[14] eritropapulo skuamosa dermatosis - dr. sunarso suyoso
DESCRIPTION
KULITTRANSCRIPT
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ERITROPAPULOSKUAMOSA DERMATOSIS
Dr. EVY ERVIANTI, Sp.KK
DEP / SMF ILMU KESEHATAN KULIT DAN KELAMINFK UNAIR / RSU Dr. SOETOMO
SURABAYA
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ERITROPAPULOSKUAMOSA DERMATOSISERITROPAPULOSKUAMOSA DERMATOSIS
• Golongan penyakit kulit • Effloresensi terutama : eritema, papula, skuama• Penyebab diketahui : – Dermatomikosis superfisialis– Lues II– MH
• Penyebab tak diketahui :– Psoriasis vulgaris– Pytiriasis rosea– Dermatitis seboroik– Lichen planus– Pityriasis Rubra Pilaris
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PSORIASIS VULGARIS
DEFINISI :• penyakit kulit, kronis dan residif• makula eritematus bulat / lonjong • skuama tebal, transparan/putih keabu-abuan
DEFINISI :• penyakit kulit, kronis dan residif• makula eritematus bulat / lonjong • skuama tebal, transparan/putih keabu-abuan
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ETIOLOGI DAN PATOFISIOLOGIPenyebab pasti tak diketahui Faktor-faktor :
– Pemendekan turn over epidermis– Predisposisi genetik– Faktor pencetus :
- infeksi - obat tertentu- stres - perubahan iklim
- trauma
EPIDEMIOLOGISemua usia, dewasa >>Pria = wanita
ETIOLOGI DAN PATOFISIOLOGIPenyebab pasti tak diketahui Faktor-faktor :
– Pemendekan turn over epidermis– Predisposisi genetik– Faktor pencetus :
- infeksi - obat tertentu- stres - perubahan iklim
- trauma
EPIDEMIOLOGISemua usia, dewasa >>Pria = wanita
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GEJALA KLINIS Keluhan
- sedikit gatal (panas / burning sensation)- kosmetik.
Kulit– Makula eritematus, batas jelas, tertutup skuama tebal, transparan, lepas dibagian tepi, lekat dibagian tengah.
– Kaarsvlek phen (+), Austpitz sign (+), Koebner phen (+)– Bentuk makula bisa berubah anular, gyrata, folikular, gutata, punctata
GEJALA KLINIS Keluhan
- sedikit gatal (panas / burning sensation)- kosmetik.
Kulit– Makula eritematus, batas jelas, tertutup skuama tebal, transparan, lepas dibagian tepi, lekat dibagian tengah.
– Kaarsvlek phen (+), Austpitz sign (+), Koebner phen (+)– Bentuk makula bisa berubah anular, gyrata, folikular, gutata, punctata
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PREDILEKSI Tempat mudah kena trauma ( siku, lutut, sakrum, kepala, genitalia)
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Kuku : – keruh, pitting, punctate– subungual hiperkeratosis – kuku tangan >>
Mukosa : geographic tongue
Sendi :Psoriasis arthropatica (interphalang dan lumbosacral)
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HISTOPATOLOGI
- Khas, diagnosis pasti- Hiperkeratosis, parakeratosis,akantosis, pemanjangan Rete ridges, permanjangan papila dermis, mitosis dari stratum basalis, mikro abses Munro
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DIAGNOSIS klinis dan histoPA
DIAGNOSIS BANDING
– MH type T – Lues II – Dermatomikosis superfisialis – Dermatitis seboroik – Pytiriasis Rosea
DIAGNOSIS klinis dan histoPA
DIAGNOSIS BANDING
– MH type T – Lues II – Dermatomikosis superfisialis – Dermatitis seboroik – Pytiriasis Rosea
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PASI(Psoriasis Area and Severity Index)
• PASI = 0,1(Rn+Tn+Sn)An + 0,2(Ru+Tu+Su)Au + 0,
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PENYULIT Eritrodermi
PENATALAKSANAAN – kausal (-)– tujuan : menghilangkan faktor pencetus/lesi
– topikal : kortikosteroid, tar, anthralin, vit D, asidum salisilikum.
– sistemik : metotrexate, retinoid, fototerapi
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PSORIASIS PUSTULOSA
Dibagi 2 : Palmo plantar Generalisata (von Zumbusch)
• Dengan atau tanpa didahului Psoriasis Vulgaris• Klinis :
Febris tingi, KU lemah
Eritema menyebar luas ditumpangi adanya pustule steril. Pustule bisa bergabung membentuk danau-danau yang berisi pus.
• Laboratorium :
Leukositosis (DL)
PMN >> dan pustule steril tidak didapatkan bakteri (Gram)• Terapi :
MTX, Siklosporin, Asitretin, Kosrtikoseroid oral
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PITYRIASIS ROSEA
DEFINISI- penyakit kulit, ringan, swasirna- makulae eritematus, oval, papulae, plak
- skuama disekeliling tepinya
ETIOLOGI DAN PATOFISIOLOGI- penyebab pasti belum diketahui- diduga ~ infeksi virus
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Pityriasis rosea is common self-limited benign
papulosquamous dermatosis associated with distinctive clinical features.
"Herald patch" followed by a widespread oval scaly red eruptions.
A viral etiology has been suggested
( human herpesvirus-7 and 6).
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PITYRIASIS ROSEA
EPIDEMIOLOGI - usia remaja, dewasa muda >>- pria = wanita
PREDILEKSI - bagian tubuh tertutup pakaian, leher – dagu
- kadang bagian tubuh terbuka Pityriasis Rosea Inversa
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PITYRIASIS ROSEA
GEJALA KLINIS - gejala konstitusi - gatal ringan - sedang / asimtomatik- herald patch / mother plaque / medalion - makulae bulat lonjong, tepi meninggi, lekat pd tepi- sumbu panjang sejajar pelipatan kulit dipunggung ~ gambaran pohon cemara.
HISTOPATOLOGI- akantosis ringan, parakeratosis fokal - infiltrat limfosit, perivaskular ringan
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PITYRIASIS ROSEA
DIAGNOSIS Klinis khas
DIAGNOSIS BANDING- Psoriasis vulgaris - Dermatitis seboroik- Lues II - Tinea corporis- MH
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PITYRIASIS ROSEA
PENATALAKSANAAN- Tx spesifik (-)- Antihistamin- Bedak mengandung asidum salicilikum- Steroid topikal / sistemik bila parah- Konseling
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DERMATITIS SEBOROIK
DEFINISI • penyakit kulit, radang superfisialis, kronis• predileksi area seboroik • remisi dan eksaserbasi
ETIOLOGI • Penyebab pasti belum diketahui• Dugaan : - Pityrosporum ovale >>
- stres - kasus parah HIV
(AIDS), penyakit neurologis
• Status seboroika yang diturunkan
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DERMATITIS SEBOROIK
EPIDEMIOLOGI• Usia bayi dan orang dewasa • pria >>
PREDILEKSI• area seboroik - kelenjar sebasea >>:• kepala, wajah, badan atas, pelipatan
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DERMATITIS SEBOROIK
HISTOPATOLOGI – Akantosis, spongiosis ringan, – Infiltrat sel-sel radang, perivaskular DIAGNOSIS – Klinis khas DIAGNOSIS BANDING– Psoriasis vulgaris– Pityriasis rosea – Tinea corporis
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DERMATITIS SEBOROIK
PENYULIT • Rambut rontok• Infeksi sekunder • Eritroderma
PENATALAKSANAAN • Diit rendah lemak• Faktor pencetus dihindari• Topikal Kepala : shampo selenium sulfide 1,8%, Zn pirithion, ketokonazole scalp solution 1%/2%, losio steroidLokasi lain : krim kortikosteroid, Imidasol
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Cradle Cap pada scalp bayi
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LICHEN PLANUS (LP)
DEFINISI :- inflamasi kulit, folikel rambut, membrana mukosa, gatal
ETIOLOGI DAN PATOFISIOLOGI– penyebab belum diketahui dengan pasti– diduga : - kelainan imunologi
- ~ infeksi bakteri, virus, jamur- paparan obat, bahan kimia
tertentu
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LICHEN PLANUS (LP)
GEJALA KLINIS• Gatal • Kulit : papulae ( 1-4 mm) permukaan rata, kering, berkilat, poligonal, keunguan, sedikit skuama Wicham's Striae (+)penyembuhan hiperpigmentasiekstremitas bawah >> Koebner phen (+), bilateral simetris
• Kuku : pterygeum, onikolisis proksimal & distal, lekukan longitudinal
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LICHEN PLANUS (LP)
GEJALA KLINIS• Mukosa : oral >> bentuk :
- Ulseratif >>- Reticulate : pipi bagian dalam >>- Atropik
• Genitalia : glans penis, labia, anus papulae poligonal- Vulvovaginal erosif / ulseratif- Varian : Linear, Anular, Folikular,
Hipertropik, Ulseratif, Bollous
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LICHEN PLANUS (LP)
DIAGNOSIS klinis
DIAGNOSIS BANDING - Psoriasis vulgaris- Candidiasis- Lues II - Pityriasis Rosea
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LICHEN PLANUS (LP)
PENATALAKSANAAN• Lesi terbatas :topikal steroid superpoten / injeksi intralesi
• Lesi tersebar : sistemik steroid, PUVA, retinoid
• Lesi oral :steroid in orabase,injeksi intralesi
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LICHEN PLANUS (LP)
HISTOPATOLOGI– awal dermatitis pada taut dermoepidermal– selanjutnya : hiperplasia epidermis, pola saw tooth– orthokeratosis, hipergranulosis– lapisan basal : keratinosit nekrotik(+)– dermis : civatte bodies (+)
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PITYRIASIS RUBRA PILARIS (PRP)
DEFINISIKelainan menahun dengan :
- Plak eritematus- Berskuama- Papul keratotik folikuler
ETIOLOGI- HEREDITER
- Autosomal dominan- Permulaan pada masa anak
- DIDAPAT- Semua umur- Riwayat keluarga (-)- Diduga defisiensi vitamin A
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PITYRIASIS RUBRA PILARIS (PRP)
KLASIFIKASI
Herediter- Meluas bertahap dan perlahan- Menetap
Didapat- Meluas dengan cepat- Remisi
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PITYRIASIS RUBRA PILARIS (PRP)
GEJALA KLINIS• Eritema dan skuama pada permulaan di muka
dan kulit kepala yang bisa meluas ke seluruh permukaan kulit, dilanjutkan eritema dan penebalan di telapak tangan dan kaki.
• Kelainan kulit batas tegas dengan pulau-pulau kulit normal.
• Kuku menunjukkan penebalan.• Kelainan sistemik (-).
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PITYRIASIS RUBRA PILARIS (PRP)
HISTOPATOLOGIS• Hiperkeratosis
• Parakeratosis
• Akantosis
• Sebukan sel radang menahun pada dermis atas.
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PITYRIASIS RUBRA PILARIS (PRP)
TERAPI
• Vit A 200.00 unit per hari.
• Asam retinoat 0,05%
• Kortkosteroid topikal + Asidum salisilikum
3 – 20%
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PITYRIASIS RUBRA PILARIS (PRP)
PROGNOSIS
Herediter : buruk
Didapat : baik
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ERITRODERMA
DEFINISIKelainan kulit ditandai adanya eritema di hampir seluruh tubuh, biasanya disertai skuama.
SINONIMDermatitis Eksfoliativa
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ERITRODERMA
PATOFISIOLOGI Tergantung faktor penyebab. Pada Eritroderma terjadi peningkatan
epidermal turn over, sehingga terbentuk skuama berlebihan.
Skuama terutama mengandung protein, asam nukleat dan asam amino bebas.
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ERITRODERMA
GEJALA KLINIS Timbul dalam waktu singkat Cepat meluas Demam, menggigil,malaise Seluruh kulit tampak eritematus,
mengkilap, mengelupas, teraba panas, gatal, kasar dan menebal.
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ERITRODERMA
PATOFISIOLOGIEritema : pelebaran pembuluh darah →
aliran darah ke kulit meningkat →kehilangan panas bertambah :
»Penderita kedinginan / menggigil»Hipotermi (akibat peningkatan perfusi kulit)»Dehidrasi (akibat penguapan cairan yang
meningkat)»Pengaturan suhu terganggu.
Kehilangan skuama dapat menyebabkan kehilangan protein (hipoproteinemia) dan oedema.
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ERITRODERMA
GEJALA KLINIS• Alergi obat secara sistemik
- Anamnesis : riwayat minum obat/jamu.- Alergi timbul secara akut (kurang lebih 10 hari).- Berupa eritema universal tanpa skuama, setelah sembuh baru timbul eritema.
• Perluasan penyakit kulitPsoriasis :
- Karena penyakitnya sendiri atau pengobtan yang terlalu kuat.
- Eritema yang tidak merata. (Eritema meninggi pada tempat predileksi psoriasis)
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ERITRODERMA
Dermatitis Seboroika pada bayi (Leiner’s disease)- Dermatitis seboroika yang meluas- Etiologi belum diketahui dengan jelas- Usia : >>> 4 – 20 minggu.- KU penderita baik.- Eritema universal disertai skuama kasar.
• Penyakit sistemik termasuk keganasan- Digolongkan dalam CTCL (Cutaneous T-Cell Lymphoma)- >>> pada manula.- Eritema universal meah membara + skuama dan sangat gatal.- Pada 1/3 penderita : splenomegali, limfadenopati superfisial, alopesia, hiperpigmentasi, hiperkeratotik palmoplantar, kuku distrofia.- Laboratorium : Limfoma atipik disebut sel sezary
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ERITRODERMA
DIAGNOSISKlinis ditemukan keradangan kulit yang eritematus disertai deskuamasi hingga ≥ 90% luas permukaan tubuh.
DIAGNOSIS BANDING
Dermatitis, Psoriasis vulgaris, Drug Eruption,Limfoma/Leukemia,Pemfigus, Pityriasis Rubra Pilaris,Likhen Planus, Dermatofitosis, Skabies
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ERITRODERMA
PENYULIT Hipotermi Dekompensasi kordis Kegagalan sirkulasi perifer Tromboflebitis Infeksi sekunder pada kulit dan
paru
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ERITRODERMA
PENATALAKSANAAN Perbaiki cairan tubuh Eliminasi faktor-faktor pencetus Kortikosteroid sistemik “tappering off” Antibiotika untuk mencegaf infeksi sekunder Antihistamin/antipruritus Topikal : emolient (oleum coccos,
hidrokortison 1%) Diit tinggi protein
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Seni yang dilakukan oleh DERMATOLOG adalah
“memberi suatu penyakit dengan nama latin yang panjang ….. dan kemudian memberinya
steroid topikal.”
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Intern’s joke about dermatology :
If it’s wet, dry it.
If it’s dry, wet it.
If it’s ugly, cover it up.
If you don’t know what it is,
put glucocorticoids on it.