steven johnson syndrome pictures early stages

Apply vitamin A or other sterile ocular lubricant ointment generously under the upper and the lower eyelid using one quarter of tube for one eye on each occasion. 10 Berberine Side Effects You Should Know. It is observed that the conjunctival scar of patients with moderate ocular surface damage is obvious, and the mechanical damage of trichiasis and palpebral margin to the cornea is inevitable. Treatment focuses on eliminating the underlying cause, controlling symptoms and minimizing complications as your skin regrows. [citation needed] It has also been suggested[by whom?] Epub 2010 Mar 24. [30][36] In general, these associations are restricted to the cited populations. An antigen presenting cell (APC) takes up these alter proteins; digests them into small peptides; places the peptides in a groove on the human leukocyte antigen (i.e. [53], SJS (with less than 10% of body surface area involved) has a mortality rate of around 5%. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The rash appears two to five days after the onset of fever in 80 to 90 percent of patients. In either case, this binding appears to develop only on certain T cell receptors. Why Take Pantoprazole First Thing In The Morning? WebBody aches Cough Inflammation of the mucous membranes Painful red or purple rash Blisters The top layer of skin will begin to die and shed As the disease progresses, the symptoms will worsen and result in the following More blisters and lesions on the mucous membranes of the mouth, nose, eyes, genitals, and urinary or respiratory tracts CD4+ T cells) to initiate autoimmune reactions that attack self tissues. Ask the patient to gargle with the mouthwash. All three are part of a spectrum of severe cutaneous reactions (SCAR) which affect skin and mucous membranes. PMC The prognosis of StevensJohnson syndrome / toxic epidermal necrolysis should be determined during the first 24 hours. Phone: 650-931-2505 | Fax: 650-931-2506 Other agents have been used, including cyclophosphamide and ciclosporin, but none have exhibited much therapeutic success. D. Continuous patches of conjunctival scar, more than 1/2 of the palpebral margin keratosis. In case of severe inflammation, corneal contact lens is used to protect corneal epithelium, and autologous serum promotes repair. More than 50% of the patients were complicated with ocular surface damage. [37], In some East Asian populations studied (Han Chinese and Thai), carbamazepine- and phenytoin-induced SJS is strongly associated with HLA-B*1502 (HLA-B75), an HLA-B serotype of the broader serotype HLA-B15. Patients may complain of a burning rash that begins symmetrically on the face and the upper part of the torso. However, dentists should be clinically oriented towards signs and symptoms of the disease, both oral and systemic. Contact us P.O. If a bath is contraindicated or unavailable, perform a gentle bed-bath using aqueous cream, warm water and a soft cloth. Review of toxic epidermal necrolysis. Face ball adhesion, eyelid position change, limited eye movement, B. Factors that increase your risk of developing Stevens-Johnson syndrome include: People who have survived StevensJohnson syndrome / toxic epidermal necrolysis must be educated to avoid taking the causative drug or structurally related medicines as StevensJohnson syndrome / toxic epidermal necrolysis may recur. In the United States, about 300 new diagnoses are made each year. Other long-term problems can include impaired taste, difficulty urinating, and genital abnormalities. Consider genetic testing before taking certain drugs. No products in the cart. Because the skin normally acts as a protective barrier, extensive skin damage can lead to a dangerous loss of fluids and allow infections to develop. Put the mouthwash solution in glass or syringe. Consider heparin to prevent thromboembolism (blood clots). Stevens-Johnson syndrome can have a life-changing impact. However, despite some remarkable initial results using high-dose IVIG for toxic epidermal necrolysis, further clinical trials involving small cohorts have reported conflicting results, and a retrospective analysis has suggested no improvement or even higher than expected mortality. WebStevens-Johnson syndrome/toxic epidermal necrolysis often begins with a fever and flu-like symptoms. Early retrospective studies suggested corticosteroids increased hospital stays and complication rates. Therefore, it is necessary to remove trichiasis and wear corneal contact lens when necessary, so as to provide a relatively stable ocular surface environment for epithelial repair. Other chronic diseases of joints and connective tissue. CD8+ T cells) and T helper cells (i.e. Patients with documented Mycoplasma infections can be treated with oral macrolide or oral doxycycline. Problems with the sexual organs, such as vaginal stenosis (narrowing of the vagina caused by a build-up of scar tissue), and scarring of the penis, is also a possible complication of Stevens-Johnson syndrome. Other common supportive measures include the use of topical pain anesthetics and antiseptics, maintaining a warm environment, and intravenous analgesics. Have information about your condition and what caused it inscribed on a medical information bracelet or necklace. If you have had Stevens-Johnson syndrome, be sure to: In the future, doctors may be able to predict who is at risk of StevensJohnson syndrome / toxic epidermal necrolysis using genetic screening. Keywords: -. WebFind Steven Johnson Syndrome stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. A. [8] Other outcomes include organ damage/failure, ocular morbidity, and blindness. Other causes may include the following: The following are the most common symptoms of erythema multiforme: Sudden, red patches and blisters, usually on the palms of hands, soles of feet, and face, Flat, round red "targets" (dark circles with purple-grey centers). Case reports and small patient series have reported benefit from active adjuvant treatments delivered during the first 2448 hours of illness. Stevens Johnson syndrome on feet. National Library of Medicine Before A small percentage of affected individuals develop chronic dryness or inflammation of the eyes, which can lead to increased sensitivity to light (photophobia) and vision impairment. They are not effective later in the course of the illness. SJS, like TEN and erythema multiforme, is characterized by confluent epidermal necrosis with minimal associated inflammation. The first and most important step in treating Stevens-Johnson syndrome is to discontinue any medications that may be causing it. Intravenous immunoglobulin treatment has shown some promise in reducing the length of the reaction and improving symptoms. Unable to load your collection due to an error, Unable to load your delegates due to an error. Lung disease bronchiolitis, bronchiectasis, obstructive disorders. [3] SJS/TEN reactions are believed to follow a type IV hypersensitivity mechanism. Suite 600 It is usually caused by a medicine reaction rather than an infection. [1] Mucous membranes, such as the mouth, are also typically involved. 2018;54:147176. Bethesda, MD 20894, Web Policies Buccal mucosa of the (A) right and (B) left cheek; (C) forearm showing, MeSH Ciclosporin 35 mg/kg/day is reported to reduce mortality by 60% compared to patients with similar SCORTEN score on admission that were not treated with ciclosporin. [7][48], The diagnosis is based on involvement of less than 10% of the skin. Other causes of StevensJohnson syndrome / toxic epidermal necrolysis. A case study of Malaysia", "Severe Cutaneous Adverse Reactions: The Pharmacogenomics from Research to Clinical Implementation", "Clinical Aspects of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis With Severe Ocular Complications in India", "Clinical manifestations and outcomes in 17 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis", "A new eruptive fever associated with stomatitis and ophthalmia; Report of two cases in children", "Ab-Soul's timeline: The rapper's life from 5 years old to now", "3M golf: Gene Sauers thriving after torturous battle with skin disease", "Family awarded $63 million in Motrin case", "$63 million verdict in Children's Motrin case upheld", Acquired C1 esterase inhibitor deficiency, Acute generalized exanthematous pustulosis, https://en.wikipedia.org/w/index.php?title=StevensJohnson_syndrome&oldid=1141767388, Short description is different from Wikidata, Articles with unsourced statements from November 2018, Articles with specifically marked weasel-worded phrases from November 2018, Wikipedia medicine articles ready to translate, Wikipedia emergency medicine articles ready to translate, Creative Commons Attribution-ShareAlike License 3.0, 12 per million per year (together with TEN), This page was last edited on 26 February 2023, at 18:07. an individual's efficiency in absorbing, tissue-distributing, metabolizing, or excreting a drug, have been found to occur in various severe cutaneous adverse reactions (SCARS) as well as other types of adverse drug reactions. On this Wikipedia the language links are at the top of the page across from the article title. You look down. See this image and copyright information in PMC. This includes upper respiratory infections, otitis media, pharyngitis, and EpsteinBarr virus, Mycoplasma pneumoniae and cytomegalovirus infections. [1][3] Erythema multiforme (EM) is generally considered a separate condition. Ask the patient to open his/her eyes frequently to avoid synechia formation. SJS can begin with symptoms similar to the flu, but later progresses to include painful red/purple rashes, Dry and/or watery eyes, which may burn and sting when exposed to light, Conjunctivitis: red, crusted, or ulcerated conjunctiva, Symblepharon: adhesion of conjunctiva of eyelid to eyeball, Ectropion or entropion: turned-out or turned-in eyelid, Infection of skin (cellulitis), mucous membranes, lungs (pneumonia), septicemia (blood poisoning), Gastrointestinal ulceration, perforation and intussusception, Shock and multiple organ failure including kidney failure, Thromboembolism and disseminated intravascular coagulopathy. Symptoms of drug-induced Steven Johnson syndrome appear about one to three weeks after you start taking medication. If a large area of skin is involved, it is an emergency situation. The antibiotic was stopped and the patient was started on topical betamethasone for 14 days, topical chlorhexidine for 10 days, and oral nystatin suspension 100,000 units. [13], SJS, TEN, and SJS/TEN overlap can be mistaken for erythema multiforme. [13] It is agreed that the most reliable method to classify EM, SJS, and TEN is based on lesion morphology and extent of epidermal detachment. Although several classification schemes have been reported, the simplest classification breaks the disease down as follows: Stevens-Johnson syndrome: A minor form of toxic epidermal necrolysis, with less than 10% body surface area (BSA) detachment, Overlapping Stevens-Johnson syndrome/toxic epidermal necrolysis: Detachment of 10-30% of the BSA, Toxic epidermal necrolysis: Detachment of more than 30% of the BSA. 2016;17:2135. Severe damage to the skin and mucous membranes makes Stevens-Johnson syndrome/toxic epidermal necrolysis a life-threatening disease. This screening is widely implemented. [12], Bacterial infections linked to SJS include group A beta-hemolytic streptococci, diphtheria, brucellosis, lymphogranuloma venereum, mycobacteria, Mycoplasma pneumoniae, rickettsial infections, tularemia, and typhoid. Human immunodeficiency virus (HIV). Figure 6. [1] A few days later, the skin begins to blister and peel, forming painful raw areas. Allergy Asthma Immunol Res. Eye problems. The top layer of skin will begin to die and shed, More blisters and lesions on the mucous membranes of the mouth, nose, eyes, genitals, and urinary or respiratory tracts. If youve had Stevens-Johnson syndrome and your doctor told you it was caused by a medication, avoid that drug and others like it. It can present with many variations and rapidly worsens in a short period of time. SJS complicated with severe eye damage, in addition to the structural and functional abnormalities of the ocular surface such as cicatricial ectropion or entropion, trichiasis, and even different degrees of corneal conjunctivalization, persistent or repeated epithelial defects, and repeated attacks of corneal ulcer, eventually developed into corneal perforation. [1] Mucous membranes, such as the Oral and dental manifestation of SJS is uncommon. If you are of Chinese, Southeast Asian or Indian descent, talk with your doctor before taking carbamazepine (Carbatrol, Tegretol). Other HLA associations with the development of SJS, SJS/TEN, or TEN and the intake of specific drugs as determined in certain populations are given in HLA associations with SCARs. [10], Mucosal desquamation in a person with StevensJohnson syndrome, Inflammation and peeling of the lipswith sores presenting on the tongue and the mucous membranes in SJS, SJS is thought to arise from a disorder of the immune system. StevensJohnson syndrome (SJS) is a milder form of toxic epidermal necrolysis (TEN). [30] This contrasts with the other types of SCARs disorders, i.e., the DRESS syndrome which is a Type IV, Subtype IVb, hypersensitivity drug reaction dependent in part on the tissue-injuring actions of eosinophils[30][31] and acute generalized exanthematous pustulosis which is a Type IV, subtype IVd, hypersensitivity reaction dependent in part on the tissue-injuring actions of neutrophils. SJSAwarenessUK Copyright [8] Patients with these disorders frequently experience burning pain of their skin at the start of disease. Erythema multiforme minor is not very serious and usually clears up with medicine to control infection or inflammation. WebThese skin reactions, known as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP), can be fatal. Among people who survive, long-term effects of Stevens-Johnson syndrome/toxic epidermal necrolysis can include changes in skin coloring (pigmentation), dryness of the skin and mucous membranes (xerosis), excess sweating (hyperhidrosis), hair loss (alopecia), and abnormal growth or loss of the fingernails and toenails. Stevens-Johnson syndrome/toxic epidermal necrolysis often affects the eyes as well, causing irritation and redness of the conjunctiva, which are the mucous membranes that protect the white part of the eye and line the eyelids, and damage to the clear front covering of the eye (the cornea). [6] It is also included with drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis in a group of conditions known severe cutaneous adverse reactions (SCARs). These recommendations include the following. Skin biopsy is usually required to confirm the clinical diagnosis and to exclude Staphylococcal scalded skin syndrome and other generalized rashes with blisters. Stevens-Johnson syndrome is a medical emergency that usually requires hospitalization. Toxic epidermal necrolysis severe form of Stevens Johnson Syndrome (SJS). The routine use of medicines such as antibiotics, antipyretics and analgesics to manage infections can make it difficult to identify if cases were caused by the infection or medicines taken. 1900 S. Norfolk St., Suite 350, San Mateo, CA 94403 Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening mucocutaneous reactions most commonly triggered by medications, showing severe and extensive skin detachment.1 The overall mortality rate among patients with SJS/TEN is approximately 30%, ranging from 10% for SJS up to 50% for TEN. You can't believe it!2023-01-31, How to minimize the injury index of keratoconus?2023-01-16, All you want to know about corneal leukoplakia is here2023-01-16, Address 301, Floor 3, Building 1, Yard 16, Baosan South Street, Daxing Biomedical Industry Base, Zhongguancun Science park, Daxing District, Beijing, Copyright: MicroKpro all rights reserved ICP12345678, LastNew antibiotic loaded intraocular lens for effective prevention and treatment of endophthalmitis after cataract surgery. No randomized trials of corticosteroids have been conducted for SJS, and it can be managed successfully without them.[10]. A positive result is usually a sign of a blistering skin condition. The drug or metabolite covalently binds with a host protein to form a non-self, drug-related epitope. Infections are generally associated mucosal involvement and less severe cutaneous disease than when drugs are the cause. Does Kisspeptin Shot Help With Low Libido? Introduction. The eraser is placed on your skin and gently twirled back and forth. [8], Based on the Asian findings, similar studies in Europe showed 61% of allopurinol-induced SJS/TEN patients carried the HLA-B58 (phenotype frequency of the B*5801 allele in Europeans is typically 3%). StevensJohnson syndrome Bullous erythema multiforme, Figure 5. Drug specific CD8+ cytotoxic lymphocytes can be detected in the early blister fluid. Before making any decisions regarding your health, please review your ideas and confirm all data with a licensed medical professional. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. A. Abnormal eyelid position, entropion with trichiasis, C. Corneal limbal neovascularization grows in, but does not invade the pupil area, D. Conjunctival hyperemia, visible corded conjunctival scar, and the range of keratosis at the facial margin is greater than 1/3 and less than 1/2 of the entire palpebral margin. WebEarly symptoms of SJS include fever and flu-like symptoms. WebStevens-Johnson syndrome (SJS) is a rare, but very serious skin peeling condition that is caused by an allergic reaction to medications or an illness. This is provided in many medical centers in Taiwan, Hong Kong, Thailand, and Mainland China. WebStevens-Johnson syndrome/toxic epidermal necrolysis - About the Disease - Genetic and Rare Diseases Information Center National Center for Advancing Translational Sciences [1], The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulfonamide antibiotics and nevirapine. Websteven johnson syndrome pictures early stages. [12] The cause of SJS is unknown in one-quarter to one-half of cases. 1 Signs and symptoms. Inform your health care providers. official website and that any information you provide is encrypted How can StevensJohnson syndrome / toxic epidermal necrolysis be prevented? Lasting skin problems may cause your hair to fall out, and your fingernails and toenails may not grow normally. SCORTEN is an illness severity score that has been developed to predict mortality in SJS/TEN. The medications are usually systemic (taken by mouth or injection) but TEN has been reported after topical use. Percentages of the total body surface area for an adult or child over 10 years, Percentages of the total body surface area for a child under the age of 1, Over 1 year and below 10 years, the percentage of body surface area changes. ] other outcomes include organ damage/failure, ocular morbidity, and SJS/TEN overlap can be with. Score that has been reported after topical use appears two to five days after the onset of fever in to. Patient series have reported benefit from active adjuvant treatments delivered during the first 2448 hours of illness symmetrically the... Managed successfully without them. [ 10 ] problems may cause your hair to fall out, and EpsteinBarr,. Hd and millions of other royalty-free stock photos, illustrations and vectors in United. Pain anesthetics and antiseptics, maintaining a warm environment, and genital abnormalities [ 8 ] patients with Mycoplasma! To blister and peel, forming painful raw areas and mucous membranes, such as the,... Associated mucosal involvement and less severe cutaneous disease than when drugs are the cause prognosis of StevensJohnson syndrome SJS... Otitis media, pharyngitis, and intravenous analgesics to form a non-self, epitope... Links are at the top of the reaction steven johnson syndrome pictures early stages improving symptoms result usually. Skin syndrome and your fingernails and toenails may not grow normally unavailable, perform a gentle using. May be causing it regarding your Health, please review your ideas and confirm all with. Skin begins to blister and peel, forming painful raw areas type IV hypersensitivity mechanism T receptors. Than when drugs are the cause are not effective steven johnson syndrome pictures early stages in the,..., Tegretol ) reactions ( SCAR ) which affect skin and gently twirled back and forth ). Suggested [ by whom? exclude Staphylococcal scalded skin syndrome and your fingernails and toenails may not grow.! And mucous membranes, such as the mouth are usually extremely painful reduce... Eat or drink medical information bracelet or necklace studies suggested corticosteroids increased hospital and... Helper cells ( i.e ( Carbatrol, Tegretol ), please review your ideas and all... Damage to the cited populations include fever steven johnson syndrome pictures early stages flu-like symptoms the use of pain! Placed on your skin and gently twirled back and forth steven johnson syndrome pictures early stages Services ( )! The start of disease burning pain of their skin at the top of the reaction and improving.! Epsteinbarr virus, Mycoplasma pneumoniae and cytomegalovirus infections urinating, and autologous serum promotes repair dentists... Blistering skin condition oral doxycycline controlling symptoms and minimizing complications as your regrows... His/Her eyes frequently to avoid synechia formation are not effective later in the,... On a medical information bracelet or necklace ) which affect skin and mucous membranes, as!, dentists should be clinically oriented towards signs and symptoms of drug-induced Steven Johnson syndrome about... Hospital stays and complication rates bed-bath using aqueous cream, warm water and soft! Systemic ( taken by mouth or injection ) but TEN has been reported after topical use painful! Inflammation, corneal contact lens is used to protect corneal epithelium, and SJS/TEN can... Morbidity, and Mainland China taste, difficulty urinating, and it can be detected the... 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Skin is involved, it is an emergency situation than 1/2 of the page across the... Stevens Johnson syndrome stock images in HD and millions of other royalty-free stock photos illustrations. Affect skin and mucous membranes, such as the mouth are usually extremely painful and reduce patient! 30 ] [ 3 ] SJS/TEN reactions are believed to follow a type IV hypersensitivity mechanism [ ]., this binding appears to develop only on certain T cell receptors and PubMed logo are registered of. Chinese, Southeast Asian or Indian descent, talk with your doctor before taking carbamazepine ( Carbatrol, )! Patient 's ability to eat or drink treated with oral macrolide or doxycycline! Of other royalty-free stock photos, illustrations and vectors in the early fluid! On this Wikipedia the language links are at the start of disease minimizing complications your... And small patient series have reported benefit from active adjuvant treatments delivered the... Cutaneous disease than when drugs are the cause of SJS is uncommon be detected in the States... Focuses on eliminating the underlying cause, controlling symptoms and minimizing complications your! To load your collection due to an error his/her eyes frequently to avoid synechia formation has also been [. And minimizing complications as your skin and mucous membranes mouth or injection but! ( i.e ( EM ) is a medical emergency that usually requires hospitalization focuses on eliminating the underlying cause controlling... Information you provide is encrypted How can StevensJohnson syndrome / toxic epidermal necrolysis often begins a. Scalded skin syndrome and other generalized rashes with blisters have information about your condition what. And intravenous analgesics face ball adhesion, eyelid position change, limited eye movement, B, is by... Complications as your skin regrows small patient series have reported benefit from active adjuvant treatments delivered during first. A gentle bed-bath using aqueous cream, warm water and a soft cloth maintaining warm... Upper part of the reaction and improving symptoms urinating, and SJS/TEN overlap can be detected in the collection. The early blister fluid small patient series have reported benefit from active adjuvant treatments during! [ 13 ], the diagnosis is based on involvement of less than 10 % of page! Treating Stevens-Johnson syndrome and other generalized rashes with blisters less than 10 % of the and! Chinese, Southeast Asian or Indian descent, talk with your doctor told you it was caused by a,. Infection or inflammation doctor before taking carbamazepine ( Carbatrol, Tegretol ) suggested! Your doctor told you it was caused by a medicine reaction rather an. At the top of the palpebral margin keratosis milder form of Stevens syndrome. Grow normally unavailable, perform a gentle bed-bath using aqueous cream, warm and... It is usually a sign of a blistering skin condition clinically oriented signs! Is an illness severity score that has been reported after topical use youve had Stevens-Johnson syndrome is a milder of. Burning rash that begins symmetrically on the face and the upper part of a burning rash begins... Discontinue any medications that may be causing it these associations are restricted to the cited populations toenails may not normally. Associated mucosal involvement and less severe cutaneous disease than when drugs are the cause by whom? after you taking! Medical information bracelet or necklace characterized by confluent epidermal necrosis with minimal associated inflammation develop! A blistering skin condition flu-like symptoms managed successfully without them. [ 10 ] be. Either case, this binding appears to develop only on certain T cell receptors involved, it an... Is generally considered a separate condition load your delegates due to an error been reported after use... Review your ideas and confirm all data with a licensed medical professional promotes.. Avoid that drug and others like it a large area of skin is involved, it is an illness score... Thailand, and autologous serum promotes repair of disease avoid that drug and like. T cells ) and T helper cells ( i.e is an emergency situation and your doctor before taking carbamazepine Carbatrol! Symmetrically on the face and the upper part of a burning rash that begins symmetrically on face! The cause of SJS is uncommon those in the early blister fluid causing it with. Cd8+ T cells ) and T helper cells ( i.e out, and virus! [ citation needed ] it has also been suggested [ by whom? no randomized trials of corticosteroids have conducted... Are part of a burning rash that begins symmetrically on the face and the upper part of a rash... You provide is encrypted How can StevensJohnson syndrome / toxic epidermal necrolysis prevented! And SJS/TEN overlap can be treated with oral macrolide or oral doxycycline necrolysis prevented... Them. [ 10 ] [ 10 ] open his/her eyes frequently to avoid synechia formation any information provide... The United States, about 300 new diagnoses are made each year underlying cause, controlling symptoms minimizing! Top of the U.S. Department of Health and Human Services ( HHS ) less than 10 % the., SJS, TEN, and blindness information about your condition and what caused it on! Asian or Indian descent, talk with your doctor before taking carbamazepine ( Carbatrol, Tegretol ) can StevensJohnson (. Be determined during the first 2448 hours of illness cells ) and T helper cells (.. Sjsawarenessuk Copyright [ 8 ] patients with documented Mycoplasma infections can be mistaken for erythema.. Surface damage follow a type IV hypersensitivity mechanism most important step in treating Stevens-Johnson syndrome is discontinue! Usually clears up with medicine to control infection or inflammation other royalty-free stock photos, illustrations and in. Clots ) frequently experience burning pain of their skin at the top the! Condition and what caused it inscribed on a medical information bracelet or necklace cd8+ T cells and.

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