Mr.

Squid, a 64 years old man, came to outpatient Clinic Bari Hospital with chief complaint progressive, itchy thick erythematous plaques in both legs, arms, buttocks, and lower lumbosacral since 6 months ago. The condition initially manifested on his left leg as a papule with thick white scales then rapidly spread to both legs, scalp, buttocks, lumbosacral, and arms. His fingers and toe nails showed destruction of the nail plate. He feel pain and rigidity on his knees since 3 months ago. He had been treated himself with topical bethamethasone ointment and moisturizer irregularly.

Physical examination General status: compos mentis, vital signs within normal limit. Dermatological status: Well demarcated, erythematous papules to plaques with a white adherent thick scales; on both of his legs, arms, buttocks, lumbosacral. Erythematous plaque with thick white scales on his scalp.

Questions: 1. What is the differential diagnosis? 2. What is the working diagnosis? 3. What is your suggestion for further examination? 4. What is the management of this case?

KLARIFIKASI ISTILAH Erythematous plaques Erythematous : kemerahan pada kulit yang dihasilkan oleh kongesti pembuluh kapiler. Plaques : setiap bercak atau daerah yang rata; lesi kulit yang superfisial yang padat dan menonjol. Papule : tonjolan lesi pada kulit yang kecil, berbatas tegas, dan padat.

Scales : sel epitel yang kornifikasi/ keratinasi yang sering bercampur dengan serum bakteri, ekstravasasi sel darah putih atau eritrosit dan debris yang lain. Nail plate : bagian yang kelihatan dari kuku yang berada diatas palung kuku mulai dari atas batas akar sampai tepi ujung lepas dan dikelilingi oleh dinding kuku. Topical Bethamethasone ointment : representative kortokosteroid topical potensi kuat untuk reaksi peradangan berat yang ada di kulit seperti dermatitis. Moisturizer : sediaan berupa emulsi semi padat dari minyak dan air. Dermatological status : status kulit berdasarkan pemeriksaan fisik. Well demarcated : berbatas tegas. White adherent thick scales : skuama tebal yang melekat dan berwarna putih; salah satu ciri bila kulit mengalami dermatitis.

IDENTIFIKASI MASALAH 1. Mr. Squid, a 64 years old man, came with chief complaint progressive, itchy thick erythematous plaques in both legs, arms, buttocks, and lower lumbosacral since 6 months ago. 2. The condition initially manifested on his left leg as a papule with thick white scales then rapidly spread to both legs, scalp, buttocks, lumbosacral, and arms. 3. His fingers and toe nails showed destruction of the nail plate. 4. He feel pain and rigidity on his knees since 3 months ago. 5. He had been treated himself with topical bethamethasone ointment and moisturizer irregularly. 6. Physical examination ANALISIS MASALAH 1. Mr. Squid, a 64 years old man, came with chief complaint progressive itchy thick erythematous plaques in both legs, arms, buttocks, and lower lumbosacral since 6 months ago.

a. Bagaimana sistem anatomi dan histologi kulit normal? Mia Bagas b. Bagaimana hubungan jenis kelamin dan umur terhadap keluhan? Delila Okta c. Apa etiologi erythematous plaque? Abang Rullis d. Bagaimana mekanisme keluhan o Progressive Prass Fadly o Itchy Ahaw Fitri o thick erythematous plaque Arief Risha o in both legs, arms, buttocks, and lower lumbosacral Wira Mia sejak 6 bulan yang lalu? e. Apa saja jenis-jenis plaque? Delila Abang 2. The condition initially manifested on his left leg as a papule with thick white scales then rapidly spread to both legs, scalp, buttocks, lumbosacral, and arms. a. Bagaimana mekanisme papule berubah menjadi plaque? Risha Mia b. Bagaimana faktor yang memperberat papule berubah menjadi plaque? Arief Bagas c. Bagaimana cara penyebaran papule? Okta Rullis d. Mengapa (mekanisme) pada papule terdapat skuama tebal berwarna putih? Fadly Fitri 3. His fingers and toe nails showed destruction of the nail plate. a. Bagaimana mekanisme terjadinya destruksi pada nail plate? Prass Ahaw 4. He feel pain and rigidity on his knees since 3 months ago. a. Apa saja jenis-jenis nyeri yang bisa terjadi pada penyakit kulit? Delila Wira b. Bagaimana mekanisme nyeri dan kekakuan pada lutut sejak 3 bulan yang lalu? Abang Ahaw c. Apa hubungan nyeri dan kekakuan pada lutut dengan plaque yang terdapat pada kaki Mr. Squid? Prass Arief 5. He had been treated himself with topical bethamethasone ointment and moisturizer irregularly. a. Bagaimana komposisi, cara kerja, efek samping, indikasi, kontraindikasi, dosis bethamethasone? Bagas Rullis b. Apa dampak pemakaian salep dan pelembab secara tidak teratur? Okta Fadly 6. Physical examination

a. Bagaimana interpretasi dan mekanisme abnormal pemeriksaan fisik? o General status: compos mentis, vital signs within normal limit. (-) o Dermatological status: Well demarcated Fitri Mia Erythematous papules to plaques with a white adherent thick scales; on both of his legs, arms, buttocks, lumbosacral. Delila Ahaw Erythematous plaque with thick white scales on his scalp. Abang Prass

7. a. Cara menegakkan diagnosis (pemeriksaan penunjang) Arief Rullis b. DD Fitri Wira c. WD Wira d. Etiologi Bagas Okta e. Epidemiologi dan factor resiko Wira Abang f. Patofisiologi (perjalanan penyakit) Fadly Risha g. Manifestasi klinik dan predileksi Mia Delila h. Klasifikasi psoriasis Arief Ahaw i. Tata laksana Prass Bagas j. Komplikasi Okta Fitri k. Pencegahan Rullis Fadly l. Prognosis Risha Wira m. KDU Wira HIPOTESIS Tn. Squid, 64 tahun, menderita psoriasis. LI 1. Anatomi dan histologi kulit Mia Delila Abang 2. Anatomi dan histologi kuku Prass Ahaw Arief 3. Psoriasis Fadly Fitri Risha 4. Effloresensi kulit Bagas Okta Rullis

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