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REFRESHINGDERMATOLOGY
DERMATOTHERAPY
Dokter Pembimbing : dr. Bowo Wahyudi, Sp. KKOleh :Muhammad Fourta Lasocto
2007730077
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Dermatoterapi : Ilmu yang mempelajari pengobatan penyakit kulit
Obat - obatan Topical Systemic
Terapi Fisik / Physical Therapy
Surgical Excision Curettage
Electrodessication Cryotherapy Radiotherapy Phototherapy Laser therapy
Sumber : Hunter, J.A.A , dkk. Clinical Dermatology 3rd Edition.
Denmark : Blackwell Science, 2002 .page 314
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PENGOBATAN TOPIKAL Topikal :
1. Mengeringkan2. Membasahi (hidrasi)3. Melembutkan 4. Mendinginkan5. Memanaskan6. Melindungi (proteksi)
Kimiawi Spesifik organisme di kulit / kulit itu sendiri
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BAHAN DASAR (VEHIKULUM)
Cairan Bedak Salap Bedak Kocok (Lotion) Krim Pasta Linimen (Pasta Pendingin) Gel
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BAHAN AKTIF Aluminium Asetat Asam Asetat,Benzoat,
Borat, Salisilat, Undesilenat, Vit. A (tretinoin, asam retinoat)
Benzokain Benzil benzoat Camphora Kortikosteroid Topikal Mentol Podofilin Selenium disulfid
Sulfur Ter Urea Zat Antiseptik Obat imunomodulator
topikal
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Gel•Sediaan hidrokoloid atau hidrofilik •Zat membuat gel diantaranya : Karbomer, Metilselulosa, & Tragakan•Gel segera mencair, jika berkontak dengan kulit dan membentuk satu lapisan•Absorpsi per kutan lebih baik daripada krim
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Linimen a/ pasta pendingin : campuran cairan, bedak, dan salap
Indikasi : Dermatosis subakut.
Kontraindikasi : Dermatitis madidans
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Pasta•Indikasi : Dermatosis basah.
•Kontraindikasi : Dermatitis eksudatif dan berambut, Genital eksterna & lipatan-lipatan badan
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Krim• W/O : air fase dalam dan minyak fase luar
• O/W : minyak fase dalam dan air fase luar
Indikasi • Kosmetik• Dermatosis subakut penetrasi yang lebih besar daripada bedak kocok
• Digunakan berambut
Kontraindikasi Dermatitis madidans
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Bedak kocok◦ Campuran air dan bedak + Gliserin (bahan perekat)
Indikasi Dermatosis kering, superfisial penetrasi Keadaan subakut
Kontraindikasi Dermatitis madidans Daerah badan berambut
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SalapIndikasi • Dermatitis yang kering dan kronik• Dermatitis yang dalam dan kronik,
penetrasi salap kuat dibandingkan dengan lainnya
• Dermatitis bersisik dan berkrusta
Kontraindikasi : Dermatitis madidans : kelainan kulit daerah berambut penggunaan salap tidak dianjurkan dan jangan dipakai di seluruh tubuh.
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BedakEfek bedak ialah :• Mendinginkan • Antiinflamasi ringan efek vasokonstriksi • Anti-pruritus lemah• Mengurangi pergeseran pada kulit yang
berlipat (intertrigo)• Proteksi mekanis
Indikasi •Dermatitis kering dan superfisial•Mempertahankan vesikel/bula agar tidak pecah varisela dan herpes zooster
Kontraindikasi•Dermatitis yang basah + infeksi sekunder
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Kompres tertutup (Kompres impermeabel)
Dasar : Vasodilatasi, bukan untuk penguapan
Indikasi : Kelainan yang dalam Limfogranuloma venerium
Cara : Digunakan pembalut tebal dan ditutup dengan bahan Impermeabel Selofan atau Plastik
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Kompres terbuka
Dasar Penguapan cairan kompres disusul oleh absorbsi eksudat atau pus
Indikasi ◦ Dermatitis madidans◦ Infeksi kulit + Eritema mencolok Erisipelas◦ Ulkus kotor + Pus dan Krusta
Efek pada kulit◦ Kulit Eksudatif kering◦ Permukaan kulit dingin◦ Vasokonstriksi◦ Eritema berkurang
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Cairan :•Solusio larutan dalam air•Tingtura larutan dalam alkohol
Solusio :•Kompres•Rendam (bath)•Mandi (full bath)
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PENGOBATAN SISTEMIK
Kortikosteroid Antihistamin Simtomatik :
nyeri Analgetik, Infeksi sekunder Antibotik
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PENGOBATAN INTRALESI Injeksi kortikosteroid
(intralesi khusus) lesi setempat (Parut keloid, Lichen planus hypertrofik atau Alopecia localised areata)
Intralesi kortikosteroid kuat (Triamsinolon asetonid 10 mg/cc) Lesi nodulo-kistik
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RADIOTERAPIRadikal (terapi paliatif) : mengurangi dan menghilangkan rasa sakit atau tidak nyaman akibat kanker dan adjuvant tujuan mengurangi risiko kekambuhan dari kanker.
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SINAR ULTRAVIOLET Kombinasi UV B dan
UV A lebih baik daripada hanya UV B
UV A Sel Langerhans & Eosinofil,
UV B (Imunosupresif) memblokade fungsi sel Langerhans, dan mengubah produksi Sitokin keratinosit
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BEDAH KULIT
Biopsi eksisional maupun insisional diagnosis a/ mengobati kelainan kulit.
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PENGOBATAN LASER
Laser + Energi tinggi (High Power Laser Therapy) Destruktif
Laser + energi rendah (Low Power Laser Therapy) Biostimulan ; stimulasi mempercepat respons fisiologis sel dan jaringan
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KRIOTERAPI
Cryotherapy : menggunakan CO2 snow (dry ice) + penekanan selama 45” - 1’/2hr
N2 liquid : Cara beku dengan menyemprotkan Kloretil sepanjang lesi
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BEDAH LISTRIK
Perantaraan panas ditimbulkan arus listrik bolak-balik frekuensi tinggi (terkontrol) Destruksi jaringan (selektif) agar jaringan parut terbentuk cukup Estetis dan aman. Page 24
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BEDAH SKALPEL
Meratakan sisi jaringan parut (menonjol )
Eksisi elips jaringan parut hipotrofik (dalam)
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DERMABRASI
Meratakan jaringan parut hipo dan hipertrofi yang luas.
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BEDAH KIMIA
Dengan asam triklor asetat atau fenol meratakan jaringan parut yang berbenjol.
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DAFTAR PUSTAKA1. Mochtar Hamzah : Dermatoterapi. Ilmu Penyakit Kulit dan Kelamin. Edisi ke-6. Jakarta: FKUI,
2010: 342-352.2. Maddin S, Ho VC : Dermatologic therapy. In: Moschella, Harry J, Hurley, eds. Dermatology.
3rd ed. Philadelphia: W.B Saunders Co, 1992. 287-293.3. Hunter, J.A.A , dkk. Clinical Dermatology 3rd Edition. Denmark : Blackwell Science, 2002 .
Hal : 314 -335).4. Adhi Djuanda : Efek samping kortikosteroid topikal dan pencegahannya; dalam : Surtito
Basuki, Sri Linuwih, maria Dwikarya, I Made Wisnu, E.C, Natahusada, 1987, halaman 27-35. 5. Schaefer H, Redelmeier TE, Ohynek GJ, Lademann J. Pharmacokinetics and topical aplication
of drugs. In: Wolf K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leff el DJ, Fitzpatrick, eds. Dermatology in general medicine. 7th ed. New York: Mc Graw-Hill, 2008. 97-100.
6. Sjamsoe Daili, Emmy S. , Menaldi , Sri Liniwuh. dan Wisnu, I made. : “Penyakit Kulit yang Umum di Indonesia” ISBN 979-9924-1-5. Jakarta : PT Medical Multimedia Indonesia UI , 2005. Hal : 8-15.
7. Wyatt EL, Sutter SH, Drake LA. Dermatological pharmacology. In: Hardman JG, Limbird IE, eds. Goodman and Gillman’s the pharmacological basis of therapeutic. 10th ed. New York: McGraw Hill, 2001: 795-814.
8. Strober BE, Washenik K, Shupack JL. Principles of topical therapy. In: Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen K, eds. Dermatology in general medicine. 7th ed. New York:McGraw-Hill, 2008: hal : 206-209
9. Roenigk R.K and Roenigk Jr. H. H: Dermatologic Surgery, Principles and Practice Second Edition. Standard Procedures pp 177-209.
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