mini poster neurodermatitis
TRANSCRIPT
7/23/2019 Mini Poster Neurodermatitis
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O L E H :
A I N I L M A K S U R A 1 1 1 2 0 1 5 0 0 4 1
F A K U L T A S K E D O K T E R A N
U N I V E R S I T A S M U S L I M K E D O K T E R A N
2 0 1 5
MINI POSTER
NEURODERMATITIS
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IDENTITAS PASIEN
Nama : Tn. S
Umur : 69 tahun
Jenis kelamin : Laki-laki
Alamat : Jl. BTN Minasa Upa blok A1 no. ! A"ama : #slam
Suku : Makassar
No. $M : 11%&9!
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ANAMNESIS
'U: luka pa(a kaki kanan (an kiri
)ialami se*ak kuran" lebih 1 tahun +an" lalu,
aaln+a han+a luka keil +an" san"at "atal, hilan"timbul (an ti(ak menentu. 'a(an" keluar (arah
akibat (i"aruk (an a"ak n+eri. $ia+at aler"i
makanan (an obat-obatan (isan"kal. $ia+at kontak
lama (en"an air atau bahan iritan tertentu ti(ak a(a.
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• Sakit rin"an / 0ii Baik / 2omposmentis
• 3emeriksaan tan(a 4ital:
T): 1&!/9! mm5"
Na(i: %!/menit
3ernapasan: /menit
Suhu: &6,& (era*at 2
KEADAAN UMUM
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• Anemis 7-8, #kterus 7-8, sianosis 7-8
• Thoraks : )alam Batas Normal
•
Ab(omen : )alam Batas Normal• kstremitas : )eormitas 7-/-8, e(ema 7-/-8,
eritema 7;/;8
• 'elen*ar Lime: )alam Batas Normal
PEMERIKSAAN FISIS
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PEMERIKSAAN STATUS DERMATOLOGIS
REGIO: 3e(is (etra et sinistra
EFFLORESENSI: 3lak hiperpi"mentasi, krusta(an ekskoriasi, likeniikasi (an se(ikit skuama
krusta (an ekskoriasi
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EFFLORESENSI
3lak hiperpi"mentasi,Likeniikasi (an se(ikit skuama
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NEURODERMATITIS
DIAGNOSA
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Seoran" pria 69 tahun (atan" ke poli 'ulit (an 'elamin
$S#< (en"an keluhan luka pa(a kaki kanan (an kiri +an"
(ialami se*ak kuran" lebih 1 tahun +an" lalu, aaln+a
han+a luka keil +an" san"at "atal, hilan" timbul (an
ti(ak menentu. 'a(an" keluar (arah akibat (i"aruk (an
a"ak n+eri. $ia+at aler"i makanan (an obat-obatan(isan"kal. $ia+at kontak lama (en"an air atau bahan
iritan tertentu ti(ak a(a.
RESUME
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PENATALAKSANAAN
1. #nerson ream ; uson ream pa"i-sore
. 2ea(roil =!! m" & (( #
&. 2etiriine 1! m" 1 (( #
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PROGNOSIS
<un"sionam : (ubia a( bonam
>itam : a( bonam
Sanationam : (ubia a( bonam
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NEURODERMATITIS
)#S'US#
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DEFINISI
A(alah pera(an"an kulit kronis, +an" (itan(ai
(en"an kulit tebal (an "aris kulit tampak menon*ol
7likeniikasi8 men+erupai batan" ka+u akibat
"arukan atau "osokan +an" berulan" ? ulan" karena
berba"ai ran"san"an prurito"enik.
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EPIDEMIOLOGI
Terserin" kelompok usia (easa &! ? =! tahun.
Neuro(ermatitis lebih serin" ter*a(i pa(a anita
terutama pa(a umur perten"ahan in(i4i(u.Jaran" ter*a(i pa(a anak-anak, karena pen+akit +an"
bersiat kronis (an (ipen"aruhi oleh kea(aan emosi
(an pen+akit +an" men(asarin+a.
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ETIOPATOGENESIS
osinoil +an" berisi protein @ (an protein kationik
Menimbulkan (e"ranulasi sel mast.
Aktikan sel-sel sara berisi 20$3 7Calcitonin Gene- Related Peptide8 (an S3 7substance P) (i (ermis
$espon (ari a(an+a kea(aan emosional / stress.trauma mekanik, pen+akit kronik +an" men(asari
5istamin lepas (ari sel mast
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Lanjutan...
no(ular likeniikasi (anh+perkeratosis.
0arukan (an "osokan berulan"
pruritus
pelepasan me(iator (an akti4itasenim proteolitik.
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DIAGNOSIS
P!"#$!%&#: leher, pun""un", (an ekstremitas
terutama per"elan"an tan"an, kaki, lutut, pubis,
4ul4a, skrotum, perianal serta bokon".
E'$(!&!n&#: berukuran mulai beberapa milimeter -
m, terlihat plak (en"an ekskoriasi, se(ikit
eritematosa e(ema, likeniikasi, hiperpi"mentasi,
serta tampak berskuama.
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rosi (an ekskoriasi
Likeniikasi, hiperpi"mentasi
ritematosa, (ema
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PEMERIKSAAN PENUN)ANG
3emeriksaan U*i Tempel
3emeriksaan Laboratorium
5istopatolo"i
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DIAGNOSA *ANDING
)ermatitis atopik tipe (easa
3ruri"o no(ularis
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PENATALAKSANAAN
Nonmedikamentosa:
1. Hindari menggaruk lesi
2. Hindari gigitan serangga
Medikamentosa:
1. Antipruritus: antihistamin yang mempunyai efek sedatif (prometazin,
difenhidramin, hidroksizin). Antihistamin topikal yang dapat
diberikan yaitu krim doxepin ! "angka pendek (maksimal # hari)
2. $ortikosteroid topikal: kortikosteroid poten atau suntikan intralesi
%. &' (<raiolet ) atau *&'A (*soralen <raiolet A)
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PROGNOSIS
<un"sionam : (ubia a( bonam
>itam : a( bonam
Sanationam : (ubia a( bonam
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KOMPLIKASI
Bisa berupa perubahan arna pa(a kulit +an"
permanen
Ter(apatn+a bekas luka akibat "arukan sampaiter*a(in+a ulkus karena serin"n+a pasien
men""aruk.
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DAFTAR PUSTAKA
1. Sularsito SA, )*uan(a S. #lmu 3en+akit 'ulit (an 'elamin .=th.
e(. 3enerbit <'U#, Jakarta !!=. p. 19-1=&. 'oeni" T, Jones S0, $enie A,Tausk <A.Nonutaneous maniestations o skin.#n:<ree(ber" #M,isen AC,ol
',Austen '<, 0ol(smith LA, 'ATC S2,e(itors.<itpatrikDs )ermatolo"+ in 0eneral Me(iine, % the(. Ne Eork : M0ra 5ill !1.p.1=%-16
&. Sire"ar $S. Atlas Berarna Saripati 3en+akit 'ulit n(e(. 3enerbit buku ke(okteran 02, Jakarta,!1&.p.1&=-F
G. Murtiastuti ), r4ianti , A"usni #, et al. Atlas 3en+akit 'ulit (an 'elamin. n(e(. Airlan"""a Uni4ersit++ 3ress,Suraba+a, !1! p 11F-%
=. 5istopatolo"i Neuro(ermatitis. )iun(uh % A"ustus !1&.http://missin"link.us.e(u/lm/(ermatolo"+"lossar+/lihenHsimpleHhronius.htm
6. Lesi Neuro(ermatitis. )iun(uh % A"ustus !1&.http://4enasaphenama"na.blo"spot.om/!11/1!/neuro(ermatitis-sirkumskripta.html
F. Lihen Simple 2hronis. )iun(uh % A"ustus !1&.http://.(ermnet.om /pruri"oHno(ularis.pi
%. )ermatitis Atopik. )iun(uh % A"ustus !1&.http://.me(iinenet.om /(ermatitis atopi.pi
9. 3ruri"o No(ularis. )iun(uh % A"ustus !1&.http://.skinsi"ht.om /Lihensimplehroni.
1!. )eoto, $. 5e(i. <armakolo"i (an Terapi. (isi =. <'U#, Jakarta !!%. 3 F&-%F
11. $a(manesh M,Sharii M,Shaiei S. #ranian Journal o )ermatolo"+ 4ol 1G.no1.#ranian Soiet+ o )ermatolo"+.Srin"
!11 p" =-%1. Shul S, Met M, Siepmann ), et al.Antipruriti eia+ o hi"h-(osa"e antihistamine therap+. $esults o a
retrospeti4el+ anal+se( ase series. 5autart !!9I 6!: =6G-%
1&. Maa M,Journal o linial pharma+ an( therapeuti 4ol &% issue 1,p"16-%,<ebuar+ !1&.
1G. Stan(er S, Shurme+er 5<,Lu"er TA, eisshaar .Treatment o pruriti (isease ith topial alineurin inhibitors.Ther 2lin $isk Mana" !!6I p" 1&-%
1=. Siepmann ), Lu"er TA, Stan(er S.Antipruriti eet o +losporine miroemulsion in pruritus : results o a aseseries.J )tsh )ermatol 0es !!%I6 p" 9G1-6