dr. suci widhiati, msc, sp - pediatricfkuns.ac.id skin disease in children...•tinea corporis,...
TRANSCRIPT
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Curriculum Vitae
dr. Suci Widhiati, MSc, Sp.KK Pendidikan
1. Dokter Umum FK UNS, lulus tahun 2004
2. Master of Science FK UGM, lulus tahun 2010
3. Dokter Spesialis Kulit Kelamin FK UGM, lulus tahun 2010
Pekerjaan
Dosen Univ. Setia Budi tahun 2004 – 2006
Kepala Komite Mutu dan Keselamatan Pasien RSUD Moewardi
Kepala subdivisi pediatri Departemen Kulit Kelamin RSUD Moewardi
Sekretaris Program Studi Departemen Kulit Kelamin RSUD Moewardi
Dosen Bagian Kulit Kelamin FK UNS – RSUD Moewardi 1
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Pediatric common skin infection in daily
practice
Suci Widhiati, Endra Yustin
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Outlines
• Diagnosis pada Dermatologi • Melihat UKK dahulu diikuti dengan anamnesis • UKK • Penunjang
• Papul, plak • Pyodermal superficialis, Scabies • Tinea corporis, Tinea capitis • Veruca vulgaris
• Vesikel, bula • Varicella, HFMD • Impetigo bulosa
• Makula • Candidiasis
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What is the diagnosis?
C A B
Siemens (1891–1969) wrote, “he who studies skin diseases and fails to study the lesion will never learn dermatology.”
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The Art and Science of Dermatologic Diagnosis
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Dermatologic Physical Diagnostic
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Manifestation Lesions of the Skin
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How to diagnose in dermatology
• History taking prior to, during, after physical examination
• Brief history
• Physical examination
• Detailed questions
• Morfology lesion
• Assesment
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Dermatologic Algorithm
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Itchy
macules and papules
verucous papules
Veruccae vulgaris
flat top papules/ plaque
Tinea korporis
Tinea kapitis
Dome shaped papules
Moluscum contagiosum
miliar papules in specific area
Scabies
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VERUCCA VULGARIS
Itchy, macules and papules
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Etiology
• HPV
History
• Can persist several years if not treated
• Common in children
• Extensor extremities
Transmission
• Fomites, skin to skin contact
Morfology
• Verucous firm papules, cleft surface with vegetations
• Patognomonic: red or brown dots
• Isolated lession, scattered discrete lesion.
https://www.childrens.com
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Verucca vulgaris
Treatment:
• Therapies for children must be
safe and preferably painless
• Destructive Methods
• Salicylic acid 30-40%
• Cantharidin 0,7%
• Cryotherapy
• Phototherapies
• Laser (CO2 and pulsed dyle lasers)
• Photodynamic Therapy
• Immunotherapies
• Cimetidine 25-40 mg/kg/day
• Zinc 10 mg/kg
• Injected Immunotherapies
• Interferon
• Imiquimod
• Antimitotic Therapies
• Bleomycin
• Podofilin
• Retinoids
Pediatric Dermatology Vol. 28 No. 3 May ⁄ June 2011 12
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MOLUSCUM CONTAGIOSUM
Itchy, macules and papules
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• Etiology • Molluscipox virus
• Transmission • Skin to skin contact • Children: common
on exposed skin sites
• Resolved spontaneously within 6 moth
• Physical examination
• Papules, nodules, pearly white or skin-colored. Round, oval, hemisphrical, umbilicated
• Distribution
• anysite
https://wikem.org/wiki/Molluscum_contagiosum
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Molluscum contagiosum
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TINEA
Itchy, macules and papules
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• Definition: group of fungi capable of infecting nonviable keratinized cutaneous structures
• Chidren common: • Tinea capitis • Tinea corporis
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• Age of onset: toddlers and school-age children,6-10 yo
• Etiology: • 90% T. tonsurans and M. audounii
• Transmission: • Person-to-person, animal-to-person, via
fomites.
• Classification • Ectothrix infection gray patch • Endothrix infection black dot, kerion,
favus
Tinea capitis
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Tinea Capitis
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Gray patch Black dot Kerion
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Always requires systemic treatment
Topical therapies act as adjuvant therapy
Topical therapy: • Selenium sulfide shampoo • Ketokonazole shampoo twice
weekly for 2-4 weeks • Topical fungisidal cream/lotion
applied to the lesion once daily for 2-4 weeks
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SCABIES
Itchy, macules and papules
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Etiology: S. Scabiei var. hominis.
Transmission: skin to skin contact
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Clinical manifestation
http://pediatric-house-calls.djmed.net/scabies/
http://wordinfo.info/results/scabies
www.drscabies.com 20
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Dermatologic Algorithme
Pain and/or fever
macules and papules
patch erythema with satelit
lesion
Candidiasis cutaneous
papul erythema with pus inside
Follicullitis
vesicles and bullae
teardrop vesicles
Varicella
hipopion bullae
Impetigo bullosa
"football-shaped" vesicles
HFMD
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MUCOCUTANEOUS CANDIDIASIS
Etiology: most frequently Candida albicans
Age of onset: children, geriatric
Courtesy: IK.KK FK UNS
Diaper dermatitis can cause secondary by candida
Pain and/or fever, papules and macules
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Gambaran klinis yang ditemukan khas dengan adanya papul eritem multipel terutama daerah sekitar lesi yang disebut lesi satelit vesikopustulosa, menyerupai gambaran “hen and chicken’, Pustula ini membesar dan pecah, meninggalkan dasar eritem dan skuama kolaret yang cepat berubah dan menyebabkan maserasi dan fissura
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Treatment
• Topical antifungi: • Imidazol
• 2 x sehari pada area lesi, dioleskan dengan radius 2 cm dari batas luar lesi
• Lanjutkan pengobatan sampai 1 minggu setelah penyembuhan klinis
• Poliene (Nistatin) • Suspensi atau pasta 4-5 kali sehari dalam 2 minggu
• Oral antifungi • Nistatin oral suspensi 100.000 U/ml 4 kali sehari
• Fluconazol oral suspensi 3mg/kgBB/hari selama 7 hari
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FOLLICULITIS, FURUNCLE, CARBUNCLE • EtiologyStaphylococcus aureus
Folliculitis: is a pyoderma that begins hin the hair follicle, and is classified according the depth of invasion (superfacial and deep)
Pain and/or fever, papules and macules
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Pain and/or fever, papules and macules
FOLLICULITIS, FURUNCLE, CARBUNCLE Furuncle or boil: is a deep-seated inflammatory nodule that develops around a hair follicle, usually from a preceding, more superficial folliculitis and often evolving into an abscess.
A carbuncle is a more extensive, deeper, communicating, and infiltrated lesion that develops when suppuration occurs in thick inelastic skin when multiple, closely set furuncles coalesce.
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Treatment
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Simple furunculosis may be aided by local application of moist heat
A systemic antibiotic (as for MRSA impetigo). For severe infections or
infections in a dangerous area, maximal antibiotic dosage should be employed by
the parenteral route. Vancomycin (1.0–2.0 g intravenously daily in divided doses) or
other systemic parenteral agents that have anti-CA-MRSA activity are indicated
for these patients for at least 1 week
When the lesions are large, painful, and fluctuant, then incision and drainage are
the most important actions that one should take in a timely manner. If the
infection is recurrent or complicated by comorbidities, a culture can be sent. Draining lesions should be covered to
prevent autoinoculation and diligent hand washing performed
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IMPETIGO
Pain and/or fever, papules and macules
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Pain and/or fever, papules and macules
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VARICELLA
Pain and/or fever, papules and macules
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Hand, foot and mouth disease
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