TEACHING BANGSAL 1

SUSPEK MORBUS
HANSEN

NAMA KELOMPOK
1.

Dewi Gemala Wahab

2.

Widuri wulandari

3.

Ine Wahyudi Dean

4.

Ratna Nur Aisyah

5.

Riffatiyani Arsyad

6.

Vany Matasak

7.

Sinta

8.

Hajratul Aswad Ute

PATIENT IDENTITY
Name

: Yoseph Wenghu

Gender

: Male

Age

: 41 years old

Admission date

: 16/02/2015

Medical record no

: 700151

ANAMNESIS
A male patient came to consult from the Outpatient Unit with dyspneu and chest pain.
The patient has experiencing it since 2 weeks ago. The patient was also experienced a
chipped-red-spots on the face region, does not itch. Initially small in the chin area and
spreads to other areas in the cheeks and eyebrows. Efflorescence: macular
erythematous, scaly (+). The patient is a patient consulted from the Internal
Departement with dyspneu and chest pain. The patient was cosulted to the Dermatology
Departement because of the existence of red spots on the eyebrows, cheeks and chin.
These complains occurred since 2 weeks ago. Pain (-), Fever (-). No history of the same
disease and have never been treated before. Family with history of the same disease (-).

CURRENT STATUS
Consciousness

: good

General Condition

: good

Hygiene

: Moderate

Nutrition

: Moderate

Vital sign

BP

: 100/70 mmHg

Pulse

: 86x/minutes

RR

: 28x/minutes

Temperature : 37,2C

DERMATO-VENEROLOGY
STATUS
Regio

: Facialis

Efflorescence : Macula erythem, Skuama

REGIO FACIALIS

DIFFERENTIAL
DIAGNOSIS
Dermatitis seboroik
Tinea facialis
Psoriasis vulgaris

DIAGNOSIS
Suspek Morbus Hansen

DERMATITIS SEBOROIK
Definition : Seborrheic dermatitis is a common mild chronic eczema
typically confined to skin regions with high sebum production and
the large body folds. Although its pathogenesis is not fully
elucidated, there is a link to sebum overproduction and the
commensal yeast Malassezia.

Clinical Features :
sharply demarcated patches or thin plaques that vary from pink yellow
to dull red to redbrown in color with bran-like to flaky greasy scales;
vesiculation and crusting may occur but are rare and mostly due to
irritation (e.g. overenthusiastic treatment)
limitation to those periods of life when sebaceous glands are active, i.e.
the first few months of life and post puberty
a predilection for areas rich in sebaceous glands, e.g. the scalp, face,
ears, presternal region and, less often, the intertriginous areas (e.g. the
axillae, inguinal and inframammary folds, and umbilicus)
a mild course with little or moderate discomfort
Treatment: topical azoles (e.g. ketoconazole), either as shampoos (scalp) or
as creams (body).
Second-line treatment options are zinc pyrithione and tar shampoos.
Hydroxypyridone ciclopirox has antifungal and anti-inflammatory activities
and has been shown to be effective as a shampoo or cream in double-blind

TINEA FACIALIS
Definition : superficial infection of the epidermis caused by dermatophites
Effloresensi: scale, annular configuration, pustules in the border

PSORIASIS VULGARIS
Skin Lesion: The classic lesion of psoriasis is a sharply marginated
erythematous papule with a silvery-white scale. Scales are lamellar,
loose, and easily removed by scratching. Removal of scale results in
the appearanceof minute blood droplets (Auspitz' sign). Papules grow
to sharply marginated plaques with lamellar scaling that coalesce to
form polycyclic or serpiginous patterns. May occur anywhere on the
body but there are classic predilection sites.
Treatment:

topical :corticosteroid, antralin, calcipotriol, derifat vit.D

topical and analog vit.A, imunomudulator topical, keratolitik terapi
(As.Salisil)
Sistemik:

metotrexat, acitretin, siclosporin,

TREATMENT PLAN
-Plan

punch iopsi

-Carmed

urea

-hidrokortison

DEFINITION AND ETIOLOGY

Definition:
Morbus Hansen is a chronic granulomatous disease caused by Mycobacterium
leprae, principally affecting peripheral nerves and skin.
Etiologi:
Mycobacterium leprae

PATOFISIOLOGI

When the bacteria M. leprae enter the body, then the body
will react issued macrophages derived from blood
monocytes. mononuclear cells and histiocytes for his
phagocytosis. Ability to phagocytosis depends on the
immune system Schwann Cells are the target cells for the
growth of M. leprae.

When going for the body's immune disorders in Schwann

cells, bacteria can migrate and air activation. As a result of
nerve regeneration activity is reduced, there is damage to
the nerves that progressiv.

CLINICAL MANIFESTATION
Lesion-tuberculoid
lepprosy
The primary skin lesion of TT:
Plaque
Central clearing
Border is sharply marginated
Elevated
Erythematous
Scaly
Dry
Hairless
Hypopigmented

 BORDERLINE
LEPROSY:
The primary skin
lesion of BB :
Annular lesions
with sharply
marginated
interior and
exterior margins.
Large plaques
with islands of
clinically normal
skin within the
plaque.

Lepromatous Leprosy
The primary skin
lesion of LL :
Poorly defined
nodules are the
most common
lesions.
Symmetrically
distributed.
Skin may be
thrown into folds,
producing leonine
facies.
Dermatofibromalike (histoid)
lesions.

WHO CLASSIFCATION
PB

MB

1. Skin lesion
( flat macule,
papule,
nodule )

1-5 lesions
Hypopigmentati
on/ erythema
Unsymmetrical
distribution
Clear lost of
sensation

> 5 lesions
The distribution
is more
symmetrical
Unclear lost of
sensation.

2. Nerve damage
( caused lost of
sensation/
weakness of
the muscles
that being
innervated by

Only 1
peripheral
nerve.

A lot of
peripheral
nerves

REGIO FACIALIS (CHIN)

REGIO FACIALIS (EYEBROWS,

CHEEKS)

TREATMENT AND MANAGEMENT

MB
Rifampisin : 600 mg once a month
Klofasimin :
300 mg/month

(observation)

50 mg/day (without observation)

DDS : 100 mg/day or 1-2 mg/kgbb without observation
Treatment for 1 year or 12 doses in 12 18 months

PB
Rifampisin & DDS as the above
Skin lession 2 5 is given 6 doses in 6-9 months
Single lesion : Rifampisin 600 mg, Ofloxasin 400 mg & Minocin
100 mg single dose.

POST TREATMENT