngaphakathi. Ama-immuneoglobulin ama-antibody asiza amasosha akho omzimba. I-IVIG kwesinye isikhathi isetshenziselwa ukulawula ukusabela. Lokhu ukusetshenziswa okungekho kwelebula kwe-IVIG.
• I-TNF alpha inhibitor etanercept ne-immunosuppressant cyclosporine. Lezi yimithi ethembisayo evame ukunconywa ngochwepheshe ekwelapheni i-TEN. Lokhu ukusetshenziswa okungekho kwelebula kwemithi yomibili.

Izitho zomzimba ezithile zingadinga ukwelashwa okuhlukile. Isibonelo, uma umlomo wakho uthintekile, i-mouthwash ethile kadokotela ingasetshenziswa ngaphezu kwezinye izindlela zokwelapha.

Ithimba lakho lasesibhedlela lizophinda liqaphe ngeso lokhozi amehlo akho nezitho zangasese ukuze uthole izimpawu. Uma bethola noma yiziphi izimpawu, bazosebenzisa izindlela ezithile zokwelapha ukuvimbela izinkinga, njengokulahleka kombono kanye nokusikeka.

Njengamanje, ayikho indlela ejwayelekile yokwelashwa ye-TEN. Ukwelashwa kungahlukahluka kuye ngesibhedlela. Isibonelo, ezinye izibhedlela zingasebenzisa i-IVIG, kanti ezinye zingasebenzisa inhlanganisela ye-etanercept ne-cyclosporine.

I-Etanercept ne-cyclosporine okwamanje azivunyelwe yi-Food and Drug Administration (FDA) ukwelapha i-TEN. Noma kunjalo, zingasetshenziswa ngaphandle kwelebula ngale njongo. Ukusetshenziswa kwelebuli engaphandle kwelebula kusho ukuthi udokotela wakho angakunikeza umuthi ngesimo esingavunyelwe uma becabanga ukuthi ungazuza kulo muthi. Funda kabanzi ngokusetshenziswa kwezidakamizwa ezingekho kwelebula.

Umbono

Izinga lokufa kwe-TEN cishe lilinganiselwa kumaphesenti angama-30, kepha lingaphezulu kakhulu. Kodwa-ke, kunezici eziningi ezithinta umbono wakho ngamunye, kufaka phakathi:

• ubudala
• impilo yonke
• ubunzima besimo sakho, kufaka phakathi indawo yomzimba ethintekayo
• inkambo yokwelashwa

Ngokuvamile, ukululama kungathatha amasonto amathathu kuye kwayisithupha. Imiphumela engaba khona yesikhathi eside ifaka:

• ukuguqulwa kwesikhumba
• izibazi
• isikhumba esomile nolwelwesi lwamafinyila
• ukulahleka kwezinwele
• inkinga yokuchama
• ukunambitheka okhubazekile
• ukukhubazeka kwezitho zobulili
• izinguquko zombono, kufaka phakathi ukulahleka

Ukudla okudlela endlini

I-epidermal necrolysis enobuthi (TEN) iyisimo esiphuthumayo esibi kakhulu. Njengesimo esisongela impilo sesikhumba, singasheshe siholele ekuphelelweni amanzi emzimbeni nasekutheleleni. Thola usizo lwezokwelapha ngokushesha uma wena noma umuntu omaziyo enezimpawu ze-TEN.

Ukwelashwa kufaka phakathi ukungeniswa esibhedlela nokungeniswa egumbini lokusha. Ithimba lakho lesibhedlela lizobeka phambili ukunakekelwa kwesilonda, ukwelashwa oketshezi nokuphathwa kobuhlungu. Kungathatha amasonto afinyelela kwayisithupha ukuba ngcono, kepha ukwelashwa kusenesikhathi kuzothuthukisa ukululama nokubukeka kwakho.