Alida Harahap Departemen Patologi Klinik FKUI-RSCM

Kelainan Kulit

Infeksi Inflamasi Autoimun Anamnesis Gambaran Klinis Pemeriksaan Lab

Diagnosis

INFEKSI KULIT
MIKROORGANISME Fungal Viral Bakterial PENYAKIT
Candidiasis Tinea Herpes simplex Varicella zoster Impetigo Folikulitis

Pemeriksaan Lab pada infeksi kulit Bakterial/Fungal

Deteksi
Langsung (mikroskopis) Isolasi Asam nukleat Serologi Deteksi antibodi Deteksi antigen Lain-lain Hematologi KOH: Candida, Trichophyton sp Biakan: agar darah, Saboraud PCR IgM, IgG

Metoda

Protein fase akut

Hitung lekosit, hitung jenis, Hitung trombosit CRP = C reactive protein

ASSAY microscopic isolation nucleic acid serology hematology acute phase protein

SPECIMEN skin scraping, hair, nail skin scraping, hair, nail blood blood blood blood

 Biakan
PCR

Deteksi Antigen

POSITIF

Konfirmasi diagnosis

Respons Imunoglobulin

Deteksi Antibodi

Infeksi Primer IgM (+), IgG (-) IgM (+), IgG (+)

Infeksi Sekunder IgM (-), IgG (+) IgM (+), IgG (+)

Pemeriksaan Hematologi
ASSAY INFEKSI BAKTERIAL Hitung lekosit Hitung jenis Hitung trombosit Neutrofilia Shift to the left INFEKSI VIRAL Limfositosis

neutrofil batang

trombosit

eosinofil

neutrofil segmen

monosit

limfosit

basofil

Hitung Jenis
JENIS SEL
Basofil Eosinofil Neutrofil batang Neutrofil segmen Limfosit Monosit

%
0-1 1-3 2-6 50-70 20-40 4-8

JUMLAH ABSOLUT

= % x hitung lekosit/mL

Granulocyte maturation
Blast

Promyelocyte
Myelocyte Metamyelocyte Stab Segmen

Shift to the left

Shift to the right

Hitung Jenis
JENIS SEL
Basofil Eosinofil Neutrofil batang Neutrofil segmen Limfosit Monosit

%
0-1 1-3 2-6 50-70 20-40 4-8

JUMLAH ABSOLUT

= % x hitung lekosit/mL

INFLAMASI KULIT
REAKSI HIPERSENSITIVITAS
HYPERSENSITIVITY TYPE I DISEASES
Atopic

eczema Acute urticaria

TYPE IV

Allergic contact - dermatitis

TYPE OF HYPERSENS
Immediate hypersens Type I

PATHOLOGIC IMMUNE MECH

IgE Ab

MECHANISM OF TISSUE INJURY

Mast cells & mediators (vasoactive amine, lipid mediators, cytokines)

Ab mediated Type II

Immune complex mediated Type III T cell mediated Type IV

IgM, IgG against cell surface Opsonization & phagocytosis Complement & Fc receptor or extracellular matrix Ag mediated recruitment & activation of leucocyte Immune complexes of circulating Ag & IgM or IgG Complement & Fc receptor mediated recruitment & activation Ab of leucocyte CD4 T cell (delayed type Macrophage activation, cytokine hypersensitivity ) CD8 T cell (T cell mediated mediated inflammation Direct cell killing, cytokine cytolysis ) mediated inflammation

REAKSI HIPERSENSITIVITAS

REAKSI HIPERSENSITIVITAS

REAKSI HIPERSENSITIVITAS

REAKSI HIPERSENSITIVITAS

Sequence of type 1 hypersensitivity

Pemeriksaan Lab
PEMERIKSAAN HipersensitivitasTipe I HASIL

Kadar IgE total Kadar IgE spesifik Hitung eosinofil Reaksi Inflamasi Sitokin inflamatori Protein Fase Akut

Meningkat Positif Meningkat

IL-4, IL-5, IL-10 CRP

AUTOIMMUNE SKIN DISEASE

SKIN DAMAGE AUTOANTIBODIES TRIGGERED BY

TO

SKIN ANTIGEN BULLOUS SKIN DISEASES DEPOSITION OF IMMUNE COMPLEXES VASCULITIS, SLE

AUTOANTIBODIES

DISEASES

SKIN ANTIGEN EPIDERMAL INTER CELLULAR CEMENT BASEMENT MEMBRANE SYSTEMIC ANTIGEN NUCLEAR

PEMPHIGUS VULGARIS

BULLOUS PEMPHIGOID

SUBACUTE CUTANEOUS LE DISCOID LE

ASSAY

RESULT

AUTOANTIBODIES COMPLEMENT LEVEL

POSITIVE DECREASED

KOMPLIKASI
DISEASES
LE STAPHYLOCOCCAL SCALDED SKIN SYNDROME (SSSS) TOXIC SHOCK SYNDROME (TSS)

ASSAY
RENAL FUNCTION: CREATININE LIVER FUNCTION : SGOT SGPT