refleksi kasus i (psoriasis vulgaris)

8/9/2019 Refleksi Kasus I (Psoriasis Vulgaris)

1/29

REFLEKSI KASUSPSORIASIS VULGARIS

Nadya Anisah102011101009

Pembimbing

dr. Rosmarini Estri Sih Hananti, M.Sc, S.KK

FAKULTAS KEDOKTERAN UNIVERSITAS JEMBER

2015


2/29

!"#inisi

Peny!i" ini "e#g$%$ng &%m &e#m"$'i'

e#i"#$'!(m$' &n be#'i)" !#$ni! &n

#e'i&i)* P& !(%i" +#n !eme#,n-

'!(m be#%.i'/%.i'- !'# &n

"#n'.#n &i'e#"i $%e, )en$men

"e"e'n %i%in- Auspitz, &n K$bne#*


3/29

Eid"mio$o%i

P#e%en'i &#i ng! !e&in .'$#i'i' &i"em(!n &i

'e%(#(, &(ni- !(#ng &#i 1 ,ingg 3 &#i .$.(%'i* In'i&en .& $#ng !(%i" .("i, 4 $#ng yng !(%i"

be#+#n*

1* E#$. 3/6 .$.(%'i

2* Ame#i! 1/2 .$.(%'i

3* Je.ng 0-7 .$.(%'i.Di In&$ne'i- .#e%en'i .en&e#i" .'$#i'i' men8.i

1/3 b,!n bi' %ebi,: &#i .$.(%'i .en&(&(!

In&$ne'i nm(n (m%, ini be%(m &i!e",(i .'"i*


4/29

Etio$o%i

F!"$# im(nF!"$# ;ene"i!

F!"$# .en8e"(' 1* In)e!'i

2* T#(m )i'i!

3* S"#e''


5/29

Pato%"n"sis

Te#&i .e#(b,n m$#)$%$gi &n !e#('!n 'e% e.i&e#mi'

menyebb!n .embe'#n &n .emnngn ..i% &e#mi'* J(m%, 'e%/'e% b'% yng be#mi"$'i' mening!" 'e,ingg

.em"ngn !e#"ini''i 'e%/'e% "n&(! be%(m 'em.(#n*Se%/'e% yng membe%, &engn 8e." be#ge#! !e bgin

.e#m(!n e.i&e#mi' yng meneb%* P#$%i)e#'i &n mig#'i

'e%/'e% e.i&e#mi' yng 8e." ini menyebb!n e.i&e#mi'

men&i "eb% &n &i%i.("i !e#"in yng "eb% be#(. '!(m* P& .'$#i'i' +!"( .(%i, "(#n $e#"ime: e.i&e#mi'

&i.e#8e." men&i 3/< ,#i- 'e&ng!n .& !(%i" n$#m%

%mny 26 ,#i*


6/29

Gam&aran K$inis

Le'i 'ime"#i'- +%(.(n &."

"e#&i 'e8# (ni%"e#%* Le'i be#(.

.%! e#i"em"(' yng be#b"' "eg'

&engn &i%.i'i '!(m "eb% be#%.i' yng "#n'.#n*

U!(#nny be##i'i m(%i &#i

..(% yng be#(!(#n !e8i% 'm.i

&engn .%! yng men("(.i #e

"(b(,


7/29

Pr"di$"'si

P#e&i%e!'i &#i .'$#i'i' &." "e#&i

&i'e%(#(, "(b(, nm(n bny! .&

bgin "(b(, yng .%ing 'e#ing

"e#!en ge'e!n "( "e!nn 'e.e#"i

'i!(- %("("- &n .(ngg(ng*

Bgin "(b(, %in 'e.e#"i &e#,

yng be#mb("* P& bgin !(%i"

!e.% !n "m.! e#i"em "i&!

e%' "e".i '!(m 8(!(. "eb%


8/29

!ia%nosis

Anmne'i' &n .eme#i!'n )i'i!

/K%ini' &i"em(!n %e'i be#(. .%! e#i"em"(' yng

be#b"' "eg' &engn &i%.i'i '!(m "eb%

be#%.i'

/ Fen$men Te"e'n Li%in

/ Fen$men Auspitz

/ Fen$men Kobner- pitting nail "( nail pit Peme#i!'n =i'"$."$%$gi Lb$#"$#i(m


9/29

!ia%nosis (andin%

De#m"$)i"$'i' Tine &n Oni!$mi!$'i':Si)i%i' P'$#i'i)$#mi'

De#m"i"i' Seb$#$i!


10/29

P"nata$a'sanaan

Peng$b"n T$.i!%

An",#%in

S%e. &engn !$n'en"#'i 0-05/0-1

Vi"min D3 >%8i.$"#i$%:Mem.(nyi e)e! n"iin)%m'i &n meng,mb" .#$%i)e#'i !e#"in$'i" &engn

meng,mb" .emben"(!n IL/7*

P#e.#" T#

P#e.#" "# 'e.e#"i %i?($# 8#b$ni' &e"e#gen" 2/5 &%m '%e. &i.!i (n"(!

.eng$b"n .'$#i'i' yng !#$ni'* Mem.(nyi e)e! yng meng,mb"

.#$%i)e#'i !e#"in$'i"*

K$#"i!$'"e#$i& "$.i!%

Bi'ny &i.!i yng mem.(nyi .$"en'i 'e&ng 'm.i !("- (n"(!

.eng$b"n %e'i .'$#i'i' yng '$%i"e#* Mem.(nyi e)e! n"i in)%m'i &n n"imi"$'i'*


11/29

Peng$b"n Si'"emi!

K$#"i!$'"e#$i&

=ny &i.!i bi% '(&, "e#&i e#i"#$&e#m "(

.'$#i'i' .('"(%$' gene#%i'"* D$'i' 'e"# &engn

30 mg .#e&ni'$n .e# ,#i*

Me",$"#e@"eMem.(nyi e)e! meng,mb" 'in"e'i' DNA &n

be#'i)" n"i in)%m'i &engn mene!n !em$"!"i!

"e#,&. 'e% ne"#$)i%*


12/29

Si!%$'.$#in

Sebgi '%, '"( $b" im(n$'(.#e'i) yng mem.(nyi e)e!

meng,mb" !"i'i &n .#$%i)e#'i 'e% T* D$'i' yng &in(#!n

&%, 2/5 mg!g BB

Re"in$i&

Me#(.!n &e#i" i"min A- mi'%ny e"#e"in" "( 8i"#e"in*

Mem.(nyi e)e! meng,en"i!n &i)e#en'i'i &n .#$%i)e#'i !e#"in$'i"

&n be#'i)" n"i in)%m'i*

DDS &imin$&i)eni%'(%)$n:

=ny &i.!i (n"(! .eng$b"n .'$#i'i' .('"(%$' %$!%i'" &engn

&$'i' 2 @100 mg,#i*


13/29

F$"$ "e#.i Sin# (%"#i$%e" mem.(nyi e)e! meng,mb" mi"$'i'-

'e,ingg &." &ig(n!n (n"(! .eng$b"n .'$#i'i'-

&ig(n!n 'in# (%#i$%e" #"i)i'i%- &in"#ny 'in# A yng&i!en% 'ebgi UVA 'e%in i"( UVB (g &." &ig(n!n

(n"(! .eng$b"n .'$#i'i' "i.e .%!- g(""- .('"(%# &n

e#i"#$&e#m*


14/29

Pro%nosis

D(bi & b$nm


15/29

REFLEKSI KASUS


16/29

Anamn"sis

I&en"i"' .'ien Nm Tn* A

Um(# 30 ",(nAgm I'%mPen&i&i!n Tm" SDS(!(Bng' J+/M&(# Jeni' Ke%min L!i/%!iA%m" P(ge#- Jembe#*


17/29

Ke%(,n U"mBe#8! Keme#,n yng meninggi .& !(%i"

yng &i'e#"i #' g"% &n be#'i'i! "eb%- be#%.i' be#+#n .("i, .& .(ngg(ng-

!e&( %engn- 'i!(- !e&( "(ng!i 'e! 3

b(%n yng %%(*


18/29

Ri+y" Peny!i" Se!#ng

Se! 3 b(%n yng %%( .'ien menge%(,!n "imb(%ny

be#8! !eme#,n .& !(%i" yng &i'e#"i #' g"% &i

.(ngg(ng- !e&( %engn- 'i!( &n !e&( "(ng!i* A+%ny .e#"m !%i .'ien menge%(,!n be#8! !eme#,n 'ebe'#

(ng !$in 100 #(.i, yng "e#&." .& !e&( %engn ny

%m !e%mn be#8! "e#'eb(" 'em!in g"% 'e,ingg .'ien

mengg#(! be#8! "e#'eb("* Be#8! !eme#,n "e#'eb("

!em(&in meninggi &n be#'i'i! "eb%- be#%.i' be#+#n

.("i, &n "e#b !e#ing "( "i&! be#miny!* Ji! be#8!/

be#8! !eme#,n "e#' g"% .'ien meng#(!ny &n

be#8! !,i#ny menge%(.'*


19/29

Bi% .'ien be#!e#ing" .& m%m ,#i "e#' %ebi, g"%

'e,ingg "e#!&ng .'ien mengg#(!ny 'm.i be#&#,-

be#8! yng +%ny be#& .& %engn .'ien %m

!e%mn me%(' "m.! !eme#,n yng &ibgin "'ny&i'e#"i &engn 'i'i! yng be#%.i'

"eb% .("i, 'e.e#"i, 'e#.i,n

!e"$mbe i! &i g#(!- &n m!in me%(' !e bgin .(ngg(ng

&n !e&( "(ng!i .'ien* P'ien 'ebe%(mny "i&!

menge%(,!n &emm- '!i" "engg$#$!n- b"(! m(.(n .i%e!*

A!,i#/!,i# ini .'ien menge%(, 'e&ng bny! .i!i#n* P'in

.e#$!$! !"i) &n "i&! meng!$n'(m'i min(mn be#%!$,$%

&n !,i#ny .'ien mem("('!n (n"(! be#$b" !e RS*


20/29

Ri+y" %e#gi

A%e#gi $b" &n m!nn &i'ng!% $%e, .'ien- A'm

/:- R,ini"i' %e#gi /:

Ri+y" .eny!i" "e#&,(%(

Ri+y" .eny!i" !(%i" yng %in &i'ng!% $%e, .'ien*

Ri+y" .eny!i" &ibe"e' me%i"(' &n .eny!i" n"(ng

&i'ng!%


21/29

Ri+y" .eny!i" &%m !e%(#g

Ti&! & !e%(#g yng meng%mi !e%(,n yng 'm-

#i+y" %e#gi &%m !e%(#g (g &i'ng!%

Ri+y" '$'i%

P'ien meni!,- '" ini '(&, "i&! be!e# &n "ingg%

be#'m n! %!i/%!i be'e#" !e%(#gny- 'e,ingg

!,i#/!,i# ini .'ien menge%(, 'e&ng bny! .i!i#n*Ri+y" me#$!$! &n min(m min(mn !e#' &i'ng!%*


22/29

S""(' ;ene#%i'

D%m b"' n$#m%


23/29

S""(' De#m"$%$gi'

P& Regi$ e#"eb#%i'- n"eb#8,ii &e@"# &n

'ini'"#- 'e#" 8#(#i' &e@"# &n 'ini'"# &i"em(!n

Tm.! .%! e#i"em"$'- (!(#n be##i'i- m(%"i.%e-

n(%# &n #eg(%e#- 'i#!(m!#i.- &i'e#"i &engn

'!(m be#+#n .("i,- "#n'.#n- "eb% &n be#%.i'/ %.i' .'$#i'i)$#mi':*


24/29


25/29

!ia%nosis (andin%

P'$#i'i' V(%g#i'

Tine K$#.$#i'Pi"i#i'i' R$'e


26/29

!ia%nosis K"r)a

P'$#i'i' V(%g#i'


27/29

P"nata$a'sanaan

UMUM Membe#i .ene%'n !e.& .'ien &n !e%(#g "en"ng

.eny!i"ny

Meng !$n&i'i "(b(, g# "e". &%m !e&n be#'i, 'e#"'e,"- meng(#ngi '"#e' &n be#$b" 'e8# "e#"(#

Peng(nn .e%embb yng &in(#!n (n"(! men8eg,

!e!e#ingn .& !(%i"* >(!(.i n("#i'i &engn m!n m!nn yng be#giCi- "i&(# yng

8(!(.* K$n"#$% !emb%i 'e"e%, $b" ,bi'- (n"(! e%('i .eng$b"n* R("in me%!(!n "e#.i .enyin#n 'e'(i &engn &+% yng

'(&, &i"e".!n*


28/29

K,('('

Peng$b"n me&i!men"$' T$.i!% O%e(m O%i#(m 2

A'm '%i'i%"


29/29

Pro%nosis

D(bi & b$nm

refleksi kasus i (psoriasis vulgaris)

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