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Acne,

Furuncle and
Carbuncle
Inggried
Laurel
Rachel Rosaline
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Demographics
Jerawat biasanya muncul saat pubertas dan menjadi parah
selama masa remaja.

Hampir 85 persen dari orang yang memiliki jerawat antara usia


12 sampai 25.

Sebanyak 20 juta remaja memiliki kondisi tersebut, jerawat


mungkin muncul pada awal usia 10, dan bahkan dapat
ditemukan di beberapa bayi yang baru lahir.

Bahkan beberapa orang mungkin terus dipengaruhi oleh jerawat


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setelah usia 30.
Definition
Jerawat adalah terjadinya peradangan
pada kelenjar sebaceous atau infeksi di
kulit; khususnya, kondisi yang ditandai
dengan jerawat merah pada wajah.
Jerawat adalah suatu kondisi di mana
jerawat muncul di wajah, dada, dan
punggung. Pada remaja, jerawat
biasanya muncul di dahi, hidung, dan
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dagu.
Classification
Acne vulgaris
adalah nama medis untuk
jerawat umum – adanya
komedo, whiteheads, dan
jenis-jenis jerawat pada
kulit. Tempat yang paling
umum untuk jerawat
adalah wajah, dada, bahu,
dan punggung.

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Classification
Komedo, atau basic acne
lesion, adalah tersumbatnya
folikel rambut dengan sel-sel
minyak dan kulit mati.
Comedones (jamak dari komedo)
dapat berkembang menjadi
benjolan yang disebut whiteheads
dan blackheads.

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Classification
Blackheads
adalah komedo yang
terbuka di permukaan
kulit; penuh dengan
minyak dan sel kulit mati.
Bukan kotoran yang
menyebabkan komedo
untuk berubah menjadi
hitam. Reaksi minyak ke
udara menyebabkan warna
hitam.
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Classification
Comedones yang tetap tertutup
pada permukaan kulit disebut
whiteheads. Hal ini terjadi
ketika sel-sel minyak dan kulit
penyumbatan folikel rambut dari
permukaan kulit.

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Classification
Papules adalah komedo
yang meradang, membentuk
benjolan kecil merah atau merah
muda pada kulit. Jenis jerawat
ini sensitif untuk disentuh.
Meremas jerawat bisa membuat
peradangan lebih buruk dan
dapat menyebabkan jaringan
parut (scarring) . Sejumlah besar
papula dapat mengindikasi
moderate acne sampai severe
acne. 8
Classification
Pustules adalah jenis lain
dari jerawat yang meradang;
menyerupai dengan lingkaran
merah di sekitar benjolan.
Benjolan biasanya penuh
dengan nanah putih atau
kuning. Hindari memilih atau
meremas pustula. Mengorek
dapat menyebabkan bekas luka
atau bintik-bintik gelap untuk
mengembangkan pada kulit.
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Classification
Nodules adalah
benjolan besar yang
meradang yang terasa
keras bila disentuh;
berkembang jauh di dalam
kulit dan menyakitkan

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Classification
Cysts yaitu luka nanah
yang besar, terlihat mirip
dengan bisul. Seperti nodul,
cysts menyakitkan dan harus
ditangani oleh dokter kulit.

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Classification
Mild acne
Acne falls into the "mild"
category if you have fewer
than 20 whiteheads or
blackheads, fewer than 15
inflamed bumps, or fewer than
30 total lesions..

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Classification
Moderate Acne
If you have 20 to 100
whiteheads or blackheads, 15
to 50 inflamed bumps, or 30
to 125 total lesions, your acne
is considered moderate.

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Classification
People with severe
nodulocystic acne
have multiple inflamed
cysts and nodules. The acne
may turn deep red or purple.
It often leaves scars.

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Classification
Acne conglobata is
one of the most severe forms
of acne. It involves many
inflamed nodules that are
connected under the skin to
other nodules. It can affect
the neck, chest, arms, and
buttocks. It often leaves
scars.

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Classification
Acne mechanica is
caused by heat, friction, and
pressure against the skin, often
the result of wearing sports
gear such as a helmet or
baseball cap. It is sometimes
called "sports-induced acne"
because it occurs frequently in
athletes. Preventive measures
include wearing an absorbent
material under sports
equipment and showering
immediately after activity.
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Etiology
• Localized skin inflammation as a result of overactivity of
the oil glands at the base of specialized hair follicles.
• It is caused by the overproduction of sebum.
• Acne is triggered by the hormonal changes that occur in
puberty. During puberty, there are increased levels of the
male hormone androgen.
• Sometimes the sebum combines with dead, sticky skin
cells and bacteria called Propioni-bacterium acnes (P.
acnes) . The mixture of oil and cells allows the bacteria to
grow in the plugged follicles.
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Etiology
There are several risk factors that make acne more likely to
occur:
Age.
Disease.
Hormonal changes.
Heredity.
Drugs.
Cosmetics.
Other factors can worsen acne or cause it to flare up:
Environmental irritants.
Friction. 18
Personal hygiene.
Pathophysiology

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Pathophysiology

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Pathophysiology
Oil (sebaceous) glands, produce and secrete oil through
openings in the skin, called sebum (natural skin moisturizer).
Death cells that are close to the openings of the oil glands block
the openings.
Bacteria, which live in everyone's skin feast on this oil, multiply,
and cause the surrounding tissues to become inflamed if the
follicle ruptures.

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Diagnosis
• Acne can be diagnosed by physical examination and a
medical history of acne, including information about skin care,
diet, medications, factors that can cause flare-ups, and prior
treatment.
• Blood tests are not usually necessary unless a hormonal
disorder is suspected.
• Physical examination will include the face, neck, shoulders,
back, and other affected areas. Using specialized lighting to
examine the affected areas to see the following:
what type and how many lesions are present
how deep the lesions are
whether they are inflamed
whether scarring or skin discoloration is present 22
Test Diagnostic
Hormonal evaluation
Elevated total testosterone, dehydroepiandrostenedione
sulphate (DHEA-S), luteinising hormone (LH), follicle stimulating
hormone (FSH).

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Test Diagnostic
Bacterial culture
positive culture of gram bacteria
• Ordered only when standard treatments are not efficacious
and there is clinical suspicion of gram-negative folliculitis.
• Sample should be collected from multiple inflammatory
lesions and also from a pustule if present.

No tests are necessary for most patients with acne. Tests may
be requested to look for infection, to investigate the cause of
the disease, or to monitor treatment.
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Treatment
Acne treatment consists of reducing the sebum production, removing dead skin
cells, and killing bacteria with oral medication and drugs used on the skin
(topical).

TOPICAL (SKIN) MEDICATION


• Treatment for mild noninflammatory acne consists of reducing the formation of
new comedones with medications including topical tretinoin, benzoyl peroxide,
adapalene, or salicylic acid. If lesions are inflamed, topical antibiotics may be
added to the treatment regimen.
• Topical medications are available as cream, gel, lotion, or pad preparations of
varying strengths. They include antibiotics (to kill bacteria) such as erythromycin,
clindamycin (Cleocin-T), and meclocycline (Meclan); and comedolytics (agents
that loosen hard plugs and open pores) such as the vitamin A acid tretinoin
(Retin-A), salicylic acid, adapalene (Differin), resorcinol, and sulfur.
Drugs that act as both comedolytics and antibiotics, such as benzoyl peroxide,
azelaic acid (Azelex), or benzoyl peroxide plus erythromycin (Benzamycin), are
also used.
• After the person washes with mild soap, the drugs are applied alone or in
combination, once or twice a day over the entire affected area of skin. Possible 25
side effects include mild redness, peeling, irritation, dryness, and an increased
sensitivity to sunlight that requires use of a sunscreen.
Treatment
ORAL DRUGS
• Oral antibiotics are taken daily for two to four months. The drugs used
include tetracycline, erythromycin, minicycline(Minocin), doxycycline,
clindamycin (Cleocin), and
• The goal of treating moderate acne is to decrease inflammation and
prevent new comedones from forming. One effective treatment is
topical tretinoin, used along with a topical or oral antibiotic.
• A drug reserved for the treatment of severe acne,
oral isotretinoin (Accutane), reduces sebum production and cell
stickiness.
• Anti-androgens are used to treat women who are unresponsive to other
therapies. Certain types of oral contraceptives (for example, Ortho-Tri-
Cyclen) and female sex hormones (estrogens) reduce hormone activity
in the ovaries. Other drugs (for example, spironolactone and
corticosteroids) reduce hormone activity in the adrenal glands.
• Oral corticosteroids, or anti-inflammatory drugs, are the treatment of
choice for an extremely severe, found mostly in adolescent males. Acne 26
conglobata is treated with oral isotretinoin and corticosteroids.
Treatment
Several surgical or medical treatments are available to alleviate
acne or the resulting scars:
• Comedone extraction. The comedo is removed from the pore
with a special tool.
• Chemical peels. Glycolic acid is applied to peel off the top
layer of skin to reduce scarring.
• Dermabrasion. The affected skin is frozen with a chemical
spray and removed by brushing or planing.
• Punch grafting. Deep scars are excised and the area repaired
with small skin grafts.
• Intralesional injection. Corticosteroids are injected directly
into inflamed pimples.
• Collagen injection. Shallow scars are elevated by collagen 27
(protein) injections.
Prevention
There are no sure ways to prevent acne, but the following steps
may be taken to minimize flare-ups:
• gentle washing of affected areas once or twice every day
• avoiding abrasive cleansers
• using noncomedogenic (does not clog pores) makeup and
moisturizers
• shampooing often and wearing hair off the face
• eating a well-balanced diet, avoiding foods that trigger flare-
ups
• unless told otherwise by the healthcare provider, giving dry
pimples a limited amount of sun exposure
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• not picking or squeezing blemishes
Nursing Diagnosis
1. Acute Pain / Chronic Pain related to the inflammatory process

Intervention:
Observation of the patient's pain level (0-10 scale)
• Teach patient distraction techniques, relaxation
• Give a comfortable position
• Collaboration of analgesic
Rational
Knowing the degree of pain
• Distraction, relaxation can help relieve pain
• Provide comfort to the patient so as to reduce the perceived
pain
• Giving analgesics can help relieve the patient's degree of pain. 29
Nursing Diagnosis
2. Disturbed Body Image related to the state of the wound

Intervention
• Observation meaning changes experienced by the patient.
• Involve the family or significant others in care.

Rational
Knowing the patient's feelings about the situation and control
his emotions.
• Support the family and those closest to accelerate the
healing process.
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Nursing Diagnosis
• 3. Knowledge Deficit related to lack of information about the disease

Intervention
• Discuss about skin care, for example: use a moisturizer and sun
protection.
• Provide information about hygiene, disease prevention and
treatment.
• Emphasize the importance of evaluating treatments.

Rational
Improve self-care after discharge and independence.
• Increase patients' knowledge.
• Continue long-term support and therapy changes are needed 31
to achieve optimal healing.