BED SIDE TEACHING 2

SEBORREICH DERMATITIS

1. Benhardy Rambu T2. Nurul Bariah3. Sri Jayanti4. Wahyuni Surya

Wulandari5. Desti Priani6. Hj. Harfana Alwi7. Lisna Rosalia Agaus8. Isnaeni Salamiya9. Surahmayanti Tahir10. Tajul Arifin

11. Marisa Trirahayu12. Steven S. Katuk13. Nahdiah Zainuddin14. Andi Fatmawati

Mahir15. Ali Khomeini16. Andi Amalia Ayu17. Arisal18. Indra Pahri Putra

GROUP MEMBERS

Name : Mr. Ridwan Ais Iwan Gender : Male Age : 33 y.o Marital Status : Single Religion : Moslem Address : Lapas Kelas II Maros Occupation : - Registered : 10 March 2013

PATIENT’S IDENTITY

Anamnesis :(Alloanamnesis from patient’s family)

Chief complaint : Pruritus

Further Anamnesis:Since four days ago. Face’s skin is abraded. It happened when his still in the jail. History of medication (-).

HISTORY TAKING

Systematical Anamnesis : Fever (+), Cough (+), chest pain (-), nausea (-), vomit (-) Defecation : normal Urination : normal

History of similar disease : (-)History of another disease: KP Patient had the same complaint : ( - ) Family History with the same complaint : ( - ) Treatment history : (-) Lifestyle : smoking (+)

alcohol (+) narcotic (+) exercise (-)

Allergic : (-) Systemic disease : (-)

General condition : Severe Consciousness : Compos mentis Vital sign:

BP : 100/70 mmHgPulse : 88x/minute,regulerBreathing : 20x/minuteTemperature : 38,50 C

Head Examination : Icteric (-) Anemic (+) Cyanosis (-)

Cor / Pulmo : BJ I/II, Pure, Reguler Thorax : Vesikuler, Rh (+)/Wh(-) Abdomen: Normal, Peristaltic (+) Extremities : Normal

PRESENT STATUS

Dermatology Status- Location : Regio Scalp, and

Facialis- Efflorescence : Makula hipopigmentasi, skuama

Venerology Status (-)

Additional Examination- Laboratory : (-)

DIAGNOSIS- Seborrheich Dermatitis

DIFFERENTIAL DIAGNOSIS - Psoriasis , Pityriasis rosea, Contact dermatitis, SLE ,

Atopic dermatitis

MANAGEMENT- Topical: Miconazole Cream (Morning, Afternoon)- Systemic : Ketokonazole 200 mg 1x1 tab

Cetimizin 1 x 1 tabKetomed shampo

PROGNOSIS- Dubia

Chronic papulosquamous condition Occur on sebum-rich area of scalp, face and trunk Occur as an isolated condition or in conjunction with

other disorder such as blepharitis, acne vulgaris, ocular rosacea

Varies from mild dandruff to exfoliative erythroderma Aggravated by change in humidity, change in season,

trauma (e.g. scratching) or emotional stress Associated with several systemic disease include

AIDS, zinc deficiency, Parkinson disease Frequently seen in patient who received psoralen

with UVA therapy

Seborrheic dermatitisDiscussion

Malassezia globosa- Lipophilic yeast

-Found in normal skin -Research document supported relation

between Malassezia and seborrheic dermatitis :clinical response to antifungal drug :increase in number of Malassezia in recurrence disease

Sebum production Genetic susceptibility for inflammatory response

Causative factor

Malassezia are not the cause but are a cofactor link to T-cell depression, increase sebum level and activation of the alternative complement pathway

Skin barrier dysfunction prone to disease Medication that induced flare up : auranofin,

aurothioglucose, buspirone, chlorpromazine, cimetidine, ethionamide, gold, griseofulvin, haloperidol, interferon Alfa, lithium, methoxsalen, methyldopa, phenothiazines, psoralens, stanozolol, thiothixene and trioxsalen

Causes

Depend on age, skin type, presence or absence of concurrent systemic illness

Dry and flaky with white scale or greasy with crusting

Skin type 4-6 :reduce visible erythema:hypo or hyperpigmented

Increase in winter and early spring Remission commonly in summer

Clinical

Differential diagnosis in adult Psoriasis Pityriasis rosea Contact dermatitis SLE Atopic dermatitis

Candidiasis Rosacea Impetigo Tinea versicolor Sarcoidosis

Early treatment Behavior modification to reduce excoriation Avoid shampoo and topical product that dry the hair and skin Steroid

:low and middle potency:may increase recurrence rate:rebound effect :discourage except for short term use

Antifungal drug:ketoconazole:ciclopiroxolamine:selenium sulfide

Treatment

Thank You