Steven johnson syndrome induce by carbamazepine in epileptic patient: a case report

Introduction: Steven Johnson Syndrome (SJS) is life-threatening skin reaction, it is a mucocutaneous disorder induced by immune complex-mediated hypersensitivity reaction. Most frequent offending agents are antibiotic, antiretroviral and aromatic anticonvulsants. Problems arise when these drugs are required for long-term use and necessary for several health conditions. These case series aim to describe SJS and provide replacement therapy especially inpatient with epilepsy.

Case report: A 37 years old female was consulted from neurology department with chief complaints an erythematous rash on her chest, back upper and lower extremities accompanied with fever, the patient also complaint erosions on her lips. She had history of seizure and was prescribe Carbamazepine. Carbamazepine was replaced and patient treated with dexamethasone intravenously. After 1 week of admitted there is an improvement.

Conclusion: Steven Johnson Syndrome (SJS) is a life-threatening disease, the replacement of the suspected drugs and appropriate therapy can improve the prognosis of patient.

High plasma H2O2 level and low plasma catalase level as risk factors for acne vulgaris

Background: In this recent time, ROS and oxidative stress have been said to play an important role in the pathogenesis of inflamed acne lesions. One example of ROS produced by neutrophil through phagocytosis is H₂O₂. Nevertheless, there is an enzymatic antioxidant which catalyses H₂O₂ called catalase. Imbalance of free radicals and antioxidants due to excessive ROS formation promotes the state of oxidative stress and inflammation of the acne lesion.

Objective: This study aimed to determine plasma H₂O₂ and catalase level as a risk factor for acne.

Methods: This matched-pair case-control observational analytic study involving 38 patients with acne and 38 patients without acne. Sampling was done using consecutive sampling which fulfils the inclusion and exclusion criteria and followed by matching with age and gender. H₂O₂ and catalase level measured on both groups. The analysis was done using SPSS.

Results: H₂O₂ mean level in the case and control group, respectively 0.68 ± 0.03 and 0.42 ± 0.04 µmol/ml. High H₂O₂ level was determined from cut-off point >0.62 µmol/ml. High H₂O₂ was a statistically significant risk factor for acne vulgaris (p<0.001; 95% CI: 4.59-40.62; OR: 13.67). The mean level of catalase in the case and control group respectively 0.48 ± 0.06 and 0.74 ± 0.07 U/ml. Low catalase level was determined from the cut-off point <0.58 U/ml. Catalase was significant risk factor for acne vulgaris (p<0.001; 95% CI: 5.18-77.21; OR: 20.00).

Conclusion: High levels of H₂O₂ plasma and low levels of catalase plasma is a risk factor of acne vulgaris.

Positive correlation of psoriasis vulgaris severity and HOMA-IR

Background: Psoriasis vulgaris is a chronic inflammatory skin disease that its aetiology is still not completely known. A chronic inflammation in psoriasis can cause organ dysfunctions. Elevation of proinflammatory cytokines gives rise to insulin resistance by inhibiting insulin and glucose transport mechanism signals. Insulin resistance is the underlying pathogenesis of metabolic syndrome.

Objective: This study aimed to undestand any correlation in the severity of psoriasis vulgaris with HOMA-IR.

Methods: A cross sectional research involving 35 subjects with psoriasis vulgaris and 15 subjects without who met the selection criteria. HOMA-IR is a formula used to measure insulin resistance which calculates the fasting insulin value in μU/ml x fasting glucose in mg/DL/405 taken from the blood veins of subjects. PASI score was used to determine psoriasis vulgaris severity.

Results: This study shows that the HOMA-IR median value was higher in psoriasis subject than the subjects without psoriasis (p<0.05). The correlaton analysis shows a moderate positive correlation between psoriasis vulgaris severity and HOMA-IR (r= 0.427; p<0.05). The prevalence ratio was 8.57, which means psoriasis vulgaris subjects were 8.57 times more likely to have HOMA-IR compared to those without psoriasis vulgaris (p<0.05; 95%CI: 1.26-58.1).

Conclusion: This study concludes that there is a moderate positive correlation between severity of psoriasis vulgaris and HOMA-IR values.