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• GO
CERVICITIS* • NON-GO
• TRIKOMONIASIS
VAGINITIS • VAGINOSIS BAKTERIAL
• CANDIDIASIS
Kuning-hijau, Putih-kuning
Putih-abu
berbuih bergumpal
Wanita
Disseminata
Cervicitis GO
Ulkus Durum
(Sifilis)
Uretritis GO Chancroid
Cervicitis NGO
Trichomoniasis
Uretritis NGO LGV
Herpes
genitalis
Candidiasis
Ulkus Genital
Secondary Syphilis
Secondary Syphilis–
Condylomata Lata
Syphilis: Workup
Indirect test: Serology
• Nontreponemal test:
• Venereal Disease Research Laboratory (VRDL)
• Rapid Plasma Reagin (RPR)
• Treponemal:
• T. Pallidum hemagglutination (TPHA)
• Fluorescent treponemal antibody-absorption (FTA-ABS)
• Quantitative VDRL/RPR
• Microhemagglutination assay T. Pallidum (MHA-TP)
• Treponemal enzym immunoassay (EIA) IgG, IgM
Cervicitis GO
Ulkus Durum
(Sifilis)
Uretritis GO Chancroid
Cervicitis NGO
Trichomoniasis
Uretritis NGO LGV
Herpes
genitalis
Candidiasis
Bubo Inguinal
• Bubo ingunalis dan femoralis: pembesaran
kelenjar getah bening setempat di daerah
pangkal paha disertai rasa sangat nyeri, dan
fluktuasi kelenjar.
• DD:
– ULKUS (-) Limfogranuloma venereum
– ULKUS (+) Chancroid*
Cervicitis GO
Ulkus Durum
(Sifilis)
Uretritis GO Chancroid
Cervicitis NGO
Trichomoniasis
Uretritis NGO LGV
Herpes
genitalis
Candidiasis
GENITAL
HPVWARTS
Warts(Condyloma Accuminata)
on the Thigh
• Kausa: HPV
• Massa seperti bunga kol
• Tes acetowhite
*Tipe HPV:
– 6, 11: warts
– 16, 18: CA
Tx:
Asiklovir 5x200 mg
Valasiklovir 2 x 500 mg
VZV –Varicella (Chicken Pox)
Lesi polimorfik (makula, papula,
vesikel, krusta)
Lesi muncul dari wajah badan
ekstremitas
Terapi: - Asiklovir 5x800
- Valasiklovir 3x1000
Hutchinson’s sign
precedes the development
of ophthalmic herpes
zooster
Ramsay Hunt Syndrome
VZV Infection of the head and neck that
involves the facial nerve, often the CN VII,
but might also CN VIII, IX, V, VI
Ganglion
geniculatum
Might be observed:
(CN VII)
• VZV auricularis
• VZV in any zoster zones of the head
and neck (herpes auricularis, herpes
facialis, herpes occipitocollaris) with
facial palsy
• VZV in any of the zoster zones with
facial palsy and auditory symptoms
(tinnitus, deafness, vertigo,
nystagmus, ataxia)
Prevensi: kortikosteroid
Furuncle Carbuncle
This lesion represents multiple confluent
furuncles draining pus from multiple openings
Terapi Pioderma
• Lokal
– Banyak pus/krusta: kompress dengan PK 1/5000, rivanol 3x sehari
@1jam selama keadaan akut
– Tidak tertutup pus/krusta: krim mupirosin 2% atau asam fusidat 2% 2x
sehari selama 7-10 hari
• Sistemik (5-7 hari)
– Kloksasilin atau dikloksasilin
• 4x250-500 mg (dewasa); 50 mg/kg/hari dalam 4 dosis (anak)
– Amoxiclav
• 3x250-500 mg (dewasa); 25 mg/kg/hari dalam 3 dosis (anak)
– Eritromisin
• 4x250-500mg (dewasa); 20-50 mg/kg/hari dalam 4 dosis
• Insisi dan drainase
– Khusus karbunkel yang menjadi abses
Erysipelas
Bacterial skin infection
involving the upper dermis
that characteristically extends
into the superficial cutaneous
lymphatics
CLUE:
• Superfisial Batas TEGAS , merah terang
• GABHS
• Wajah, tungkai
Treatment:
• penicillin PO or IV for 5 days
• Cold compress
• Elevation and rest
Selulitis
CLUE:
• Deeper (subkutan)
Batas TIDAK TEGAS
• S. aureus/GABHS
• Tungkai
Treatment:
• penicillin PO or IV for 5 days
• Cold compress
• Elevation and rest
Phlegmon
• Selulitis dengan supurasi (undrainable)
• Acute diffuse purulent inflammation of the
adipose tissue
Treatment:
• penicillin PO or IV for 5 days
• Cold compress
• Elevation and rest
Erythrasma
CLUE:
• Corynebacterium
minutissimum
• Flexural areas
• Macules/patch with
fine scales and
sharply defined
borders
• Wood’s lamp: CORAL
RED (bacteria produce
fluorescent porphyrins)
• Tx: erythromycin
Wood’s lamp
Furunculosis
Cutaneous Anthrax
• Spores inoculate a host
through skin laceration,
abrasions or biting flies
• Upper extremities, head and
neck
• Pruritic papule that enlarges
within 24-48 hours 1-cm
vesicle ulcer surrounded
by an edematous halo
black eschar within 7-10
days
• DOC : Doxycycline,
Quinolone(Ciprofloxacin)
Infeksi Jamur Superfisial
Wood’s lamp
PVC - Tx
Candidiasis
CLUE:
• C.albicans
• Makula patch eritem
membasah, erosi, lesi
satelit
• Flexural area
• KOH: ragi, pseudohifa,
blastospora
Dermatofitosis
(Tinea--)
CLUE:
• Trichophyton, epidermophyton,
microsporum
• Tepi aktif, central healing
• KOH: hifa panjang bersekat. TIDAK
ADA ragi
Tinea cruris
“Black dot” tinea capitis
Tinea Infection with fractures of the hair leaving the
infected dark stubs visible in the follicular orifices
Capitis
Kerion
heavily crusted, hairless plaque Tinea capitis “gray patch”
Heals with scarring and permanent A large, round hyperkeratotic plaque of alopecia due
alopecia to breaking off of hair shafts close to the surface.
Most common in
Exothrix Endothrix
• Perkembangan • Adanya
arthrocodinia di perkembangan
bagian eksterior ahtrocodinia
batang rambut. hanya di dalam
Kutikula rambut batang rambut
hancur kuning kronis.
kehijauan di Kutikula rambut
bawah sinar intak dan tes
lampu Wood lampu Wood (-)
• Paparan hewan • Black dot
peliharaan
• Gray patch
Tinea manuum
Griseofulvin TINEA
• Dosis: 1x500mg atau 2x250mg
• Utk tinea PEDIS dan ONYCHOMYCOSIS 2x500mg atau 4x250mg.
• Lama terapi tergantung jenis
• 2 to 4 weeks for tinea barbae, tinea corporis, and tinea cruris
• 4 to 6 weeks for tinea capitis
• 4 to 8 weeks for tinea pedis
• 4 months for onychomycosis of the fingernail
• 6 months for onychomycosis of the toenail.
Nystatin CANDIDIASIS
• Drop oral thrush
• Suppositoria candidiasis vaginal, apalagi ibu hamil
• Tablet Esophagus & GIT. Langsung bekerja on site, tdk diserap sistemik
Ketoconazole
• Ketokonazol: 200 mg/hari (10 hari)
• Itrakonazol: 200 mg/hari (7 hari) PVC, 100 mg/ hari (10-14 hari) Tinea
Keywords
PVC Tinea Candidiasis
Makula-patch, skuama Tepi aktif, central healing Area lipatan, lesi satelit
halus Finger nail sign (+)
Skabies
Pedikulosis
Ptiriasis
Pediculosis Corporis
TERAPI
Pediculosis Pubis • Medikamentosa:
• First line: Permethrin cream 1% 2 jam
• Alternative: Malathion 0.5% lotion semalam
Gameksan 1% 12 jam
• Nonmedikamentosa:
• Cuci dengan air hangat. Lice and eggs are
killed by exposure for 5 minutes to
temperatures >53.5°C
Pediculosis Capitis
Cutaneus Larva Migrans
( creeping’s eruption)
• Larva Ancylostoma
braziliensis
• Treatment:
– Albendazole 1x400
mg (3d) OR
– Ivermektin 2x6mg
– Topical
corticosteroid
TB Chancre
Exogeneous
TB Verucosa Cutis
(Direct inoculation
(TVC)
into the skin)
Lupus Vulgaris
(LV)
Cutaneous TB Scrofuloderma
Contiguous
Infection Orificial TB
TB Milier Akut
Endogenous
Metastatic TB
Hematogenous
Abscess
Lupus Vulgaris
(LV)
Lupus Vulgaris
Lymphogenous
(LV)
TB Chancre
• Primary inoculation TB
typically follows a
penetrating injury that
results in the direct
introduction of
mycobacterium into
the skin or mucosa of
an individual with no
previous TB infection.
• Papul shallow firm
nonhealing nontender
ulcer
TB verukosa
• direct inoculation of TB into
the skin of people who were
previously infected.
• a painless, solitary, purplish or
brownish-red warty plaque
that may extend peripherally
causing central atrophy or
form fissures that exude pus
or keratinous material.
• Hiperkeratosis (verrucous)
• Knees, elbows, hands, feet
• may persist for years but can
clear up even without
treatment
TB verukosa
Lupus Vulgaris
• Chronic and progressive form of CTB that
is widely described as the most common
form of CTB with a multitude of
presentations.
• Lesions occur in normal skin as a result of
direct extension from underlying deeper
TB focus, by lymphatic or hematogenous
spread, after primary inoculation, after
BCG vaccination, or in scars of old
scrofuloderma.
• small, solitary, nodular, sharply defined,
reddish-brown lesions with a gelatinous
consistency (called apple-jelly nodules) on
the head and neck, lower extremities or
buttocks
• persist for years, leading to disfigurement
and sometimes skin cancer
Scrofuloderma
• direct extension of
underlying TB
infection of lymph
nodes, bone or
joints.
• Anak & dewasa
muda
• Kronik, sering
kambuh
• Nodul supurasi
ulkus tepi
ireguler
Orificial TB
• Advanced TB
• Imun jelek
• Autoinokulasi
• Ulkus bergaung,
eritem, purulen,
hemoragik
TB milier –kulit
• Chronic TB infection that has
spread from the primary
infection (usually in the
lungs) to other organs and
tissues via the bloodstream
• Immunocompromised:
HIV/AIDS, cancer, bayi/anak
• Poor prognosis
• Small, erythematous to
violaceous papules or
pustules with hemorrhagic
necrosis and umbilication
affecting a substantial
portion of the body
Metastatic TB Abscess
(TB Gumma)
• can arise from breakdown
of an old healed tubercle
that still contains live
organisms or from cell-
mediated immune defense
inhibition that reactivates
• malnourished children and
immunosuppressed adults
• nontender, fluctuant
nodules develop forming
draining sinus abscesses
“Metastatic abscess” unless surgically incised
and drained
s
Miliaria profunda
Lepra
CMI: cell mediated immunity
Klasifikasi Lepra menurut WHO
Clinical features Paucibacillary (PB) Multibacillary (MB)
Erythema Multiforme
Urticaria
Urticaria
• Akut: <6 weeks
• Terapi:
– Antihistamin H1
• Bila gagal ganti/ naikkan dosis/ kombinasi
– Kortikosteroid, indikasi
• Angioedema (+)
• Refractory effect of antiH1
Cold Urticaria: ice cube test
Exanthematous
Drug Eruption
Farmakoterapi
• Kortikosteroid sistemik:
Prednison 3x10 mg/hari (1
minggu)
• Antihistamin sistemik:
Obat pencetus: antibiotik, NSAID
– Setirizin2x10 mg/hari (7
Reaksi hipersensitivitas tipe IV hari) k/p
– Loratadin 10 mg/hari (7
Erupsi makulopapular hari) k/p
eritematosa tersebar • Topikal:
morbiliformis, simetris – Bedak salisilat 2% dan
antipruritus (Menthol 0.5%
Predileksi: Tungkai, lipat paha, - 1%)
dan lipat ketiak
Fixed Drug Eruption
Reexposure obat lesi pada tempat yan
sama.
Obat pencetus: Sulfonamid, Barbiturat,
Trimetoprim, dan analgetik
Reaksi hipersensitivitas tipe II
Lesi khas:
• Vesikel, bercak eritema
• Lesi target,bentuk bulat lonjong atau
numular , adang disertai erosi
• Bercak hiperpigmentasi dengan kemerahan
di tepinya, terutama pada lesi berulang
Major
• Target lesions with severe mucosal involvement and systemic features
• Epidermal detachment <10% TBSA
Etiology:
• infection (HSV)
• rarely drugs
Patognomonis :
typical targets or
raise, edematous
papules, distributed
akrofasial
Stevens-Johnson Syndrome
Toxic Epidermal Necrolysis
• potentially life-threatening dermatologic disorder
characterized by widespread erythema, necrosis, and
bullous detachment of the epidermis and mucous
membranes, resulting in exfoliation and possible
sepsis and/or death
• Drug Reaction >50%
Pemphigus vulgaris
• Penyakit autoimun pada kulit dan
membran mukosa, ditandai dengan
bula intraepidermal yang terjadi
akibat proses akantolisis, dan
disertai adanya sirkulasi antibodi IgG
terhadap permukaan sel keratosit.
• Lesi awal di kulit kepala yang
berambut atau di rongga mulut
berlangsung berbulan-bulan bula
generalisata.
• Nikolsky sign positif.
• Pemeriksaan histopatologik &
imunofluoresensi
Pemfigus Vulgaris
Pemfigoid Bullosa
• AutoAb directed against two hemidesmosomal proteins:
• BP 230 or BP antigen 1 (BPAG1)
• BP 180 or BP antigen 2 (BPAG2)
Newborn, children
(almost all <6yo), adult
with chronic disease
Etiology: Staphylococcus
Immune reaction for
exotoxin (exfoliatin)
Management:
Hospitalization
Antibiotics (dikloksasilin)
Dermatitis Dermatitis
Dermatitis atopi
Kontak Iritan Kontak Alergi
Pengobatan pemeliharaan
• Setelah fase akut teratasi, max 4 minggu
• Kortikosteroid topikal q24h
• Krim pelembab q12h
DKI vs DKA
Acute allergic contact dermatitis due to nickel. This papular erythematous eruption with vesiculation and
crusting occurred at the site of contact with the clasp of a watch band. Contact hypersensitivity to nickel
was verified by patch testing.
DKA
Patch test
Dilakukan minimal 2 minggu setelah dermatitis
mereda, pada bagian tubuh yang tidak memiliki
riwayat terpapar dermatitis
Indikasi:
• DKA idiopatik
• Dermatitis yang tidak sembuh dalam waktu singkat/persisten
• Penggunaan terapi topikal kronis
DKI Kumulatif
• Kontak berulang pada iritan lemah (ex:deterjen)
• Predileksi ditangan
Dermatitis kontak iritan akut: • Kelainan muncul dalam hitungan minggu, bulan
• iritan kuat (H2SO4 atau HCl) bahkan tahun
• Lesi: eritem, edema, bula kadang nekrosis
• Tepi berbatas tegas
TOXIC IRRITANT CONTACT DERMATITIS
ec insect bite
Treatment :
• Topical steroids in the mid to high
potency
• Oral antihistamines are useful if
pruritus is severe
• Oral antibiotics are indicated
when secondary infection is
present
Stasis Dermatitis
SS
Doksisiklin50-100 mg 2x sehari
Trauma/manipulasi
Skuama Yang
pada kulit pasien akan Kerokan skuama
warnanya berubah
menimbulkan kelainan menyisakan lapisan
menjadi putih karena
yang sama dengan lesi dengan bintik-bintik
goresan
sebelumnya
VITILIGO
• Vitiligo adalah hipomelanosis idiopatik yang didapat dan
ditandai dengan adanya makula putih (depigmentasi) yang
bisa meluas. Kasus vitiligo dapat mengenai seluruh bagian
tubuh yang mengandung sel melanosit, misalnya rambut dan
mata.
• Patogenesis kombinasi faktor autoimun, genetik dan
lingkungan
Klasifikasi Vitiligo
a. Vitiligo lokalisata
• Fokal : terdapat satu atau lebih
makula pada satu area tetapi tidak
segmental.
• Segmental : terdapat satu atau
lebih makula pada satu area
dengan distribusi menurut
dermatom misalnya satu tungkai.
• Mukosal : lesi hanya terdapat
pada membran mukosa.
b. Vitiligo Generalisata : hampir
90% pasien menderita vitiligo tipe
generalisata dan biasanya terjadi
simetris (koebnerisasi). Vitiligo
generalisata terbagi menjadi:
• Akrofasial : depigmentasi hanya
terjadi di bagian distal
eksterimitas dan wajah,
merupakan stadium awal dari
vitiligo generalisata.
• Vulgaris : makula tanpa pola
tertentu di banyak tempat.
• Campuran : depigmentasi
terjadi menyeluruh atau
hampir menyeluruh yang
merupakan vitiligo total
Penatalaksanaan
• Sistemik : trimetilpsoralen/metoksipsoralen + sinar UVA PUVA
• Psoralen 0,6 mg/kg 2 jam sebelum penyinaran selama 6-12 bulan
• <18 th topikal dengan losio metoksalen yang diencerkan 1:10
dengan spiritus dilutus. Cairan tersebut dioleskan pada lesi. Setelah
didiamkan 15 menit lalu dijemur selama 10 menit. Waktu
penjemuran makin diperlama dimana yang dikehendaki ialah timbul
eritema
• > 18 th jk lokal diberikan topikal, jk generalisata pengobatannya
digabung dengan kapsul metoksalen (10 mg). Obat tersebut dimakan
2 kapsul (20 mg) 2 jam sebelum dijemur semingu 3 kali.
• MBEH (monobenzylether of hydroquinone) 20% dapat dipakai untuk
pengobatan vitiligo yang luas lebih dari 50% permukaan kulit dan
tidak berhasil dengan pengobatan psoralen.
Melasma
Lentigo Simplex
• Most common, appears at birth or early childhood
• Small dark papule distributed widely including in mucosa and
conjunctiva
• Consider syndrome association when numerous an/or involve mucosa
Solar Lentigo
• Age spots / liver spots / actinic lentigine
• Sun exposed areas
• Benign, not associated with any medical conditions, risk for skin cancer
Alopecia Areata
• A recurrent non
scarring type of hair
loss that can affect any
hair-bearing area and
can manifest in many
different patterns.
• Asymptomatic
• Exclamation point hairs
Basal Cell Carcinoma
Basal cell carcinoma: rodent-ulcer type. A large ulcer filled with black necrosis
and hemorrhagic crusts is surrounded by a well-demarcated rolled border
consisting of typical nodules of a BCC (translucency, teleangiectasia). It has
destroyed almost the entire cheek.
Squamous Cell Carcinoma