Kelainan Adneksa Kulit

Dr. ISMIRALDA OKE PUTRANTI, SpKK

Dep/KSM IK Kulit dan Kelamin
FK UNSOED / RSMS
2017
Kelainan Adneksa Kulit

• Kelenjar :
• Sebasea  Acne >, erupsi acneiformis, rosasea, dermatitis perioral
• Ekrin  Hiperhidrosis, anhidrosis
• Apokrin  bromhidrosis, kromhidrosis, Hidradenitis supurativa
• Rambut  Keratosis pilaris,ggn pertumbuhan rambut
• Kuku  Perubahan warna, lempeng kuku
Acne

• Acne  Kelainan pilosebasea yg plg sering tjd

• >> adolesen (remaja), pubertas
• Patogenesis
1. Hiperproliferasi epidermis folikuler 
pembentukan mikrokomedo
2. Produksi sebum >>  Sebum tdr dr trigliserid dan
lipoperoksidase. TG didegradasi P.acnes  asam
lemak bebas  kolonisasi >>. Lipoperoksidase 
proinflammasi  aktivasi kel. Sebasea 
produksi >>
3. Kolonisasi bakteri Propionibacterium acnes
4. Inflamasi  krn sumbatan folikuler ruptur/peran
P.acnes
• Gambaran Klinis Whitehead
comedo
Non Inflamasi
Blackhead
Comedo

Klinis Papul, nodul,

Inflamasi
kista

Ice pick, box,

Scar rolling
hipertrofik
• Terapi :
• Topikal :
• sulfur/resorsinol,
• asam salisilat 0,5-2%,
• asam azelaic 15-20% 
komedolitik dan antimikroba,
aman utk bumil
• Benzoilperoksida  antimikroba,
hidrolisis trigliserida
• AB topical  eritromisisn,
klindamisin
• Retinoid  komedolitik,
antiinflamasi, antiproliferative
• Injeksi intralesi Triamsilonon
aseotinid
• Terapi sistemik :
• Antibiotik :
• tertrasiklin (doksisiklin 2x50-100mg; minoksiklin 2x100-200mg)
• Makrolid  eritromisin (bumil & anak2), azitromisin 250-500mg 3x/mgg
• Klindamisin
• Hormonal
• Kontrasepsi oral 
• Menekan produksi LH menurunkan produksi androgen gonad
• Menurunkan kadar testosterone bebas dg meningkatkan produksi globulin pengikat
testosterone
• Menghambat aktivitas 5-alfa-reductase  menghambat konversi testosterone menjadi
DHT
• Progestin menghambat reseptor androgen pada keratinosit dan sebosit
• Steroid  terbatas pada acne berat
• Antiandrogen  spironolactone (2x50-100mg)
• Isotretinoin  tu. Acne nodular, rekalsitran
• Non-medikamentosa
• Ekstraksi komedo
• Laser/ fototerapi
Erupsi Acneiformis

• Acne steroid  muncul pasca terapi steroid sistemik (2mgg),

sebaran lesi lbh byk di area badan
• Drug induced acne  phenytoin, lithium, isoniazid, vit Bcom dosis
tinggi, halogenated compounds, and kemoterapi

• Non komedonal
Rosacea

• Kelainan kulit yg ditandai dengan kemerahan pada wajah (flushing)

• Etio dan patogenenis  blm jelas
• Reaktivitas vascular
• Komposisi dermal, matriks dan pilosebasea
• Kolonisasi bakteri : P.acnes, Demodex follicularum,
• Faktor pencetus :
• Cuaca panas dan dingin
• Paparan sinar matahari, angin panas
• Minuman panas, alkohol, makanan pedas
• Olah raga
• Kosmetik, paparan bahan kimia iritan
• Obat2an
• Gambaran Klinis:
• Eritematoteleangiotacic
Rosacea (ETR)  flushing
persisten dg teleangiektasis,
central face edema, rasa
terbakar dan tersengat,
kasar dan bersisik.
• Papulopustular Rosacea
(PPR)  flushing minimal,
kemerahan di pertengahan
wajah terutama area
convex,
• Phymoatous Rosacea (PR)
 penebalan kulit,
bernodul-nodul dan
penutupan orifisium
folikel, contour irregular
pada area convex
• Ocular Rosacea  muncul
sblm manif kulit.
• Granulomatous Rosacea  pembentukan
granuloma
• Terapi :
• Topikal : as. Azeleat 15%,
metronidazol1%, tretinoin
• Sistemik : Doksisiklin,
tetrasiklin,minoksiklin
isotretinoin
 13
Dermatitis Perioral

• Dermatitis yang bersifat kronik

residif
• Etiologi :
• Tidak diketahui pasti
• Pemakaian kortikosteroid topikal
• Pasta gigi fluorinated, kosmetik
• Faktor fisik : sinar UV, panas, angin
• Mikrobiologi: bakteri jamur Candida
• Hormonala
• >> wanita & anak2
• Gejala : gatal dan panas • Papul kemerahan, gatal, kering
• Terapi : antibiotic topical,
moisturizer
Hiperhidrosis

• Produksi keringat >> Bentuk Klinis :

• Hyperhidrosis  excessive sweat production
• Primary Hyperhidrosis  focally on hands, face,
underarms and feet), without apparent reason,
anxiety >>
• Secondary Hyperhidrosis  generalized, during sleep
• Hormonal : pregnancy, DM, Hyyperthyroidism,
Menopause
• Obesity
• Parkinson’s disease
• Rheumatoid arthritis, Gout
• Lymphoma
• Infection
• Primary focal Hyperhidrosis
• >> keringat berlebih di telapak tangan.kaki > 6bln
• Dengan minimal 2 tanda berikut :
• Bilateral simetris
• Keringat >> mengganggu aktivitas
• Frek min 1 episode/mgg
• Onset pada usia <25 th
• Adanya riwayat keluarga
• Keringat >> saat tidur
• Terapi :
• Topikal : Aluminium klorida heksahidrat / glikopirolat
• Hiperhidrosis Sekunder Lokalisata
• Etio :
• Gustatory sweating
• Gangguan metabolik  GH def
• Keganasan  Limfoma Hodgkin

• Hiperhidrosis Generalisata
• Etio : obat-obatan
Hypo/Anhidrosis

• Produksi keringat berkurang/bahkan tidak berproduksi

• Etiologi :
• Kongenital
• Infeksi : MH
• Kerusakan akibat agen fisik  trauma, skar, tekanan, radiasi
• Obat2an  BTXA, dll
• Sumbatan kel ekrin  milia
• Gangguan komposisi kel keringat  dermatitis atopik, fibrosis kistik
Kelainan Kel. Apokrin

• Bromhidrosis
• Bau menyengat, tidak enak
• Axilla >>
• Treatment :
• Penggunaan antiperspirant/deodorant
• Inj BTXA, laser NdYAG
• Reseksi kel apokrin

• Chromhydrosis
• Keringat berwarna
Hair Disorders

• Colour changes
• Hair colour  eumelanin & pheomelanin
• Nomal hair colour  race associated

Condition affecting hair colour changes :

• Grey-white
• Aging  ec depigmentation (canitis)
• Genetic  albinism, piebaldism, vitiligo
• Thyroid deficiency,
• Waardenburg’s syndrome, Vit B12 def
• Stress  premature achromotrichia
• Reddish/blondish hair  lighter, thinner and brittle malnutrition
• Other  artificial hair coloring
Hair Shedding (hair loss) and Alopecia 20
• Normal hair shedding  50 – 150 hairs/day
• Excessive hair shedding  hair loss  alopecia
• Etiology :
• Telogen effluvium (hair shedding in telogen phase)
 when some stress causes hair roots to be pushed
prematurely into the resting state  with small
hair bulb
• 2 -3 months following provocating event “shock
event”
• Shock events  Parturition, sudden weight loss,
blood loss, fever, stress; Drugs
• Diffuse hair loss  hair thinning
• Pull test  easily plucked from the scalp
• Fully reversible
• Pathogenesis :
• Shock environmental  follicles decide into
resting state
• Longer resting state  chronic TE
• Hair follicles don’t stay in resting state 
truncated growth cycle
• Anagen effluvium (hair shedding
in anagen phase)  insulted
hair follicles  impairs 21
mitotic/metabolic activity  no
hair bulb
• >> chemotherapeutic agents 
alkylating agent,
antimetabolites, mitotic
inhibitors
• Inhibition /arrest of hair
matrix  narrow and
weakened hair segment 
easily fracture with minimal
trauma
• Complete failure in hair
formation  hair bulb
damage  hair separated
then fall out
• Alopecia areata 
autoimmune disease
• Inflammatory insult the hair
matrix
 Alopecia 22

• Absence / loss of hairs

• Chronic disorder
• Secondary to disease of hair
follicles, hair shaft or scalp

• Classification :
• Non Cicatrical Alopecia
• Cicatrical Alopecia
 23

Androgenetic alopecia
Excessive Hair 24
• >> hair growth
• Hirsutism :
• Excessive hair growth on female (darker skinned
European/Middle eastern)
• Male pattern hair growth (beard, chest, nipples, pubic
hair)
• Vellus convertion to terminal hair induced by androgen
• Etio : endogen (adrenal, pituitary or ovarian origin);
exogen (androgenic drugs-steroid)
• Excessive androgen also found in virilism, amenorrhea,
infertility

• Hypertrichosis
• Congenital  congenital hairy naevi, hyoerthrichosis
lanuginose, familial hyperthrichosis)
• Aquired  medication (cyclosporine, minoxidil,
antiepileptics); diseases (hypercorticism, hypothyroidism,
porphyria cutanea tarda, anorexia nervosa)
Hair shaft abnormalities 25
IRREGULARITIES
• Monilethrix (beaded hair)
• rare autosomal dominant hair disease
• short, fragile, broken hair that appears
beaded.
• It comes from the Latin word for necklace
(monile) and the Greek word for hair
(thrix).

• Pili annulati (Ringed hair)

• genetic trait in which the hair seems
banded by alternating segments of light
and dark color when seen in reflected
light
• Woolly hair
• Congenital abnormality 26
• Extreme kinkiness of the hair

• May associated with syndrome :

• Carvajal syndrome  woolly hair,
cardiomyopathy, palmoplantar keratoderma
• Naxos disease  woolly hair, arithmogenic right
ventricular cardiomyopathy, palmoplantar
keratoderma
• Menkes disease  woolly hair, filure growth,
neurologic symptoms

• Pili torti (Twisted hair)

• short and brittle hairs that appear flattened
and twisted
 27
• Trichothiodystrophy
• autosomal recessive inherited
disorder characterised by brittle hair
and intellectual impairment, with or
without photosensitivity
FRACTURES
• Trichorrhexis nodosa
28
• efect in the hair shaft characterized
by thickening or weak points (nodes)
that cause the hair to break off easily
• Causes : genetic, environmental
(perming, blow drying, aggressive hair
brushing,excessive chemical exposure)
• Symptoms :
• lack of apparent hair growth
• hair appears patchy
• hair breaks easily close to scalp
• hair may have thickenings or nodes in
the shaft
• ends of hair thinned or split
• whitish discoloration of hair tips
• hair breaks easily at tips
• Trichorrhexis invaginata (bamboo
hair) 29
• Autosomal recessive
• Sporadically distinctive hair shaft
abnormality that may occur,
• Regularly as a marker for Netherton's
syndrome
• Primary defect  abnormal
keratinization of the hair shaft in the
keratogenous zone,  intussusception of
the fully keratinized and hard distal shaft
into the incompletely keratinized and
soft proximal portion of the shaft
• Trichoschisis 30
• Congenital hair defect
• Low Sulphur content
• Localized absence of the cuticle at the site of
fracture

• Trichoclasis
• hair breakage that is seen as a clean fracture across
the hair fiber.
• Secondary to hair conditions that make hair fiber
weak such as trichothiodsytrophy.
• Bubbled Hair
• Hair fiber contain minute air filled
(vacuoles)
31
• The vacuoles may fill with water
• Over bow drying  too much heat 
water in hair fibers vaporizing 
force spaces inside the fibres  hair
sponge like structure
• These damaged hairs are weak and
brittle as the bubbles destroy the
integrity of the fiber. The hair may be
kinked, break off.

• Split Ends
• Trichoptilosis  “arranged like
feathers” hair / Schizotrichia
• Causes  Thermal, chemical or
mechanical stress
• Pili Bifurcati
• abnormal branching of the hair shaft.
• This can occur at multiple points.
32
• The branches often fuse together again further
up the shaft.
• Each branch has its own cuticle.

• Pili Multigemini
• multiple hair shafts bunched together and
emerging from one follicle (like a toothbrush or
doll's hair)
STRUCTURE CHANGES
• How is healthy nail?
OF NAILS 33
• smooth, without ridges or grooves (although
these are often normal variants).
• Uniform in color and consistency and free of
spots or discoloration
• Nail structure
A.Nail plate;
B.lunula;
C.root;
D.sinus;
E.Matrix  producing cell become nail plate
F.nail bed;
G.hyponychium;
H.free margin
Abnormalities of the nail plate surface
• Pitting 34
• Ice pick like depression on nails
• defective development of the layers of the
superficial nail plate
• >> psoriasis, alopecia areata, sarcoidosis,
eczema

• Transverse Ridging (Beau’s line)

• Horizontal groove of the nail
• occur when the nail matrix is injured and the
growth of the nail is slowed
• usually transient and due to a temporary
disturbance of nail growth
• Causes : injury, eczema, Habit Tic Deformity,
subungual hematoma, paronychia, onychia,
CTS
• Onychorrhexis (Brittle nails)
• Longitudinal ridging
• Dryness of the nails  genetic predisposition, 35
ageed people, dry air

• Disorder related brittle nail :

• Hypothyroidism
• Raynaud’s phenomenon
• Psoriasis
• Endocrine disorder
• Malnutrition
• Predisposition factors :
• frequent handwashing, which may be
associated with the person's job
• prolonged exposure to cold, dry weather
• sunburn or windburn
• excess exposure to chemicals, such as
nail polish remover
• Repeated injury to the nail tip can also
lead to brittle nails.
• Median Canaliform Dystrophy
• midline or a paramedian ridge or
split and canal formation in the 36
midline of the nail plate of one or
both the thumb nails
• Intentional trauma in the form of
pushing back of cuticle and proximal
nail fold (habitual tic)

• Median Nail dystrophy

• Feathered longitudinal ridge
• Onychogryphosis
• Thickening of the nail plate, (big toes of
the elderly >>)  claw like, ram’s horn 37
nail
• associated with injury to the foot, badly
fitting shoes or poor blood supply
• occurs due to neglect and failure to
properly trim and care for the nails,
repetitive trauma to the nail or nail
beds

• Onychauxis
• Nail thickening  hyperkeratotic
• Causes : congenital, trauma due to
improperly fitted shoes, diabetes,
psoriasis, nutritional def.
• Angel wing deformity
• Thinning of the nail plate
• Causes : drug side effect, disease
38
(lichen planus)

• Trachyonychia (rough nails)

• 20-nails dystrophy
• Vertical ridging, rough and pitted
• Colour muddy brown to greyish white
• Associated with eczema, lichen planus,
alopecia areata, psoriasis, ichtyosis.
Nail discolorations 39
• Green nail  pseudomonas infection
• Blue nails  side effect of anti-malarial drugs
• Black Nails 
• Peutz-Jeghers syndrome, vitamin B12 deficiency and post-
irradiation.
• Black streaks may indicate a junctional melanocytic naevus or
malignant melanoma.
• White Nails (Leuconychia)
• congenital or due to minor trauma,
• hypoalbuminaemia in chronic liver disease, renal failure,
• fungal infection or lymphoma.
• Yellow nails syndrome
• slow-growing, excessively curved and thickened yellow nails
• associated with peripheral lymphoedema and exudative pleural
effusions.
40
• Red and white streaks
• Darier’s disease
41
• Red purple streaks
• Haemorrhagic splinter

• Purple black
• Hematoma

• Onycholysis
• White yellow distal nail, lifted
 42

Abnormality
of the cuticle
and nail fold
43
44
Nail Shaped
• Clubbing fingers
Changes 45
• increase in the soft tissue of the distal part of the
fingers or toes
• Causes :
• Cyanotic congenital heart disease, infective
endocarditis.
• Lung cancer, pulmonary fibrosis, cystic fibrosis,
bronchiectasis, empyema, lung abscess

• Koilonychia
• Dystrophy of the fingernails in which they are
thinned and concave with raised edges (spoon-
shaped nails).
• May be due to iron deficiency or trauma.
46