ERITROPAPULO

ERITROPAPULO
SKUAMOSA
SKUAMOSA DERMATOSIS
DERMATOSIS
ERITROPAPULOSKUAMOSA
ERITROPAPULOSKUAMOSA DERMATOSIS
DERMATOSIS
 Golongan
Golongan penyakit
penyakit kulit
kulit
 Effloresensi
Effloresensi terutama
terutama :: eritema,
eritema, papula,
papula, skuama
skuama

 Penyebab
Penyebab diketahui
diketahui ::

 Dermatomikosis
Dermatomikosis superfisialis
superfisialis

 Lues
Lues IIII

 MH
MH
 Penyebab
Penyebab tak
tak diketahui
diketahui ::

 Psoriasis
Psoriasis vulgaris
vulgaris

 Pytiriasis
Pytiriasis rosea
rosea

 Dermatitis
Dermatitis seboroik
seboroik

 Lichen
Lichen planus
planus

 Pityriasis
Pityriasis Rubra
Rubra Pilaris
Pilaris
 PSORIASIS VULGARIS

DEFINISI
DEFINISI ::
 penyakit
penyakit kulit,
kulit, kronis
kronis dan
dan residif
residif
 makula
makula eritematus
eritematus bulat
bulat // lonjong
lonjong
 skuama
skuama tebal,
tebal, transparan/putih
transparan/putih keabu-abuan
keabu-abuan
ETIOLOGI
ETIOLOGI DAN
DAN PATOFISIOLOGI
PATOFISIOLOGI
Penyebab
Penyebab pasti
pasti tak
tak diketahui
diketahui
Faktor-faktor
Faktor-faktor ::
Pemendekan turn
 Pemendekan turn over
over epidermis
epidermis
 Predisposisi
Predisposisi genetik
genetik
 Faktor
Faktor pencetus
pencetus ::
-- infeksi
infeksi -- obat
obat tertentu
tertentu
-- stres
stres -- perubahan
perubahan
iklim
iklim
- trauma
trauma

EPIDEMIOLOGI
EPIDEMIOLOGI
Semua
Semua usia,
usia, dewasa
dewasa >>
>>
Pria
Pria == wanita
wanita
GEJALA
GEJALA KLINIS
KLINIS
Keluhan
Keluhan
-- sedikit
sedikit gatal
gatal (panas
(panas // burning
burning sensation)
sensation)
-- kosmetik.
kosmetik.

Kulit
Kulit
 Makula

Makula eritematus,
eritematus, batas batas jelas,
jelas, tertutup
tertutup skuama
skuama tebal,
tebal,
transparan,
transparan, lepas
lepas dibagian
dibagian tepi,
tepi, lekat
lekat dibagian
dibagian tengah.
tengah.
 Kaarsvlek phen (+), Austpitz sign (+), Koebner phen (+)

Kaarsvlek phen (+), Austpitz sign (+), Koebner phen (+)
 Bentuk makula bisa berubah 

Bentuk makula bisa berubah 
anular,
anular, gyrata,
gyrata, folikular,
folikular, gutata,
gutata, punctata
punctata
PREDILEKSI
Tempat mudah kena trauma
( siku, lutut, sakrum, kepala, genitalia)
Kuku
Kuku ::
 keruh, pitting, punctate

keruh, pitting, punctate
 subungual hiperkeratosis

subungual hiperkeratosis
 kuku tangan >>

kuku tangan >>

Mukosa
Mukosa ::
 geographic
 geographic tongue
tongue
Sendi
Sendi ::
Psoriasis
Psoriasis arthropatica
arthropatica
(interphalang
(interphalang dan
dan lumbosacral)
lumbosacral)
 HISTOPATOLOGI
HISTOPATOLOGI
-- Khas,
Khas, diagnosis
diagnosis pasti
pasti
-- Hiperkeratosis,
Hiperkeratosis,
parakeratosis,akantosis,
parakeratosis,akantosis,
pemanjangan Rete
pemanjangan Rete ridges,
ridges,
permanjangan
permanjangan papila
papila dermis,
dermis,
mitosis
mitosis dari
dari stratum basalis,,
stratum basalis
mikro
mikro abses
abses Munro
Munro
DIAGNOSIS
DIAGNOSIS
 klinis
 klinis dan
dan histoPA
histoPA

DIAGNOSIS
DIAGNOSIS BANDING
BANDING

 MH
MH type
type TT
 Lues

Lues IIII
 Dermatomikosis

Dermatomikosis superfisialis
superfisialis
 Dermatitis

Dermatitis seboroik
seboroik
 Pytiriasis

Pytiriasis Rosea
Rosea
PENYULIT
PENYULIT
Eritrodermi
Eritrodermi

PENATALAKSANAAN
PENATALAKSANAAN

 kausal
kausal (-)
(-)

 tujuan
tujuan :: menghilangkan
menghilangkan faktor
faktor pencetus/lesi
pencetus/lesi

 topikal
topikal :: kortikosteroid,
kortikosteroid, tar,
tar, anthralin,
anthralin, vit
vit D,
D,
asidum
asidum salisilikum.
salisilikum.

 sistemik
sistemik :: metotrexate,
metotrexate, retinoid,
retinoid, fototerapi
fototerapi
PSORIASIS PUSTULOSA

Dibagi 2 :
 Palmo plantar
 Generalisata (von Zumbusch)
• Dengan atau tanpa didahului Psoriasis Vulgaris
• Klinis :
Febris tingi, KU lemah
Eritema menyebar luas ditumpangi adanya pustule steril. Pustule bisa
bergabung membentuk danau-danau yang berisi pus.
• Laboratorium :
Leukositosis (DL)
PMN >> dan pustule steril tidak didapatkan bakteri (Gram)
• Terapi :
MTX, Siklosporin, Asitretin, Kosrtikoseroid oral
 PITYRIASIS
PITYRIASIS ROSEA
ROSEA
DEFINISI
DEFINISI
-- penyakit kulit, ringan, swasirna
penyakit kulit, ringan, swasirna
-- makulae eritematus, oval, papulae, plak
makulae eritematus, oval, papulae, plak
-- skuama disekeliling tepinya
skuama disekeliling tepinya

ETIOLOGI
ETIOLOGI DANDAN PATOFISIOLOGI
PATOFISIOLOGI
-- penyebab pasti belum diketahui
penyebab pasti belum diketahui
-- diduga ~ infeksi virus
diduga ~ infeksi virus
 Pityriasis rosea
is common self-limited benign
papulosquamous dermatosis associated
with distinctive clinical features.
"Herald patch" followed by a widespread
oval scaly red eruptions.
A viral etiology has been suggested
( human herpesvirus-7 and 6).
 PITYRIASIS ROSEA

EPIDEMIOLOGI
EPIDEMIOLOGI
-- usia remaja, dewasa muda >>
usia remaja, dewasa muda >>
-- pria = wanita
pria = wanita

PREDILEKSI
PREDILEKSI
-- bagian tubuh tertutup pakaian, leher – dagu
bagian tubuh tertutup pakaian, leher – dagu
-- kadang bagian tubuh terbuka  Pityriasis
kadang bagian tubuh terbuka  Pityriasis
Rosea
Rosea Inversa
Inversa
 PITYRIASIS ROSEA

GEJALA KLINIS
- gejala konstitusi 

- gatal ringan - sedang / asimtomatik

- herald patch / mother plaque / medalion

- makulae bulat lonjong, tepi meninggi, lekat pd tepi

- sumbu panjang sejajar pelipatan kulit  dipunggung ~

gambaran pohon cemara.

HISTOPATOLOGI
- akantosis ringan, parakeratosis fokal

- infiltrat limfosit, perivaskular ringan

 PITYRIASIS ROSEA

DIAGNOSIS
Klinis khas

DIAGNOSIS BANDING
- Psoriasis vulgaris

- Dermatitis seboroik

- Lues II

- Tinea corporis

- MH
 PITYRIASIS ROSEA

PENATALAKSANAAN
- Tx spesifik (-)

- Antihistamin

- Bedak mengandung asidum salicilikum

- Steroid topikal / sistemik  bila parah

- Konseling
Pityriasis Rosea, or "PR" for short, is a skin problem of unknown origin. It behaves somewhat like a virus, since most people get it once in
their lives and never again. No one has been able to find an infection agent in most cases studied. Several years ago, some researchers
found a virus-like particle in some skin biopsies.
Pityriasis rosea is:
A. A NUISANCE
B. SELF-LIMITING
C. NON-SCARRING (as long as you don't scratch a lot)
D. NOT SERIOUS
E. NOT DUE TO SOMETHING YOU ATE
F. NOT AIDS
G. NOT VITAMIN DEFICIENCY
H. NOT ANY FORM OF CANCER
I. NOT CONTAGIOUS
There is no need to sterilize your dishes or glasses. You do not have to wash your towels and linens separately from everyone else, and you
do NOT have to isolate yourself from anyone else.
Typical "PR" is characterized by 1-2 centimeter sized oval spots, usually somewhat pink to red, with a little "collar" or scaling. A "herald
patch" that is larger than all the rest comes first in around 50% of cases, and is usually followed by a shower of smaller ones in several days.
They are usually located on your trunk in the folds of the skin. They do NOT usually involve the face, palms or soles.
Unusual cases of "PR" have fine red bumps, about the size of a mosquito bite, in clusters and patches on the body, face, under arms, in the
groin, and sometimes on your palms. These bumps also develop those little collars of scale over time.
TREATMENT: Typically, a course of "PR" will take 2-3 months to clear if no therapy is used. Erythromycin seems to help in some cases, may
be prescribed and may shorten your course to weeks instead of months. Topical cortisones also help for symptomatic relief of your itching.
Sometimes cortisone injections are given in the buttocks to shorten the course.
Going to the beach and getting into the cool water, and simultaneously getting some sun may also help. Ultraviolet light does shorten the
course. Heat aggravates the itching, so stay cool. Good old- fashioned calamine lotion also seems to help. Apply it with a paint brush.
© 2006 Pacific Monograph
 Pityriasis Rosea
My Diary

~Jim Spence ~If you are reading this, more than likely you have just found you that you have Pityriasis Rosea,
or you know someone that does. You've probably been searching web sites, trying to find out anything you
can about it, and you've noticed that there's a lot of information, some of it contradictive, but no clear cut
ideas on what you can actually do about it. Of course, it's impossible to diagnose a disease on line; however,
you can make informed decisions on the information that's available and try some things yourself to make this
disease easier to deal with.
You've probably seen the following information but, just in case you haven't, I'm going to go over some of the
basics. Please know that I'm not a doctor; all I'm doing is compiling the information that I've gotten from
dozens of web sites, a few books, and my own doctor. If you heed any advice that I give you and harm comes
to you … shame on you. You should have known better.
The main reason I'm compiling this information is … I had Pityriasis Rosea and cured it much quicker than the
norm, in part, I think, because I did my homework. If you're lucky, you can cheat off of me.
Pityriasis Rosea (pit' - e - RYE' - uh - sis RO' - sha) is caused by a virus. What kind of virus is unknown. A few
web sites don't agree with this, but the overwhelming majority (and my personal physician) do, so that's what
I'm going with. The virus enters your body in some unknown manner and manifests itself in a single spot,
usually the size of a nickel, somewhere on your torso, though it can start other places on your body. In my
case, it started on the back of my right thigh.
This spot is called the herald patch. The entire rash that will take place over your body in the next few months
comes from this spot. Sometime between one and 30 days later, you'll notice a rash forming on the trunk of
your body. This rash takes the initial form of a typical bumpy rash, then changes to larger, wrinkled, pinker
spots. The rash usually follows the creases in your skin … under your arms, the crease in your neck, around
your navel, on your ribs. The disease, and it's referred to as a disease because it's viral in nature, is truncated
… meaning that it usually stays on your torso, down to the shirt sleeve line on your arms, and to the shorts
line on your pants. It reacts differently to different people, of course, but it usually is a thick covering of your
torso, front and back.
Pityriasis Rosea (pit' - e - RYE' - uh - sis RO' - sha) is caused by a virus. What kind of virus is unknown. A few web
sites don't agree with this, but the overwhelming majority (and my personal physician) do, so that's what I'm going
with. The virus enters your body in some unknown manner and manifests itself in a single spot, usually the size of a
nickel, somewhere on your torso, though it can start other places on your body. In my case, it started on the back of
my right thigh.
This spot is called the herald patch. The entire rash that will take place over your body in the next few months comes
from this spot. Sometime between one and 30 days later, you'll notice a rash forming on the trunk of your body. This
rash takes the initial form of a typical bumpy rash, then changes to larger, wrinkled, pinker spots. The rash usually
follows the creases in your skin … under your arms, the crease in your neck, around your navel, on your ribs. The
disease, and it's referred to as a disease because it's viral in nature, is truncated … meaning that it usually stays on
your torso, down to the shirt sleeve line on your arms, and to the shorts line on your pants. It reacts differently to
different people, of course, but it usually is a thick covering of your torso, front and back.
The rash can itch, as all rashes do. There is no cure for the disease. All you can do is treat the symptoms and let it run
its course.
The disease is not fatal. The disease is also not communicable … no one can catch it from you.

Now, here's the real kicker … the disease can last from six weeks to six months.
My doctor prescribed a cream and told me there wasn't much else I could do about it. He told me to check web sites …
even he knew there was some good information out there.
At least my doctor had a sense of humor about it. After he let me know what it was, he told me that they call it
Pityriasis Rosea because "we pity the poor son of a bitch that gets it".
So, he sent me home with a cream, and a rash that was beginning to cover over half of my body.
If you read anything about this disease, you'll notice that it predominately stays on your trunk, rarely going down your
arms or legs, or much further than your neck. In my case, the rash spread all the way down to my wrists, almost
getting on the palms of my hands, and down my legs just above my ankles. It also ran up the back of my neck into my
hair and up the front of my neck to my chin. I was covered with it. I had to have a layer of cream applied over virtually
my entire body twice a day.
There are three things that aggravate the rash, besides scratching it … sweat, hot water, and soap. Hot water, in fact, is painful.
The first days of your disease, if you take hot showers or baths, you'll notice pain in areas where you seem to have no rash. This
is a good precursor to the rash appearing in these spots soon.
The worst part is at night. During the day, you can at least give yourself temporary relief with over the counter creams. At night,
you wake up at 2:00 am, itching all over, and can't sleep.
A few of the web sites said some studies were being done, and that they'd had limited success with ultraviolet light. They said if
you have ultraviolet light treatments, make sure they're prescribed by a physician.
So, you have a disease the stays under your clothes and is killed by ultraviolet light. Since I caught this disease in early spring, I
was still wearing long sleeves and long pants … which is why, I believe, the disease spread as far as it did on my body.
Again, I do not recommend or in any way represent that what I did to rid myself of this disease should be tried by anyone else. I
read the information, made a decision, and tried it … and it worked.
DAY 1: I woke up and noticed that I had a sore on the back of my right thigh … a small scaly patch about the size of a penny. It
itched a bit, but wasn't overly troublesome. In fact, by the next day I didn't really think about it.
DAY 4: My butt started to itch a bit. You could see the beginnings of a rash.
DAY 5: The rash had become a bit worse, and had spread around my body to the crease between my thighs and my torso on the
front of my body.
I called my doctor, but he was booked. I agreed to see a nurse practitioner. My best guess was that I'd gotten this rash from
wearing clothing with some kind of mites (since I'd worn a pair of shorts that I hadn't worn in months a few days before). The
nurse agreed with my assessment, gave me a shot of steroids, a prescription for some cream, and a handful of antihistamines
which, I found out, can relieve itching a bit.
DAY 8: The rash had spread to my shoulder blades, and was beginning to make its way under my arms. It also was appearing on
my chest, and had become much thicker on my butt and above my thighs.

DAY 9: This rash obviously wasn't caused by mites so I saw my physician at 9:00 in the morning. I told him about the rash, what
the nurse had thought it was, and took off my shirt to show him how far it had spread on my body. His first question was "did
you have one spot that you noticed itched before all the others?" The herald spot. I showed him, he looked at it, and told me
about Pityriasis Rosea.
DAY 11: I'd spent the last two days getting covered from head to toe with a particular cream that was a bit stronger than the
normal prescription. The rash continued to cover my body and was now making its way up the back of my neck, through
my arm pits, and down my arms. Also, I started to get a low grade fever that would last for the next five days.
DAY 13: I finally discovered the correlation between hot water and the disease. I started taking the coldest showers
possible, using soap only on my face and my hair.
DAY 16: My back was completely covered. My chest was showing signs of complete coverage within a few days, my
stomach was starting to get the small bumps, and the rash had made its way to the bend in both elbows. The worst itching
came from my navel; the rash had it covered.
For the past week, I hadn't slept more than three hours at a time. I woke up, itching badly. I would apply some over the
counter medicine to various spots that itched, but I'd be back up in three hours or less doing the same thing again.
I was still taking cold showers with no soap, but this time I broke down and used soap on my entire body. The rash was
redder than ever before, and itched worse than it had previously.
DAY 17 - 18: The rash continued to grow. I was covered from head to toe twice a day with prescription itch cream. During
the day I would cover particularly itchy spots with over the counter medicine. I was still waking up two or three times a
night, applying over the counter medicine to spots that itched so badly they woke me up.
DAY 19: The rash still had my entire back covered, by now in large, pink wrinkled masses. The rash was completely under
both arms, all the way down both arms to my wrists; in fact, my wrists were the worst spot on both arms. The rash had also
made its way down my legs, well past my knees, and looked a lot like my wrists. A huge rash was growing up the front of
my neck, and had made its all the way to my chin. It had grown up the back of my neck, well into my hair. Luckily, the rash
didn't find its way to my "sensitive areas", but I was afraid that it would soon. It was itching tremendously, and showed no
signs of slowing down. By this time I'd gone 10 days without much sleep and nothing but cold showers.

I felt like the elephant man. I was embarrassed to go out in public because the rash was becoming quite visible.
This was when I made up my mind to try something.
I went to a tanning salon and bought a month's pass. I spent 15 minutes on a tanning bed that evening (completely naked,
save for my … well, my manhood).
DAY 20: The rash looked no better, but no worse. It was a warm sunny day, so I mowed the grass with no shirt on. The
sweat, and the grass trimmings and pollen that stuck to the sweat, made me itch worse than I had so far. A cold shower
helped that.
DAY 21: I spent 20 minutes on a tanning bed (as naked as the first day). The rash was beginning to show signs of
stopping its forward advance. One spot, the huge rash that was growing up my neck to my chin, had in fact begun to
dwindle away.
DAY 23: I spent another 20 minutes on a tanning bed, this time wearing just my briefs. The heaviest part of the rash on my
back was diminishing. The rash on my neck was just a small mark. The rash itched less than it had in two weeks. The
rash on my butt, the original rash, was now nothing more than small dark bumps, and didn't itch much at all. Same as the
rash that was on the front crease of my thighs. For the first night, I went to bed without using any cream. I still got up
once during the night to apply some over the counter medicine, but after falling back to sleep, I slept for six hours … the
longest stretch of sleep I'd had in two weeks.
DAY 24: I didn't use cream again this morning. The rash under my arms now looked like the rash on my butt the previous
day; small, dark spots that don't particularly itch. The rash on my lower thighs, below my knees, was thinning out. The
largest spots, on my back over my shoulder blades, were now just blotchy red spots, and itched less than usual. The
rash that was making its way up the front of my neck just five days before was almost completely gone. The rash was
almost gone from my hair, but was still hanging on; I reasoned that was because the tanning bed couldn't get through my
hair completely.
I took a warm shower, and used soap on my entire body, for the first time in 12 days.

DAY 25: Three weeks ago today I noticed the first rash on my butt. Since all of the information I'd gotten said the rash
would last from six weeks to six months, I should be, at best, halfway through the disease; meaning that the disease
should, as of today, be at just about it's worst point. It was obvious that the rash, and the disease, was subsiding much
faster than it should have been.
I took another warm shower with soap, and didn't have to apply any cream to what was left of the rash. It itched a bit, but
nowhere near as badly as it did just a week before. Eventually you get used to minor itching and pay it no mind.
I spent another 20 minutes on the tanning bed.
DAY 26: The rash on my neck is completely gone. The rash in my hair is virtually gone, save for a few
small spots. The rash on my butt and the front of my thighs is nothing more than small, dark spots that
don't itch. The rash down my thighs is almost gone, save for a few dark red spots, and they don't itch.
The rash on my shoulder blades, the worst areas affected, continued to thin out, becoming darker and
more pronounced.
Another 20 minutes on the tanning bad, and every spot on my body continued to heal; the small amount
of rash in my hair was still holding on, but sure wasn't growing.
DAY 27: I was winning the battle. I hadn't applied prescription cream in four days, except on the
occasional spots that would itch, and those were rare
DAY 30: I went an extra day between tanning appointments. I was by now quite dark, and the rash was on
the run. Another 20 minutes on the tanning bed. The rash in my hair was almost gone.
DAY 32: Four weeks ago today the first rash started. Now … it was totally gone. In four weeks. Six tanning
bed sessions in two weeks had killed it. Now, I'm sure there are some in the medical profession that
would disagree with me, saying that perhaps I had had a mild case of the disease. To that I say … horse
hockey. I was eaten up with it, it was growing by leaps and bounds and, from the second trip to the
tanning salon, I noticed it diminishing.
I killed it. With a half dozen sun tans.
Again, I make no claims or representations that what I did in any way affected this disease. But, in my
heart, I know it did.
I rid myself of a disease that can last up to six months in four weeks … and got one hell of a tan in the
process.

Jim Spence
 A cure means :
the freedom to be my self
again and no more tears.
Anonymous
 DERMATITIS
DERMATITIS SEBOROIK
SEBOROIK
DEFINISI
DEFINISI
•• penyakit
penyakit kulit,
kulit, radang
radang superfisialis,
superfisialis, kronis
kronis
•• predileksi
predileksi area
area seboroik
seboroik
•• remisi
remisi dan
dan eksaserbasi
eksaserbasi
ETIOLOGI
ETIOLOGI
•• Penyebab
Penyebab pasti
pasti belum
belum diketahui
diketahui
•• Dugaan
Dugaan :: -- Pityrosporum
Pityrosporum ovale
ovale >>
>>
-- stres
stres
-- kasus
kasus parah
parah  HIVHIV
(AIDS),
(AIDS),
penyakit
penyakit neurologis
neurologis
•• Status
Status seboroika
seboroika yang
yang diturunkan
diturunkan
 DERMATITIS SEBOROIK

EPIDEMIOLOGI
EPIDEMIOLOGI
•• Usia
Usia bayi
bayi dan
dan orang
orang dewasa
dewasa
•• pria
pria >>
>>

PREDILEKSI
PREDILEKSI
•• area
area seboroik
seboroik -- kelenjar
kelenjar sebasea
sebasea >>>> ::
•• kepala,
kepala, wajah,
wajah, badan
badan atas,
atas, pelipatan
pelipatan
 DERMATITIS SEBOROIK

HISTOPATOLOGI
HISTOPATOLOGI
 Akantosis, spongiosis ringan,

Akantosis, spongiosis ringan,
 Infiltrat sel-sel radang, perivaskular

Infiltrat sel-sel radang, perivaskular
DIAGNOSIS
DIAGNOSIS
 Klinis khas

Klinis khas
DIAGNOSIS
DIAGNOSIS BANDING
BANDING
 Psoriasis vulgaris

Psoriasis vulgaris
 Pityriasis rosea

Pityriasis rosea
 Tinea corporis

Tinea corporis
 DERMATITIS SEBOROIK

PENYULIT
PENYULIT
•• Rambut
Rambut rontok
rontok
•• Infeksi
Infeksi sekunder
sekunder
•• Eritroderma
Eritroderma

PENATALAKSANAAN
PENATALAKSANAAN
•• Diit rendah lemak
Diit rendah lemak
•• Faktor pencetus dihindari
Faktor pencetus dihindari
•• Topikal
Topikal
Kepala
Kepala :: shampo
shampo selenium
selenium sulfide
sulfide 1,8%,
1,8%, ZnZn pirithion,
pirithion,
ketokonazole
ketokonazole scalpscalp solution
solution 1%/2%,
1%/2%, losio
losio steroid
steroid
Lokasi
Lokasi lain
lain :: krim
krim kortikosteroid,
kortikosteroid, Imidasol
Imidasol
Cradle Cap pada scalp bayi
TIDAK ADA PANDANGAN
YANG LEBIH MENYEDIHKAN
DARIPADA
ORANG MUDA YANG PESIMIS
Mark Twain
 LICHEN
LICHEN PLANUS
PLANUS (LP)
(LP)
DEFINISI
DEFINISI ::
-- inflamasi
inflamasi kulit,
kulit, folikel
folikel rambut,
rambut, membrana
membrana mukosa,
mukosa,
gatal
gatal

ETIOLOGI
ETIOLOGI DAN DAN PATOFISIOLOGI
PATOFISIOLOGI
 penyebab belum diketahui dengan pasti

penyebab belum diketahui dengan pasti
 diduga : -- kelainan

diduga : kelainan imunologi
imunologi
-- ~~ infeksi
infeksi bakteri,
bakteri, virus,
virus, jamur
jamur
-- paparan
paparan obat,
obat, bahan
bahan kimia
kimia
tertentu
tertentu
 LICHEN PLANUS (LP)

GEJALA
GEJALA KLINIS
KLINIS
• Gatal
Gatal
• Kulit papulae ((
Kulit :: papulae  1-4
1-4 mm)
mm) permukaan
permukaan rata,
rata, kering,
kering,
berkilat,
berkilat, poligonal,
poligonal, keunguan,
keunguan, sedikit
sedikit skuama
skuama
Wicham's
Wicham's Striae
Striae (+)
(+)
penyembuhan
penyembuhan   hiperpigmentasi
hiperpigmentasi
ekstremitas
ekstremitas bawah
bawah >> >> Koebner
Koebner phen
phen (+),
(+), bilateral
bilateral
simetris
simetris
• Kuku
Kuku :: pterygeum,
pterygeum, onikolisis
onikolisis proksimal
proksimal && distal,
distal,
lekukan
lekukan longitudinal
longitudinal
 LICHEN PLANUS (LP)

GEJALA
GEJALA KLINIS
KLINIS
• Mukosa
Mukosa :: oral oral >>
>>  bentuk
bentuk ::
-- Ulseratif
Ulseratif >>>>
-- Reticulate
Reticulate :: pipi
pipi bagian
bagian dalam
dalam >>
>>
-- Atropik
Atropik
• Genitalia
Genitalia ::
glans
glans penis,
penis, labia,
labia, anus
anus   papulae
papulae poligonal
poligonal
-- Vulvovaginal
Vulvovaginal   erosif
erosif // ulseratif
ulseratif
-- Varian
Varian :: Linear,
Linear, Anular,
Anular, Folikular,
Folikular,
Hipertropik,
Hipertropik, Ulseratif,
Ulseratif, Bollous
Bollous
 LICHEN PLANUS (LP)

DIAGNOSIS
DIAGNOSIS
klinis
klinis

DIAGNOSIS
DIAGNOSIS BANDING
BANDING
-- Psoriasis
Psoriasis vulgaris
vulgaris
-- Candidiasis
Candidiasis
-- Lues
Lues IIII
-- Pityriasis
Pityriasis Rosea
Rosea
 LICHEN PLANUS (LP)

PENATALAKSANAAN
PENATALAKSANAAN
• Lesi
Lesi terbatas
terbatas ::
topikal
topikal steroid
steroid superpoten
superpoten // injeksi
injeksi intralesi
intralesi
• Lesi
Lesi tersebar
tersebar ::
sistemik
sistemik steroid,
steroid, PUVA,
PUVA, retinoid
retinoid
• Lesi
Lesi oral
oral ::
steroid in
steroid in orabase,
orabase,
injeksi
injeksi intralesi
intralesi
 LICHEN PLANUS (LP)

HISTOPATOLOGI
HISTOPATOLOGI
 awal  dermatitis pada taut dermoepidermal

awal  dermatitis pada taut dermoepidermal
 selanjutnya : hiperplasia epidermis, pola saw tooth

selanjutnya : hiperplasia epidermis, pola saw tooth
 orthokeratosis, hipergranulosis

orthokeratosis, hipergranulosis
 lapisan basal : keratinosit

lapisan basal : keratinosit nekrotik(+)
nekrotik(+)
 dermis : civatte bodies (+)

dermis : civatte bodies (+)
 Ada
Ada dua
dua jenis
jenis manusia
manusia di di dunia
dunia ini,
ini,
seorang
seorang realis
realis dan
dan pemimpi.
pemimpi.
Mereka
Mereka yang
yang realis
realis tahu
tahu kemana
kemana akan
akan pergi.
pergi.
Mereka
Mereka yang
yang pemimpi
pemimpi telah
telah tiba
tiba di
di sana…
sana…

Robert
Robert Orben
Orben
 PITYRIASIS RUBRA PILARIS (PRP)

DEFINISI
Kelainan menahun dengan :
- Plak eritematus
- Berskuama
- Papul keratotik folikuler

ETIOLOGI
- HEREDITER
- Autosomal dominan
- Permulaan pada masa anak
- DIDAPAT
- Semua umur
- Riwayat keluarga (-)
- Diduga defisiensi vitamin A
 PITYRIASIS RUBRA PILARIS (PRP)

KLASIFIKASI

Herediter
- Meluas bertahap dan perlahan
- Menetap

Didapat
- Meluas dengan cepat
- Remisi
 PITYRIASIS RUBRA PILARIS (PRP)

GEJALA KLINIS
• Eritema dan skuama pada permulaan di muka
dan kulit kepala yang bisa meluas ke seluruh
permukaan kulit, dilanjutkan eritema dan
penebalan di telapak tangan dan kaki.
• Kelainan kulit batas tegas dengan pulau-pulau
kulit normal.
• Kuku menunjukkan penebalan.
• Kelainan sistemik (-).
 PITYRIASIS RUBRA PILARIS (PRP)

HISTOPATOLOGIS
• Hiperkeratosis
• Parakeratosis
• Akantosis
• Sebukan sel radang menahun pada dermis
atas.
 PITYRIASIS RUBRA PILARIS (PRP)

TERAPI

• Vit A 200.00 unit per hari.

• Asam retinoat 0,05%
• Kortkosteroid topikal + Asidum salisilikum
3 – 20%
 PITYRIASIS RUBRA PILARIS (PRP)

PROGNOSIS

Herediter : buruk
Didapat : baik
 ERITRODERMA

DEFINISI
DEFINISI
Kelainan
Kelainan kulit
kulit ditandai
ditandai adanya
adanya eritema
eritema di di
hampir
hampir seluruh
seluruh tubuh,
tubuh, biasanya
biasanya disertai
disertai
skuama.
skuama.

SINONIM
SINONIM
Dermatitis
Dermatitis Eksfoliativa
Eksfoliativa
 ERITRODERMA

PATOFISIOLOGI
 Tergantung faktor penyebab.
 Pada Eritroderma terjadi peningkatan
epidermal turn over, sehingga terbentuk
skuama berlebihan.
 Skuama terutama mengandung protein,
asam nukleat dan asam amino bebas.
 ERITRODERMA

GEJALA KLINIS
 Timbul dalam waktu singkat
 Cepat meluas
 Demam, menggigil,malaise
 Seluruh kulit tampak eritematus, mengkilap,
mengelupas, teraba panas, gatal, kasar dan
menebal.
 ERITRODERMA

PATOFISIOLOGI
Eritema : pelebaran pembuluh darah →
aliran darah ke kulit meningkat →
kehilangan panas bertambah :
• Penderita kedinginan / menggigil
• Hipotermi (akibat peningkatan perfusi kulit)
• Dehidrasi (akibat penguapan cairan yang meningkat)
• Pengaturan suhu terganggu.

Kehilangan skuama dapat menyebabkan kehilangan

protein (hipoproteinemia) dan oedema.
 ERITRODERMA

GEJALA KLINIS
• Alergi obat secara sistemik
- Anamnesis : riwayat minum obat/jamu.
- Alergi timbul secara akut (kurang lebih 10 hari).
- Berupa eritema universal tanpa skuama,
setelah sembuh baru timbul eritema.

• Perluasan penyakit kulit

Psoriasis :
- Karena penyakitnya sendiri atau pengobtan yang terlalu
kuat.
- Eritema yang tidak merata.
(Eritema meninggi pada tempat predileksi psoriasis)
 ERITRODERMA
Dermatitis Seboroika pada bayi (Leiner’s disease)
- Dermatitis seboroika yang meluas
- Etiologi belum diketahui dengan jelas
- Usia : >>> 4 – 20 minggu.
- KU penderita baik.
- Eritema universal disertai skuama kasar.

• Penyakit sistemik termasuk keganasan

- Digolongkan dalam CTCL (Cutaneous T-Cell Lymphoma)
- >>> pada manula.
- Eritema universal meah membara + skuama dan sangat gatal.
- Pada 1/3 penderita : splenomegali, limfadenopati
superfisial, alopesia, hiperpigmentasi, hiperkeratotik
palmoplantar, kuku distrofia.
- Laboratorium : Limfoma atipik disebut sel sezary
 ERITRODERMA

DIAGNOSIS
Klinis ditemukan keradangan kulit yang eritematus
disertai deskuamasi hingga ≥ 90% luas permukaan
tubuh.

DIAGNOSIS BANDING
Dermatitis, Psoriasis vulgaris, Drug
Eruption,Limfoma/Leukemia,Pemfigus, Pityriasis Rubra
Pilaris,Likhen Planus, Dermatofitosis, Skabies
 ERITRODERMA

PENYULIT
 Hipotermi
 Dekompensasi kordis
 Kegagalan sirkulasi perifer
 Tromboflebitis
 Infeksi sekunder pada kulit dan paru
 ERITRODERMA

PENATALAKSANAAN
 Perbaiki cairan tubuh
 Eliminasi faktor-faktor pencetus
 Kortikosteroid sistemik “tappering off”
 Antibiotika untuk mencegaf infeksi sekunder
 Antihistamin/antipruritus
 Topikal : emolient (oleum coccos, hidrokortison 1%)
 Diit tinggi protein
 Seni yang dilakukan
oleh DERMATOLOG adalah
“memberi suatu penyakit dengan
nama latin yang panjang …..
dan kemudian memberinya
steroid topikal.”
Intern’s joke about dermatology :
If it’s wet, dry it.
If it’s dry, wet it.
If it’s ugly, cover it up.
If you don’t know what it is,
put glucocorticoids on it.
TIDAK
TIDAK ADA
ADA SUATU
SUATU PEKERJAAN
PEKERJAAN
YANG
YANG MEMPUNYAI
MEMPUNYAI PROSPEK
PROSPEK YANG
YANG BAIK,
BAIK,
MASA
MASA DEPAN
DEPAN DI
DI TANGAN
TANGAN ORANG
ORANG YANG
YANG MENGERJAKANNYA.
MENGERJAKANNYA.
(George
(George W
W Grane)
Grane)

KUNCI PERTAMA UNTUK SUKSES

ADALAH MEMUTUSKAN DENGAN TEPAT
APA YANG ANDA INGINKAN DALAM
KEHIDUPAN ANDA. (W.
(W. Hunt)
Hunt)