SKENARIO A BLOK 19

KELOMPOK L8 TUTOR: DR. LINDA TRISNA, Sp.M(K)

ANGGOTA KELOMPOK 8
R. A. DELILA TSANIYAH 04111001043

MIA HAYATI KHAIRUNNISA

WIRA DHARMA UTAMA RISHA MEILINDA M FITRI NURRAHMI RULLIS DWI I FADHLI AUFAR KASYFI NURBAITI OKTAVIA A

04111001045
04111001048 04111001069 04111001077 04111001082 04111001091 04111001100

BHAGASKARA
ARIEF TRI WIBOWO AGUNG HADI WIBOWO PRASS EKASETIA P. MUCHTAR LUTHFI

04111001101
04111001119 04111001135 04111001139 04111001142

SKENARIO A
MR. SQUID, A 64 YEARS OLD MAN, CAME TO OUTPATIENT CLINIC BARI HOSPITAL WITH CHIEF COMPLAINT PROGRESSIVE ITCHY THICK ERYTHEMATOUS PLAQUES IN BOTH LEGS, ARMS, BUTTOCKS, AND LOWER LUMBOSACRAL SINCE 6 MONTHS AGO. THE CONDITION INITIALLY MANIFESTED ON HIS LEFT LEG AS A PAPULE WITH THICK WHITE SCALES THEN RAPIDLY SPREAD TO BOTH LEGS, SCALP, BUTTOCKS, LUMBOSACRAL, AND ARMS. HIS FINGERS AND TOE NAILS SHOWED DESTRUCTION OF THE NAIL PLATE. HE FEEL PAIN AND RIGIDITY ON HIS KNEES SINCE 3 MONTHS AGO. HE HAD BEEN TREATED HIMSELF WITH TOPICAL BETHAMETHASONE OINTMENT AND MOISTURIZER IRREGULARLY.

PHYSICAL EXAMINATION GENERAL STATUS: COMPOS MENTIS, VITAL SIGNS WITHIN NORMAL LIMIT.

DERMATOLOGICAL STATUS:
-WELL DEMARCATED, ERYTHEMATOUS PAPULES TO PLAQUES WITH A WHITE ADHERENT THICK SCALES; ON BOTH OF HIS LEGS, ARMS, BUTTOCKS, LUMBOSACRAL.

-ERYTHEMATOUS PLAQUE WITH THICK WHITE SCALES ON HIS SCALP.

PREDILEKSI

KLARIFIKASI ISTILAH
1. ERYTHEMATOUS 2. PLAQUES 3. PAPULE 4. SCALES 5. NAIL PLATE 6. TOPICAL BETHAMETHASONE OINTMENT 7. MOISTURIZER 8. DERMATOLOGICAL STATUS 9. WELL DEMARCATED 10. WHITE ADHERENT THICK SCALES

ANATOMI DAN HISTOLOGI KULIT

PSORIASIS
1. PENEGAKAN DIAGNOSIS:
- ANAMNESIS (BENTUK, PREDILEKSI, ONSET, RIWAYAT (PENYAKIT, KELUARGA, OBAT-OBATAN, KEBIASAAN) - PEMERIKSAAN FISIK : DERMATOLOGICAL STATUS, TIGA TANDA PSORIASIS (FENOMENA TETESAN LILIN, AUSPITZ SIGN, FENOMENA KOEBNER) - PEMERIKSAAN PA 2. DD:

DERMATOFITOSIS (TINEA DAN ONIKOMIKOSIS) SIFILIS PSORIASIFORMIS DERMATITIS SEBOROIK PITIRIASIS ROSEA MIKOSIS FUNGOIDES DERMATITIS ATOPI LIKEN PLANUS SUBACUTE CUTANEUS LUPUS ERYTEMATUS DISCOID/NUMULAR ECZEMA

ETIOLOGI: HIPERPROLIFERASI KERATINOSIT DAN EPIDERMIS. FAKTOR LINGKUNGAN, GENTIK, DAN IMUNOLOGI BERPERAN PENTING. LINGKUNGAN: STRES, OBAT-OABTAN, INFEKSI, TRAUMA. GENETIK: PSORIASIS TIPE I : HLA-B13, HLA-B17, BW57, DAN CW6 PSORIASIS TIPE II : HLA-B27 DAN CW2 PSORIASIS PUSTULOSA : HLA-B27 IMUNOLOGI: SEL LANGERHANS, SEL PENYAJI ANTIGEN (DERMAL), LIMFOSIT T EPIDEMIOLOGI: KULIT PUTIH > KULIT BERWARNA. DI DUNIA, 2-3 %. AMERIKA (4,6%), KANADA (4,7%). DI ASIA JARANG. TIMBUL USIA KAPAN SAJA SAMPAI DEKADE KEDELAPAN KEHIDUPAN.

2 PUNCAK: 20-30 TAHUN DAN 50-6O TAHUN. INSIDENS PRIA SAMA DENGAN WANITA.

PREDILEKSI: KLASIFIKASI:

1. PSORIASIS VULGARIS
2. PSORIASIS GUTATA 3. PSORIASIS PUSTULOSA

4. PSORIASIS INVERSA
5. PSORIASIS EKSUDATIVA 6. PSORIASIS SEBOROIK

7. PSORIASIS ERITRODERMA

MANAGEMEN TATA LAKSANA

MENGHENTIKAN PENINGKATAN PRODUKSI SEL KULIT DAN MENURUNKAN INFLAMASI DAN PEMBENTUKAN PLAK. MENGHILANGKAN SISIK DAN MELEMBUTKAN KULIT,

PENGOBATAN TOPIKAL : KORTIKOSTEROID TOPIKAL, VITAMIN D, ASAM SALISILAT, TAR BATUBARA, PELEMBAB
PENGOBATAN SISTEMIK: METHOTREXATE, RETINOID, CYCLOSPORINE, HYDROXYUREA, IMMUNOMODULATOR DRUGS, THIOGUANINE. PENGOBATAN DENGAN PENYINARAN: CAHAYA MATAHARI, PHOTOTERAPI UVB, TERAPI UVB SEMPIT, TERAPI GOECKERMAN, FOTOKEMOTERAPI, LASER EXCIMER. PENGOBATAN BIOLOGI AGEN: ALEFACEPT, EFALIZUMAB, ETANERCEPT, INFLIXIMAB, ADALIMUMAB. PENCEGAHAN: HINDARI STRES PSIKIS, MEMAKAI SABUN DENGAN PELEMBAB, HINDARI FAKTOR PENCETUS. KOMPLIKASI: PSORIASIS ARTHRITIS, PSORIASIS ERITRODERMA, INFARK MIOKARDIUM, GANGGUAN EMOSIONAL & PSIKOLOGI.

KERANGKA KONSEP

KESIMPULAN
TN. SQUID, 64 TAHUN, MENDERITA PSORIASIS VULGARIS DISERTAI PSORIASIS ARTHRITIS.
PROGNOSIS: DUBIA AD BONAM KDU: 3A

DAFTAR PUSTAKA
GUDJONSSON JE, ELDER JT. PSORIASIS. DALAM: WOLFF K, GOLDSMITH LA, KATZ SI, GILCHREST BA, PALLER AS, LEFFELL DJ, EDITOR. FITZPATRICKS DERMATOLOGY IN GENERAL MEDICINE. EDISI KE-7. NEW YORK. MCGRAW-HILL;2008. H.169-193. CASSELL S, KAVANAUGH A. REVIEW OPEN ACCESS PSORIATIC ARTHRITIS: PATHOGENESIS AND NOVEL IMMUNOMODULATORY APPROACHES TO TREATMENT. DALAM: JOURNAL OF IMMUNE BASED THERAPIES AND VACCINES 2005. DJUANDA, ADHI (EDS.). 2010. ILMU PENYAKIT KULIT DAN KELAMIN EDISI KEENAM. JAKARTA: BADAN PENERBIT FKUI. DORLAND, W. A. NEWMAN. 2002. KAMUS KEDOKTERAN DORLAND EDISI 29. JAKARTA: EGC. GUYTON A.C., AND HALL JE. 2000. TEXTBOOK OF MED. PHYS, 10TH ED. SAUNDERS PHILADELPHIA. GUYTON A.C., AND HALL. 2008. BUKU AJAR FISIOLOGI KEDOKTERAN EDISI 11. JAKARTA : EGC. KUMAR, VINAY, RAMZI S. COTRAN & STANLEY L. ROBBINS. 2012. BUKU AJAR PATOLOGI ROBBINS EDISI 7 VOLUME 1. JAKARTA: PENERBIT BUKU KEDOKTERAN EGC. KUMAR, VINAY, RAMZI S. COTRAN & STANLEY L. ROBBINS. 2012. BUKU AJAR PATOLOGI ROBBINS EDISI 7 VOLUME 2. JAKARTA: PENERBIT BUKU KEDOKTERAN EGC. NESTLE FO, KAPLAN DH, BARKER J (2009). "PSORIASIS". N. ENGL. J. MED. 361 (5): 496509. PRICE, SYLVIA ANDERSON DAN LORRAINE MCCARTY WILSON. 2005. PATOFISOLOGI: KONSEP KLINIS PROSES-PROSES PENYAKIT. JAKARTA: EGC. HTTP://WWW.NLM.NIH.GOV/MEDLINEPLUS/PSORIASIS.HTML