PENGANTAR

SISTEM INTEGUMEN

Oleh:
Dr. Winawati E.P, SpKK
 ANATOMI KULIT
• Lapisan kulit:
1. Lapisan epidermis/kutikel
2. Lapisan dermis
3. Lapisan subkutis (hipodermis)
• Lapisan epidermis
1. Stratum korneum (lapisan tanduk)
2. Stratum lusidum
3. Stratum granulosum (lapisan keratohialin)
4. Stratum spinosum (stratum malphigi)
5. Stratum basale
• Lapisan dermis
1. Pars papilare (ujung serabut saraf dan pembuluh
darah)
2. Pars retikulare (serabut kolagen, elastin dan
retikulin)
• Lapisan subkutis
Jaringan ikat longgar berisi sel lemak
• Adneksa kulit
1. Kelenjar kulit-dermis
a. Kelenjar keringat (glandula sudorifera)-ekrin dan
apokrin
b. Kelenjar sebasea/holokrin-kec.telapak tangan dan kaki
2. Kuku
- Bagian terminal lapisan tanduk menebal
- Tumbuh 1 mm/minggu
3. Rambut
a. Lanugo (rambut halus, pigmen -, >>bayi)
b. Terminal (rambut lebih kasar, pigmen +, dewasa)
 FAAL KULIT
• Fungsi kulit:
1. Proteksi
- gangguan fisik dan mekanis
- bantalan lemak, tebalnya lapisan kulit, serabut jaringan
penunjang
-Melanosit-thdp sinar matahari
-sifat stratum korneum impermeabel
-pH kulit 5-6,5-dari produk kelenjar lemak dan keringat
2. Absorbsi
- Dipengaruhi tebal tipis kulit, hidrasi, metabolisme dan jenis

vehikulum
3. Ekskresi
- Mengeluarkan sisa metabolisme NaCl, urea, asam urat dan
amonia
4. Persepsi
- Ujung saraf sensorik dermis dan subkutis
- Panas-Ruffini, dingin-Krause, raba-Meissner, Ranvier,
tekanan-
Paccini
5. Pengaturan suhu tubuh
-Berkeringat dan mengerutkan pembuluh darah kulit
6. Pembentukan pigmen
-Lapisan basalmelanosit
-dipengaruhi: tebal tipis kulit, reduksi Hb, oksiHb, karoten
7. Keratinisasi
-Lapisan epidermis
- Berlangsung 14-21 hari
- Perlindungan secara mekanis fisiologik
8. Pembentukan vitamin D
- Mengubah 7 dihidroksikolestrol dg bantuan matahari
 Ax
dermatolo
gik
Pemeriksaan fisik dermatologik
EFLORESENSI KULIT
Macule

A macule is a localized area of

colour change in the skin.
Macules can be hyperpigmented,
hypopigmented, or erythematous.
Papule

• Papule is a solid,
elevation of the skin
less than 0.5 cm in
diameter.
Plaque

• Plaque is a solid plateau-like

elevation of the skin, more
than 0.5 cm in diameter.
Nodule
• Nodule is a solid, round or
ellipsoidal, palpable lesion that has
a diameter larger than 0.5 cm.
• Depth of involvement and/or
substantive palpability (rather
than diameter) differentiates a
nodule from a large papule or
plaque.
 • Wheal or hives or urtica is
Wheal a swelling of the skin,
usually disapearing within
hours. These lesions are
the result of edema in the
upper portion of the
dermis.
• Angioedema is a deeper,
edematous reaction that
occurs in the area with
very loose dermis and
subcutaneous tissue (lips,
eyelid, or scrotum).
Vesicle and bulla
• A vesicle is a clear fluid- filled
cavity or elevation smaller
than or equal to 0.5 cm (b),
whereas a bulla (blister)
measures larger than 0.5 cm
(a).
Pustule
• Pustule is a circumscribed,
raised cavity in the
epidermis or infundibulum
containing pus.
Erosion

• Erosion is a moist,
circumscribed, usually
depressed lesion that
results from loss of a
portion or all of the
viable epidermis.
Fissures
Fissure is a linear loss of
continuity of the skin's
surface or mucosa that
results from excessive
tension or decreased
elasticity of the involved
tissue.
Ulcer
• Ulcer is a defect in which the
epidermis and at least the
upper (papillary) dermis has
been removed. The defect heals
with scarring.
• Borders of the ulcer may rolled,
undermined, punched out, or
angular.
• The base may be clean, ragged,
or necrotic.
• Discharge may be purulent,
granular, or malodorous.
• Surrounding skin may be red,
indurated, sclerotic.
Crust

• Crusts are hardened

deposits that result when
serum, blood, or purulent
exudate dries on the surface
of the skin.
• Removal of the crust may
reveal an underlying
erosion or ulcer.
Scale

• Scale is flat plate or flake

arising from the outer-most
layer of the stratum
corneum.
Cyst

Cyst is an encapsulated cavity

or sac lined with a true
epithelium that contains fluid
or semisolid material (cells
and cell products such as
keratin).
Atrophy
• Atrophy refers to a
diminution in the size of a
cell, tissue, organ, or part of
the body. A decrease in the
number of epidemal cells
results in thinning of the
epidermis.
Lichenification

Lichenification is an area of
thickened skin with accentuated
skin markings, induced by
repeated rubbing.
Excoriations

Excoriations are surface

excavations of epidermis
that result from scratching
and are frequent findings in
patients experiencing
pruritus.
Scar

• A scar arises from

proliferation of fibrous
tissue that replaces
previously normal collagen
after a wound or ulceration
breaches the reticular
dermis.
• A scar may be hypertrophic
(A) or atrophic (B)
• Erythema is blanchable change in colour of skin due to
dilatation of arteries and veins in the papillary and reticular
dermis.

• Telangiectases are persistent dilatations of small capillaries in

the superficial dermis, that may or may not disappear with
diascopy.

• Purpura is a reddish-purple lesion caused by extravasation od

red blood from cutaneous vessels into skin or mucous
membranes

• Petechiae are small, pinpoint purpuric macules.

• Ecchymoses are larger, bruise-like purpuric patches.

• Infarct is an area of cutaneous necrosis resulting from occlusion

of
blood vessels in the skin, as in vasculitis and bacterial embolism

• Tumor is a general term for any mass, benign or malignant, and

is sometimes used to indicate a large nodule.
Telangiectasia Purpura

Infarct
eritem
Shape or configuration of skin lesions

1. Annular : ring-shaped; implies that the edge of the lesion differs

from the center, either by being raised, scaly, or differing in color
(e.g : granuloma annulare, tinea corporis).

2. Round/nummular/discoid: coin-shaped; usually a round to

oval lesion with uniform morphology from the edges to the
center
(e.g : nummular eczema, plaque-type psoriasis, discoid lupus).

3. Polycyclic : formed from coalescing circles, rings, or incomplete

rings (e.g : tinea corporis)

4. Arcuate : arc-shaped; often a result of incomplete formation of an

annular lesion (e.g : urticaria, subacute cutaneous lupus
erythematosus).
5.Linear : resembling a straight line; often implies an external
contactant or Koebner phenomenon has occurred in response to
scratching.
single lesion (e.g : a scabies burrow, poison ivy dermatitis)
multiple lesions (e.g : lichen nitidus or lichen planus).

6.Reticular : net-like or lacy in appearance, with somewhat

regularly spaced rings or partial rings and sparing of intervening
skin (e.g., livedo reticularis, cutis marmorata).

7.Serpiginous : serpentine or snake-like

(e.g : cutaneous larva migrans).

8.Targetoid : target-like, with at least three distinct zones

(e.g : erythema multiforme)

9.Whorled : like marble cake, with two distinct colors interspersed

in a wavy pattern; usually seen in mosaic disorders in which cells
of differing genotypes are interspersed
(e.g : incontinentia pigmenti, hypomelanosis of Ito)
Arrangement of Multiple Lesions
1. Grouped/herpetiform : lesions clustered together (e.g :
herpes zoster).
2. Scattered : irregularly distributed.
 Distributions of Multiple Lesions
1. Dermatomal/zosteriform : unilateral and lying in the
distribution of a single spinal afferent nerve root. (e.g : HZ).

2. Blaschkoid : following lines of skin cell migration during

embryogenesis; generally longitudinally oriented on the limbs
and circumferential on the trunk, but not perfectly linear.
Implies a mosaic disorder (e.g : incontinentia pigmenti).

3. Lymphangitic : lying along the distribution of a lymph vessel

e.g : cellulitis due to a staphylococcal or streptococcal infections.

4. Sun exposed : occurring in areas usually not covered by

clothing, namely the face, and dorsal hands (e.g :
photodermatitis, polymorphous light eruption, squamous cell
carcinoma).

5. Sun protected : occurring in areas usually covered by one or

more layers of clothing. (e.g : parapsoriasis, mycosis fungoides).

6. Acral : occurring in distal locations, such as on the hands, feet,

wrists, and ankles (e.g : palmoplantar pustulosis, chilblains).
Lesions in the distribution
described by Blaschko for Scattered lesion.
developmental
7.Truncal : occurring on the trunk or central body.

8.Extensor : occurring over the dorsal extremities, overlying the

extensor muscles, knees, or elbows (e.g., psoriasis).

9.Flexor : overlying the flexor muscles of the extremities, the

antecubital and popliteal fossae (e.g : atopic
dermatitis).

10.Intertriginous : occurring in the skin folds : axillae, inguinal

folds, inner thighs, inframammary skin. (e.g., candidiasis).

11.Localized : confined to a single body location (e.g., cellulitis).

12.Generalized : widespread. (e.g., viral exanthems, drug

eruption).

13.Bilateral symmetric : occurring with mirror-image symmetry

on both sides of the body (e.g., vitiligo, plaque-type psoriasis).

14.Universal : involving the entire cutaneous surface. (e.g.,

Shape and arrangement of lesions
TERIMA KASIH