+ PSORIASIS

Definisi peradangan kulit kronik dg karakteristik perubahan

pertumbuhan dan diferensiasi sel2 epidermis disertai
manifestasi vaskular dan adanya pengaruh sistem saraf
Etiopatoge Dasar genetik dan autoimun (tipe 1: < 40thn, tipe 2: >
nesis 40thn)  reaksi inflamasi
Faktor - Predisposisi genetik
pencetus - Kimiawi, mekanik, termal mekanisme koebner
- Obat (beta blocker, ACE-Inhibitor, antimalaria, litium,
NSAID, Gemfibrozil)
histopatolo Psoriasis plakat matur :
gi - Akantosis dg penebalan/penipisan epidermis diatas
papilla dermis
- Ujung rete ridge berbentuk gada yg saling
bertautan
- Hiperkeratosis/parakeratosis dg.
Berkurang/menghilangnya str.granulosum
Psoriasis matang :
- Limfosit dermis dan epidermis
- Migrasi sel radang granulosit-neutrofilik
FKUI. Ilmu Penyakit Kulit dan Kelamin
 + PSORIASIS
Psoriasis Makula eritematosa dikelilingi
Plakat woronoff’s ring linier (psoriasis
gurata), psoriasis annular, psoriasis
folikular

Psoriasis - Lesi papul eruptif warna merah

Gutata salmon menyebar scr sentripetal
- Pencetus: infeksi streptokokus
beta hemolitikus (faringitis,
laringitis, tonsilitis)
- Predileksi: badan, ekstremitas,
kepala

FKUI. Ilmu Psoriasis - Kulit merah, nyeri, meradang

Penyakit Pustulosa dengan pustul milier diatasnya
Kulit dan lake of pustules mengering dan
Kelamin
krusta lepas: lapisan merah
Fitzpatrick terang
s. Atlas of - Pencetus: putus obat
dermatolo kortikosteroid
gy
+ PSORIASIS
Eritroderma - Lesi terbagi 2: psoriasis plakat, psoriasis
vulgaris
- Pencetus: infeksi, obat, putus obat
kortikosteroid
- Kegawatdaruratan o.k: terganggunya
sistem panas tubuh, payah jantung,
kegagalan fx. Hati dan ginjal
- Kulit eritema difus, demam menggigil,
malaise

Psoriasis - yellowish-discoloration
Kuku - Oil-spots
- Onikolisis
FKUI. - Hiperkeratosis subungual
Ilmu - crumbling – splinter hemorraghia
Penyakit
Kulit
dan
Kelamin
Psoriasis Predisposisi: gangguan sendi (artritis
Fitzpatri
Artritis perifer, entesitis, tenosinovitis, nyeri tulang
cks. belakang, artalgia non-spesifik)
Atlas of
dermato
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PSORIASIS
Tatalaksana Topikal
- Kalsipotriol/kalsiprotrien (analog Vit.D)  First Line
- Kortikosteroid (2minggu)  tdk membaik : ganti terapi
lain
- Retinoid (tazaroten 0,1%) selama 12mingggu
- ter (antralin 0,05-1%) kontak singkat 15-30menit
Sistemik
- Metotrexat 7,5-15mg/minggu
- Asitrenin (derivat Vit.A) 0,5-1mg/kg/BB
- Siklosporin (kalsineurin inhibitor) 2-4mg/kg/BB
Agen Biologis
- Alefacept
- Evalizumab, infliximab
Komplikasi - Limfoma malignum
- Eritroderma: hipotermia, gagal jantung, pneumonia
- Artralgia, myalgia, lesi mukosa

FKUI. Ilmu Penyakit Kulit dan Kelamin

 + PTRIASIS ROSEA
Definisi Erupsi kulit yg akut sembuh sendiri dengan lesi inisial
berbentuk eritema dan skuama halus. Menyembuh dalam
waktu 2-8minggu
Etiologi - Idiopatik
- HHV-7 HHV-6
Gambaran - Flu like symptom
Klinis - Sakit kepala
- Nausea, hilang nafsu makan
- Lesi pertama: herald patch
- Lesi berikutnya: pohon cemara terbalik (christmast
tree apperance)
Diagnosis - Tinea corporis
banding - Sifilis sekunder
- Dermatitis numularis, dermatitis seboroik
Tatalaksa - Gatal : sedative
- Bedak asam salisilat yg diberi mentol 1%
FKUI. - Flu like symptom: Acyclovir 5x800mg/hr (1minggu)
Ilmu - Lesi luas: terapi sinar UVB
penyakit
kulit dan
 + DERMATITIS SEBOROIK
Definisi Kelainan kulit papuloskwamosa dengan predileksi kelenjar sebacea,
skalp, wajah dan badan, dikaitkan dg. Malesesia dan ggg. imunologis
Predisposisi - Kulit berminyak
- Tanda awal infeksi HIV
- Pityrosporum: degradasi sebum yg mengiritasi kulit mekanisme
eksema
- Transplantasi organ
- Pankreatitis alkoholik kronis, hepatitis C, parkinson
Gambaran klinis - Skuama kuning berminyak eksematosa ringan
- Lanjut: kemerahan perifolikular plak eritematosa berkonfluens
- Korona seboroika: rangkaian plak disepanjang batas rambut
frontal
- Kronis: kerontokan rambut
- Telinga: otitis eksterna, Kelopak mata: blefaritis
Tatalaksana - Sampo anti malasezia : selenium sulfida, zinc, ketoconazole, ter
dan solusio terbinafin 1%
- Skuama tebal: cuci wajah berulang + krim imidazole
- Kortikosteroid topikal, imunosupresan topikal (takrolimus,
pimekrolimus)
FKUI. - Metronidazole topikal, siklopiroksolamin, talkasitol, benzoil
Ilmu peroksida
penyakit
kulit dan
kelamin
+

 Menjelaskan kelainan kulit akibat reaksi obat2an

 Stevens johnson syndrome
 Toxic epidermal necrolysis
+
Epidermal necrolysis

  acute life-threatening mucocutaneous reactions (extensive

necrosis & detachment of epidermis)
+

 Pathogenesis
 CD8+ T killer lymphocytes in epidermis & dermis  cytotoxicity
against keratinocytes  massive apoptosis
 IL-6, TNF-alpha, Fas-ligand
 Acetylation in patient with sulfonamide induced TEN
 HLA-B1502  carbamazepine induced SJS >
 HLA-B5801  allopurinol induced SJS >
+
 Clinical findings
 History
 Begins 8 weeks after drugs exposure (usually 4-30 days)
 Fever, headache, rhinitis, myalgias  1-3 days before lesion
 Pain on swallowing, burning / stinging in the eyes, heralding mucous
membrane involvement
 Cutaneous lesion
 Symmetrically eruption
 Face, upper trunk, proximal extremities (distal portion spared)
 Initial lesion  erythematous, dusky red, purpuric macule, irregulary
shaped
 Atypical target lesion with dark centers
 Nikolsky sign  flaccid blisters (spread with pressure & break easily)
 frictional trauma + pressure  red, oozing dermis
+

SJS  nikolsky’s 10%

of body surface

TEN  nikolsky’s >

30% of body surface
+

 Mucous membrane
involvement
 Erythema  painful
erosions of buccal, ocular,
genital mucosa
 Painful hemorrhagic
erosions coated by
grayish white
pseudomembranes &
crusts of the lips

 Ocular  hyperemia,
erosions, chemosis,
photophobia, lacrimation,
sheeding
+

 Extracutaneous symptoms
 High fever, pain, weakness
 Visceral involvement
 Pulmonary  dyspnea, bronchial hypersecretion, hypoxemia,
hemoptysis
 Digestive (GIT)  epithelial necrosis of esophagus, small
bowel, colon
 Renal  proteinuria, microalbuminuria, hematuria, azotemia
+

 Approach to the patients

+

 Laboratory tests
 Evaluation of respiratory rate & blood oxygenation
 Transient peripheral CD4+ lymphopenia
 Anemia
 Massive transdermal fluid loss  electrolyte imbalance,
hypoalbuminemia, hypoproteinemia, prerenal azotemia
 Hypercatabolic state  insulin resistance  blood glucose >>
+

 Histopathologic test
+

 DD
 Limited EN (SJS)
 Erythema multiforme major
 Varicella
 Widespread EN
 Acute generalized exanthematous pustulosis
 Generalized bullous fixed drug eruption
+

 Complications
 Acute phase  sepsis
 Pulmonary complications & multiple organ failures
 Late ophthalmic complications
 Chronic inflammation, fibrosis, entropion, trichiasis, symblepharon
 hypo/hyperpigmentation
 Hyper/atrophic scars
 Nail changes
 Pigmentation of nail bed, ridging, dystrophic nails, anonychia
 Vulval & vaginal
 Dryness, itching, pain, bleeding
 Genital adhesion (severe cases), other stictures
+
 Treatment
 Symptomatic treatment
 Withdrawal of the offending
drugs
 Specific treatment
 Fluid replacement
 Corticosteroids
 Raise the environment
temperature (28°C – 30°C)  IVIg
 early nutritional support  Cyclosporin A
 Skin, blood, urine specimen  Plasmapheresis /
 cultured hemodialysis
 Wound dressings  Anti-tumor necrosis
factors
 Artificial tears + antibiotic
eyedrops + vit A every 2   extreme cautions !!
hours
 Mouth rinsing 
antiseptic/antifungal solution
+

 Prognosis