DISUSUN OLEH :

NUR INTAN HAYATI HK., S.Kep., Ners., M.Kep

 Kulit seperti lapisan kue anatomi ,
Kulit merupakan atau bagai kertas pembungkus yang
pembungkus yang memberikan keindahan, dan
elastis yang Where Is ? tanpanya anda tampak tidak
melindungi tubuh menarik
dari pengaruh
lingkungan 1. Organ Terberat (15% dari Tubuh) dan terluas (1.50 -
1.75m2 ) dengan ketebalan 1-2 mm paling tebal (6mm) di
telapak kaki& tangan , paling tipis di alat vital pria (0.5mm)
2. Cutaneous membrane (skin) – our largest organ,Accounts
for 7% of body weight, Divided into two distinct layers;
Epidermis, Dermis, Accessory structures,
3. Subcutaneous layer (hypodermis)

Kulit berasal dari :

Lapisan Ektoderm Embrio : Epidermis
Lapisan Mesoderm : Dermis
 FUNGSI KULIT:

1. Proteksi; Cushions and insulates deeper organs, Protects body

from abrasion, trauma, chemicals, pathogens, temperature extremes
and UV rays
2. Absorbsi, Ekskresi, pigmen, keratinisasi, Excretion and secretion
3. Pengatur suhu
4. Contains sensory receptors associated with nerve endings; Indera
perasa (panas : Badan ruffini , Dingin : badan krause, raba : badan
taktil meissner , Ranueir), tekanan : badan pacini
5. Faal pergetahan (faal sekretoris)
6. Pengatur keseimbangan cairan
7. Imunologis
8. Sintesis Vit D; Synthesis and storage of nutrients (vitamin D3)
9. Daya tarik seksual dan interaksi sosial
• Components of the Integumentary System

Figure 5-1
Kulit Dibagi Atas 3 Lapisan Pokok
yaitu :
1. Epidermis atau kutikel
2. Lapisan Dermis (Korium, Kutis
Vera, Trueskin)
3. Lapisan Subkutis (hipodermis

EPIDERMIS :
 Lapisan terluar
 Dengan aksesoris (rambut,
kuku, kelenjar sebasea, dan
kelenjar keringat )
 Epitel Gepeng dengan jenis
sel utama disebut Keratinosit
• Tidak memiliki Pembuluh
darah
 Epidermis terdiri atas 4 lapisan :
1. Lapisan basal atau stratum germinativum /Basale
2. Lapisan malpighi atau spinosum
3. Lapisan granular atau stratum granulosum (lapisan
keratohialin)
4. Lapisan tanduk atau stratum corneum
5. Stratum lusidum (langsung dibawah corneum) ada
pada tangan dan kaki
Pada lapisan ini kita dapat menemukan :
• Melanocytes - found in basal layer, manufacture and
secrete pigment
• Merkel cells - basal layer, attached to sensory nerve
endings
• Keratinocytes – Arise from deepest layer of epidermis
to stratum spinosum
Produce keratin – a tough fibrous protein
Produce antibodies and enzymes
Keratinocytes are dead at skin's surface
• Langerhans cells - stratum spinosum, part of immune
system macrophage-like
• Stratified squamous epithelium
• Several distinct cell layers
Thick skin—five layers on palms and soles
Thin skin—four layers on rest of body
• Stratum corneum
Most superficial layer
Dead, flattened (squamous) cells
Abundant keratin - Keratinized
(cornified) tough, water-resistant protein
Protects skin against abrasion and
penetration
Lapisan palinmg tebal dan kuat
Sel poligonal dan berubah jadi gepeng
Mempunyai protoplasma

• Stratum lucidum (clear layer)

Occurs only in thick skin – palms and
soles
Composed of a few rows of flat, dead
keratinocytes
Satu lapis sel-sel tanpa inti
Stratum Corneum /tanduk
Terdiri 20-25 lapis sel-sel tanduk tanpa
inti, gepeng, tipis, mati
• Stratum granulosum (grainy layer)
Consists of keratinocytes
Tonofilaments
Keratohyaline granules – help
form keratin
Lamellated granules – contain
a waterproofing glycolipid
Terdiri dari 1-4 baris sel
berbentuk intan berisi granul
keratohialin

• Stratum spinosum (spiny layer)

“Spiny” appearance caused by
artifacts of histological
preparation
Contains thick bundles of
intermediate filaments
(tonofilaments)
Resist tension
Contain protein prekeratin
Contains star-shaped Langerhans
cells
• Stratum basale
Deepest layer of epidermis
Attached to underlying dermis
Stem cells actively divide
Merkel cells – associated with sensory
nerve ending
Melanocytes – secrete the pigment
melanin
Pada Stratum basale melakukan mitosis
dan berfungsi refroduktif
Ada 2 jenis sel :
1. Sel-sel yang berbentuk kolumnar
2. Sel pembentuk melamin (melanosit) yang
berasal dari neural embrio., Melamin
berfungsi melindungi kulit terhadap sinar
matahari
Figure 5.3
• Melanocytes
Make melanin from tyrosine
Melanin provides UVprotection
Gives reddish-brown to brown-
black color
• Carotene
Contributes orange-yellow color
Provided from diet (carrots and
tomatoes)
• Hemoglobin - blood pigment
Caucasian skin contains little
melanin
Allows crimson color of blood to
show through
ACESORIS EPIDERMIS :
1. Kelenjar keringat
• Ada 2 jenis (apokrin dan ekrin )
• Fungsi : mengatur suhu
• Ekrin ada diseluruh kulit kecuali selaput
lendir, 2-5 juta, 99% mengandung
klorida,asam laktat, nitrogen,dll, sekret
encer 1,5L/24jam udara panas dan 6L/24
jam kering, Dipengaruhi oleh stress, faktor
panas, fungsi mengeluarkan keringat,
pengatur suhu.
• Apokrin bermuara di folikel rambut
(ketiak, anogenital, putting susu, areola),
sekresi kental fungsi belum jelas.
2. Kelenjar sebaseus
• Terdapat diseluruh tubuh kecuali telapak
tangan, kaki, punggung kaki
• Ada di kulit kepala, muka, kening, dagu
• Sekret berupa sebum mengandung asam
lemak dan kolesterol dan zat lain
• Fungsi memberikan lapisan lemak,
bakteriostatik dan menahan evavorasi
3. Rambut
• Terdapat diseluruh kulit kecuali
telapak tangan, telapak kai dan
bagian dorsal dari palang distal jari
tangan dan kaki, penis, labia minora
dan bibir.
• Ada 2 jenis yaitu : terminal dan velus
• Fungsi ; melindungi kulit terhadap
pengaruh buruk , pengatur suhu,
indera peraba yang sensitif.
• Terdiri dari (akar, batang, papil)
4. Kuku
• Lempeng sel tanduk
• Terdiri dari : pinggir bebas, badan,
akar
• Fungsi : mengutip benda-benda
kecil, melindungi jari tangan
• Tumbuh 1mm /minggu
• Filamentous strands of dead
keratinized cells produced by
hair follicles
• Contains hard keratin which is
tougher and more durable than
soft keratin of the skin
• Chief parts of a hair
Root – imbedded in the skin
Shaft – projects aboveskin's
surface
• Hair Shaft organized into three concentric layers
Medulla – central core
Cortex – surrounds medulla
Cuticle – outermost layer
• Pigmented by melanocytes at the base of the hair
Figure 5.7 a, b
• Root sheath extending from the epidermal
surface into the dermis
• Deep end is expanded forming a hair bulb
• Papilla - nipple-shaped indentation with
blood vessels and nerves
• Matrix - germinal layer of cells (actively
dividing cells) right above the papilla
• A knot of sensory nerve endings (a root
hair plexus) wraps around each hair bulb
• Bending a hair stimulates these endings,
hence our hairs act as sensitive touch
receptors
• Arrector pili muscle - b undle of smooth
muscle contracts to make hair stand erect
Figure 5.7c, d
• Functions of hair include:
Helping to maintain warmth
Alerting the body to presence of insects on the skin
Guarding the scalp against physical trauma, heat
loss, and sunlight
• Hair is distributed over the entire skin surface
except
Palms, soles, and lips
Nipples and portions of the external genitalia
• Occur over entire body - Except palms and soles
• Simple alveolar glands
Holocrine secretion – entire cell breaks up to form secretion
Secretes an oily substance called sebum
Most are associated with a hair follicle
• Functions of sebum
Softens and lubricates hair and skin
Skin waterproofing
Collects dirt
• Two types:
• Eccrine (Merocrine)
Most abundant sweat gland
“True sweat”
99% water with some salts
Contains traces of metabolic
wastes ~ 2% urea
Role in thermoregulation
Widely present in skin (up to
500/cm 2 )
• Apocrine
Odorous secretion
Absent before puberty
Present in axillary, areolar,
anal and genital areas
Figure 5.10b
• Scalelike modification of epidermis made of hard keratin
• Parts of the nail
Free edge
Body - d ense mass ofkeratinized cells
Root
Nail folds
Eponychium – cutic le
• Second major layer of the skin
• Provides mechanical strength, flexibility, and
protection for underlying tissues
• Highly vascular and contains a variety of sensory
receptors that provide information about the external
environment
• Two layers
Papillary layer – includes dermal papillae
Reticular layer - d eeper layer – 80% of thickness of dermis
• Flexure lines - creases on palms
• Papillary layer
Underlies epidermis
Named for dermalpapillae
Aerolar connective tissue
Supports, nourishes epidermis
Provides sensory nerves,lymphatics,
and capillaries
• Reticular layer
Tough, dense, fibrous layer
Dense irregular connective tissue
Collagen fibers - limit stretch
Elastic fibers - provide flexibility
Blends into papillary layer (above)
Blends into subcutaneous layer
(below)
• Epidermal accessory
organs
• Cells of connective
tissues proper
• Communication with
other organ systems
Cardiovascular
Lymphatic
Nervous
Sensation
Control of blood flowand
secretion
 Lapisan dermis ; Lapisan Sub Cutis :
1. Tebal melebihi epidermis 1. Jar ingan ikat longar
2. Terdiri atas pars papilarie (berisi 2. Isulator panas
syaraf dan pembuluh darah) dan 3. Berisi lemak (panikulus adipose )
pars Retikulare ( serabut penunjang 4. Berfungsi sebagai cadangan
ex : serabut kasolen, elastin, makanan
retikulin)
3. Dibentuk oleh jaringan pengikat
(kolagen dan elastis)
4. Fungsi : sentuhan, tekanan
temperatur, nyeri, dingin
• Composed of loose connective tissue - areolar and adipose
• Stabilizes skin position
Loosely attached to dermis
Loosely attached to muscle
• Contains many fat cells
Provides thermal insulation
Cushions underlying organs
• Safely receives hypodermic needles
Four Stages in Skin Healing
Inflammation
• Blood flow increases
• Phagocytes attracted
Scab formation
Cell division and migration
Scar formation
Bleeding occurs at the site of injury
immediately after the injury, and mast
cells in the region trigger an
inflammatory response.
Epidermis
After several hours, a scab has formed
and cells of the stratum germinativum are
migrating along the edges of the wound.
Phagocytic cells are removing debris,
and more of these cells are arriving with
the enhanced circulation
in the area. Clotting around the edges
of the affected area partially isolates
the region.

Scab
Migratory
Macrophages epithelial
and cells
Dermis Sweat fibroblasts
gland
Granulation
tissue
One week after the injury, the scab has
been undermined by epidermal cells
migrating over the meshwork produced by
fibroblast activity. Phagocytic activity
around the site has almost ended, and the
fibrin clot is disintegrating.
Fibroblasts
After several weeks, the scab has been
shed, and the epidermis is complete. A
shallow depression marks the injury site,
but fibroblasts in the dermis continue to
create scar tissue that will gradually
elevate the overlying epidermis.
Scar
tissue
Table 5-1
• Major Age-Related Changes
Injury and infection increase
Immune cellsdecrease
Sun protection diminishes
Skin becomes dry, scaly
Hair thins, grays
Sagging, wrinkles occur
Heat loss decreases
Repair slows
• Beneficial effect - activates synthesis of
vitamin D3
• Harmful effects
Sun burn
Wrinkles, premature aging
Malignant melanoma
Basal cell carcinoma
Vellus hairs
Body hairs of women and children
Terminal hairs
Hair of scalp
Axillary and pubic area (at puberty)
Hair thinning and baldness
Due to aging
Male pattern baldness
Classified by severity
First-degree burn – only upper epidermis is damaged
Second-degree burn – upper part of dermis is also
damaged
Blisters appear
Skin heals with little scarring
Third-degree burn
Consume thickness ofskin
Burned area appears white, red, or blackened
Figure 5.11a
Basal cell carcinoma
Least malignant and most common
Squamous cell carcinoma
Arises from keratinocytes of stratum spinosum
Melanoma
A cancer of melanocytes
The most dangerous type of skin cancer
Squamous cell carcinoma

Melanoma Figure 5.12

Epidermis
Develops from embryonic ectoderm
Dermis and hypodermis
Develop from mesoderm
Melanocytes
Develop from neural crest cells
Fetal skin
Well formed after the fourth month
At 5-6 months
The fetus is covered with lanugo (downy hairs)
Fetal sebaceous glands produce vernix caseosa
Middle to old age
Skin thins and becomes less elastic
Shows harmful effects of environmental damage
Skin inflammations become more common
 DISUSUN OLEH :
NUR INTAN HAYATI HK., S.Kep., Ners.,M.Kep
 Untuk mengetahui dan
memperoleh data dasar
tentang Kulit
Tujuan
Umum
 Untuk mengetahui adanya
gangguan pada bagian tertentu
 Untuk memperoleh data dasar
tentang riwayat kesehatan klien
dan keluhan klien

Peralatan Yang Diperlukan

 Berbeda dengan penyakit

lain, kulit dapat dilihat
langsung dengan mata
pemeriksa
 Faktor yang dapat mengganggu penampilan dan
fungsi kulit :
1. Penuaan
2. Emotional Stress
3. Injury
4. Penyakit
Langkah Pemeriksaan
Persiapan Klien
Posisi klien tergantung pada area mana
yang diperiksa, dapat duduk, terbaring,
terlentang atau berdiri.
Sebelum tindakan informasikan terlebih
dahulu tujuan tindakan
Tubuh klien dapat dilihat dengan jelas, dan
perhatikan suhu ruangan, ruangan harus
cukup luas.

Anamese (Data Subjektif)

Langkah-langkah anamnese:
Perkenalkan diri
Uraikan maksud/tujuan, isi anamnese,
dan lamanya wawancara.
Mulai dengan pertanyaan yang tidak
menakutkan,
 Kaji identitas klien meliputi :
 Nama
 Alamat : Geografis
 Jenis Kelamin
 Umur
 Bangsa
 Agama
 Pekerjaan
Alasan Masuk Rumah Sakit
Riwayat Kesehatan
 Mengenai Keluhan pokok :
1. Keluhan. Menjalarkah, apakah
hilang timbul, berapa lama, kering
atau basah, gatal atau nyeri
 Mengenai penderita dan
keluarganya
1. Apakah ada riwayat DM, TB,
Gangguan kulit yang pernah
diderita, alergi,obat-obat yang
pernah digunakan, penyakit
keturunan dan penyakit menular,
keadaan lingkungan rumah dan
pekerjaan, penggunaan kosmetik
Manifestasi klinik :
1. Adanya rasa gatal, pedih, nyeri, baal
2. Gangguan aktivitas istirahat tidur,
gangguan konsentrasi, dll
Pola Aktivitas sehari-hari (status nutrisi,
makanan kesukaan
Data Psikologis (perasaan malu, menarik
diri, poor hygiene, .
Data Sosial (pekerjaan, kondisi
lingkungan, sarana air, cara mandi)
Data Spiritual
Pemeriksaan Fisik
1. TB, BB, postur
2. Inspeksi : amati seluruh permukaan kulit
termasuk kulit kepala, rambut, kuku, mukosa
membran daerah lipatan , catat perubahan
warna, pvaskularisasi, kelembaban, edema,
lesi, integritas, kebersihan, jelaskan lokasi,
ukuran, penyebaran, tanda infeksi
 Inspeksi Secara Umum Gambaran Morfologi kulit
 Penyimpangan dari normal: Makula * Ekskoriasi
Gambaran konfigurasi Lesi:
Eritema * Ulkus
Urtikaria * Skuama
1. Anular
Vesikel * Krusta
2. Cirkuler
Pustul * Likenfikasi
3. Crustered
Bula * Gumma
4. Difuse
Kista * Eksantema
5. Linear
Abses *Telangiektasis
6. Serpingiosum
Papul * Roseola
7. Universal Nodus
8. Lesi yang menggambarkan Tumor
kanker kulit : asymetris of
shape, border ireguler, Infiltrat
colour variation within one Vegetasi
lesion, Diameter >5 m m Sikatrik
Atrofik
Anetoderma
Erosi
 KUKU
Palpasi Warna : pucat, merah, kuning, biru
Lesi Bentuk : Clumbing
Kelembaban Ketebalan
Suhu tekstur
Turgor Lesi
Tekstur
Diagnostik
Pengkajian Rambut
Inspeksi, palpsi
Laboratorium
Kebersihan Kultur (jamur, bakteri, virus)
Distribusi Biopsi kulit
Kuantitas Puch Biopsi (alat 2-6 diameter
Kualitas ditusukkan ke jaringan sampai
lemak subkutan diangkat dengan
Pengkajian Kulit Kepala forcep dan digunting)
Penebalan,
Shave biopsi (yang diangkat hanya
Kemerahan, gatal, kutu, telur kulit atas, dipotong dengan scapel
kutu, danruff
Lesi yang digerakkan secara pararel, (lesi
Eksoriasis
superfisialis, tdk dihecting)
Kekeringan Excici Biopsi (Lebih luas, ada bekas
Tenderness jahit)
Tes sensifitas
Pacth Tes ( deteksi zat alergen dalam 48-96 jam reaksi hipersensitif
Scratch Test (menyuntikkan alergen untuk lihat penyebab urtikaria,
(hati-hati anafilaktik )