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MORFOLOGI & CARA MEMBUAT DIAGSIS

Benny Effendi Wiryadi

URUTAN PEMERIKSAAN & MENENTUKAN DIAGNOSIS


1. ANAMNESIS . Berobat utk peny apa / keluhannya apa . Riw peny, penggunaan obat utk peny yg diderita, maupun peny lain, peny yg diderita oleh anggota keluarga yg lain, peny lain yg diderita sekarang maupun pada masa lampau, dan kebiasaan tertentu

LANJUTAN URUTAN PEMERIKSAAN


2. Inspeksi Mutlak dilakukan dlm ruangan yg terang Boleh memakai kaca pembesar Anamnesis terarah ditanyakan saat inspeksi, utk melengkapi data D/ (mis dalam hal dermatitis pada tangan, perlu ditanyakan klnan di tempat lain.Dalam hal ini perlu pemeriksaan seluruh kulit tubuh.

LANJUTAN URUTAN PEMERIKSAAN


Perlu pem rambut, kuku, & mukosa terutama pd peny tertentu, mis liken planus & sifilis. Perhatikan lokalisasi, warna, bentuk, ukuran, penyebaran, batas, & efloresensi yg khusus. Bila terdapat kemerahan pada kulit, ada 3 kemungkian: eritema,purpura, dan telangiektasis

CARA MEMBEDEKAN KEMERAHAN KULIT


Tekan dgn jari & digeser eritem: akan menghilang & warna akan kembali setelah jari dilepaskan, krn terjadi vasodilatasi kapiler purpura: tidak menghilang, sebab terjadi perdarahan di kulit telangiektasis: juga tidak hilang, sebab terjadi pelebaran kapiler yg. menetap

LANJUTAN MEMBEDAKAN KEMERAHAN KULIT


Pemeriksaan diaskopi (menekan dgn benda transparan di tempat kemerahan) diaskopi pos: warna merah menghilang (eritema) diaskopi neg: warna merah tidak menghilang (purpura atau telangiektasis). Telangiektasis akan tampak spt benang berkelok-kelok yg berwarna merah atau biru

LANJUTAN URUTAN PEMERIKSAAN


PALPASI perhatikan tanda radang akut (dolor, kalor, fungsiolesa {rubor & tumor dapat pula dilihat}, indurasi, fluktuasi, & pembesaran kelenjar regional maupun generalisata Setelah pem dermatologik dan pem umum selesai, dpt dibuat D/sementara dan DD/

LANJUTAN URUTAN PEMERIKSAAN


Konsultasi ke bagian lain, mis utk pem umum internis Juga dpt dilakukan pem pembantu, mis darah, urin, bakteriologik, mikologik, histopatologik, dan imunologik ( a.l., serologik, tes tempel, imunofloresensi) Setelah pem selesai dpt diharapkan sampai pada D/ pasti

MORFOLOGI KULIT
Utk mempelajari ilmu peny kulit mutlak diperlukan pengetahuan tentang efloresensi (ruam) kulit/ morfologi/ ilmu yg mempelajari lesi kulit. Demi kepentingan diagnosis penting sekali utk mencari kelainan yg pertama (efloresensi primer), yg biasanya khas utk peny tsb.

LAN. Morfologi Kulit


Efloresensi kulit dpt berubah pada waktu berlangsungnya peny Proses tsb dpt merupakan akibat biasa dalam perjalanan proses patologik

LAN.MORFOLOGI
Kadang kadang perubahan juga dapat terjadi akb Keadaan dari luar, mis trauma garukan, pengobatan yg diberikan, sehingga perubahan tsb tidak biasa lagi. Gambaran klinis morfologik peny menyimpang dari biasanya & sulit dikenali Efloresensi yg timbul kemudian setelah efloresensi primer ini, disebut efloresensi sekunder.

EFLORESENSI
Efloresensi primer: Makula, papul, plak, urtika, nodus, nodulus, vesikel, bula, pustul, dan kista Efloresensi sekunder: skuama (jarang sekali timbul sbg efloresensi primer), krusta, erosi, ulkus, dan sikatriks

Lan. Morfologi Kulit


Definisi morfologi kulit ini dikutip dari: Garg A, Levin NA, and Bernhard JD.: Structure of skin lesion and fundamentals of clinical diagnosis; in Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, and Leffell DJ, : Fitzpatricks Dermatology in General Medicine; 7th ed, pp 23-40 (Mc Graw-Hill Medical, New York 2008). Parallel & amplify those of the Dermatology Lexicon Project.

Morphologic Lesions
Raised Papule Plaque nodule Cyst Wheal Scar Comedo Horn Calcinosis Depress ed Erosion Ulcer Atrophy Poikiloder ma Sinus Striae Burrow Sclerosis Flat Macule Patch Erythema Erythrode rma Surface Change Scale Crust Excoriatio n Fissure Lichenific ation Keratoder ma Eschar Fluid filled Vesicle Bulla Pustule Furuncle Abscess Vascular Purpura Telangiect asia Infarct

Papul (Papule)
Penonjolan padat di atas permukaan kulit, Diameter <0.5 cm Bentuk & permukaan nya dpt bermacam-macam: sesil, pedunculated {(bertangkai) : fibroma pendulans & veruka filiformis}, dom-shaped (dermatitis), flat-topped (veruka plana, liken planus), rough (veruka vulgaris), smooth, filiform, mammillated, acuminate (keratosis follikularis), and umbillicated (moluskum contagiosum)

Plak (Plaque)
.Peninggian diatas permukaan kulit, Permukaan rata Berisi zat padat (biasanya infiltrat) Diameternya > 0.5 cm Dapat terbentuk dari papul yg melebar atau papul-papul berkonfluensi pada psoriasis.

Nodul (Nodule)
Lesi kulit yg dapat diraba, padat, bulat atau oval Diameter > 0.5 cm Letaknya bisa epidermal, epidermal-dermal, dermal, dermal-subdermal, dan subcutaneous Tumor kadang kadang dimasukkan dalam heading nodul. Bila diameter >1 cm disebut nodus Gumma: specifically granulomatous nodular lesionof tertiary syphilis

Kista (cyst)
Ruangan berdinding atau kantong yg dilapisi oleh epitel sejati ( true epithelium) Isinya ialah cairan atau semisolid material (sel / produk sel seperti keratin) Palpasi: biasanya resilient Kista terbentuk bukan akibat peradangan, walaupun kemudian dapat meradang. Kista terbentuk dari kelenjar yg melebar & tertutup, saluran kelenjar, pembuluh darah, saluran getah bening, atau lapisan epidermis

Urtika (Wheal)
Edema setempat yg mendadak & menghilang perlahan lahan (evanescent), disebabkan keluarnya plasma melalui dinding pembuluh darah di dermis bagian atas Disebut juga Hive / urticaria Bisa berupa tiny papule (2-4mm) sampai giant plaques (sampai > 10 cm) Angioedema: a deeper, edematous reaction that occurs in areas with very loose dermis & subcutaneous tissue (lip, eyelid, or scrotum)

Sikatriks (Scar)
Terjadi dari proliferasi jaringan fibrosa, yg menggantikan kolagen normal setelah luka atau ulserasi sampai dermis retikularis. Epidermis menipis & mengerut (wrinkled) tidak ada adneksa kulit Sikatriks dapat atrofik (kulit mencekung) atau hipertrofik yg kelihatan menonjol, krn kelebihan jaringan ikat. sikatriks hipertrofik yg pertumbuhannya >batas luka,disebut keloid

Komedo (Comedo)
Hair follicle infudibulum yg melebar & tersumbat oleh keratin & lipid Bila pilosebaceous unit terbuka sampai ke permukaan kulit dan terlihat keratinaceuos plug,disebut open comedo. The oxidized sebaceous content of the infudibulum (black head) A closed infudibulum (follicular opening is unapparent accumulates whitish keratin) disebut closed comedo

Horn
A conical mass of cornified cells arising over an abnormally differentiating epidermis. Contohnya: squamous cell carcinoma, veruka vulgaris.

Calcinosis
Deposit of calcium in the dermis or subcutaneous tissue may be appreciated as hard, whitish nodules or plaques, with or without visible alteration of the skins surface Cutaneous calcinosis in dermatomyositis

Erosi (Erosion)
A moist, circumscribed, depressed lesion Result from loss of a portion or all of the viable epidermal or mucosal epithelium Unless they become secondarily infected, erosion do not scar Toxic epiderma necrolysis

Ekskoriasis (Excoriasion)
Loss of tissue that extending to the most superficial parts of dermis (tip of the papilla dermis) May result in pin-point bleeding

Ulkus (Ulcers)
A defect in which the epidermis & at least the upper (papillary) dermis has been removed Breach (menembus) dermis & destruction of adnexal structures impedes re-epithelialization & the defect heal with scarring Mempunyai tepi, dinding, dasar dan isi.

Fissure
A linear loss of continuity of the skin surface or mucosa that result from excessive tension or decreased elasticity of the involved tissue

Atrofi (Atrophy)
Istilah atrofi dipergunakan utkukuran sel, jaringan,organ, atau bagian dari tubuh A decreased in the number of epidermal cells results in the thinning of the epidermis Atrophic epidermis is glossy, almost transparan, paper thin & wrinkled & may not retain normal skin lines

Atrofi
Epidermal atrophy may also be associated with similar alterations in the dermis. A decreasein the papillary & reticular dermal connective tissue manifest as depression of the skin Atrophy of the panniculus results in a more substantial depression of the skin

Poikiloderma
The combination of atrophy, telangiectasia, and varied pigmentary changes (hyper- and hypo-) over an area of skin. This combination of features may give rise to a dappled appearance(belang belang) of the skin

Sinus
A tract connecting deep suppurative cavities to each other or to the surface of the skin The contents of the cavity usually pus, fluid, or keratin, may drain to the surface when such communication exists

Striae
The linear depression of the skin that usually measure several centimeters in length & result from changes to the reticular collagen that occur with rapid stretching of the skin. The surface of the striae may be thin & wrinkled. They may be pink to red in color & raised before becoming paller & flattened out

Burrow
A wavy, threadlike tunnel through the outer portion of the epidermis excavated by a parasite.

Sclerossis
A circumscribed or diffuse hardening or induration in the skin that isa result of dermal fibrosis. It is detected more easily by palpation (on which the skin may feel board-like, immobile, & difficult to pick up) Hypopigmentation or hyperpigmentation may also distinguish the area of induration from normal skin. The epidermis overlying sclerotic dermis may be atrophy

Lichenification
Repeated rubbing of the skin may induced a reactive thickening of the epidermis, with changes in the collagen of the underlying su Thickened skin with accentuated markings, which may be resemble tree barkperficial dermis

Keratoderma
An excessive hyperkeratosis of the stratum corneum that results in a yellowish thickening of the skin, usually on the palms and soles, that may be inherited or acquired

Eschar
The presence of an eschar implies tissue necrosis, infarction, deep burns, gangrene, or ulcerating process. It is a circumscribed, adherent, hard, black crust on the surface of the skin that is moist initially, protein rich, and avascular. This milieu fosters microbial growth

Vesicle & Bulla


A vesicle is a fluid filled cavity or elevation smaller than or equal to 0.5 cm, whereas a bulla measures larger than 0.5 cm.

Pustul (Pustule)
Vesicle yg berisi nanah Bila nanah mengendap di bagian bawah vesikel, disebut hipopion

Abses (Abscess)
Abscess is a localized accumulation purulent material so deep in the dermis or subcutaneous tissue that pus usually not visible on the surface of the skin An abscess is a pink erythematous, warm, tender, fluctuant nodule that may be associated with other signs of infection such as fever.

Macule
A flat lesion, even with the surface level of surrounding skin, perceptible as an area of color different from the surrounding skin mucous membrane. Macules are nonpalpable. Their shapes are varied & borders may be distinct or vague. Maculosquamous is a neologism invented to describe macules withn fine non-palpable scaling, which may become apparent only after light scraping & scratching

Erythema
The blanchable change in color of skin or mucous membrane that is due to dilatation of arteries and veins in the papillary & reticular dermis.

Erythroderma
Generalized deep redness of the skin involving more than 90% of the body surface with days to weeks. Scaling or desquamation generally follows establishment of the generalized erythema

Scale, Desquamation (scaling)


A scale is flat plate or flake arising from the outer-most layer of the stratum corneum

Krusta (Crust)
Hardened deposits that result when serum, blood, or purulent exudate dries on the surface of the skin

Ukuran lesi
Milier Lentikuler Numuler plakat

Susunan Lesi
Linear Circiner/ arciner Polisiklik Herpetiformis Korimbiformis