eritroderma ec pemfigus vulgaris

8/18/2019 eritroderma ec pemfigus vulgaris

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BAB I

PENDAHULUAN

Kulit adalah organ tubuh yang terletak paling luar dan

membatasinya dari lingkungan hidup manusia. Kulit merupakan organ

yang esensial dan vital serta merupakan cermin kesehatan dan

kehidupan. Salah satu kelainan kulit yang dapat menyebabkan

terganggunya fungsi kulit adalah eritroderma (Munyao dkk, 2007.

!ritroderma, disebut "uga sebagai dermatitis eksfoliatif,

diperkenalkan pertama kali oleh #ebra pada $%&%, merupakan kelainan

kulit inflamasi yang ditandai kulit eritem generalisata dan skuama yang

luas melibatkan '0 luas permukaan kulit. !ritroderma dan

dermatitis eksfoliatif merupakan satu per"alanan klinis, yakni tahap

a)al berupa kulit eritem generalisata yang kemudian diikuti dengan

pengelupapasan kulit (*uan dkk, 20$0. +ada penelitian ini selan"utnya

akan menggunakan terminologi eritroderma.

!ritroderma bukan merupakan kasus yang sering ditemukan, namun

masalah yang ditimbulkannya cukup parah (Mapar dkk, 20$$.

!ritroderma dapat berakibat fatal, maka diperlukan penatalaksanaan

yang baik karena dapat mengganggu metabolisme tubuh dengan

berbagai komplikasinya, oleh karena itu perlu mengidentifikasi penyakit

yang mendasari dan memberikan terapi kausatif secara adekuat (+al dan

#aroon, $''% -kodu)a dkk, 200'.

$


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CATATAN MEDIS

KEPANITERAAN KLINIK SENIOR

ILMU KESEHATAN KULIT DAN KELAMIN

RSUD CUT NYAK DHIEN -MEULABOH

IDENTITAS PENDERITA

Nama : Ny.M

Umur : 48 tahu

!"#$ K"%am# : P"r"m&ua

A'ama : I$%am

P"(#(#)a T"ra)h#r : SD

P")"r*aa : P"ta# + P")",u

A%amat : D"$a Puu) Kaay I/

N0.RM : 81.23.11

Ta''a% ma$u) RS : 1 Mar"t 152

Rua' : Rua' Raat 6a,u'a Ku%#t (a K"%am#

ANAMNESIS

Aam"$#$ (#%a)u)a $"7ara aut0aam"$#$ &a(a ta''a% 1 Mar"t 152 &u)u% 1.5

9IB.

a. Keluhan Utama :

2


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- Pa$#" (ata' ("'a )"%uha 'ata% (a &aa$ (#$"%uruh tu,uh (#$"rta# t#m,u% ,"r7a)

)"m"raha (a t#m,u% )u%#t ya' t"r)"%ua$ (#$"%uruh tu,uh.

b. Keluhan Tambahan :

- Ba(a t"ra$a %"ma$ ; har# ya' %a%u SMRS )"%uha 'ata% (a %u)a (#ra$a)a (#a*ah (#$"rta# %u)a

m"m,a$a$ (a m"'"%u&a$.

.

!. Riwayat Penyakit Dahulu

- K"%uha $"ru&a : D#$a')a%

- A%"r'# : D#$a')a%

- D#a,"t"$ M"%%#tu$ : D#$a')a%

- H#&"rt"$# : D#$a')a%

- !atu' : D#$a')a%

- N"ur0%0'# : Lum&uh ;


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Kea!aan Umum :

- K"$a(ara : C0m&0$ M"t#$

- 6CS : ; E 4 / M 2=

'ital $in :

% TD : 5 + 5 mmH'- Na(# : 85 + m"#t.

- RR : 15 +m"#t

- Suhu : 8 0 C

Statu$ (enerali$ata :

- Ku%#t : 9ara $a0 mata' h#(ra$# 7u)u&

- K"&a%a : N0rm07"&ha%#

- Mata : C0r&u$ a%#"um;-+-= )0*u't#Fa: a"m#$ ;-+-=

H#&"r"m#$ ;-+-=#)t"r#) ;-+-= R"@%") 7ahaya ;


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D"&a

I$&")$#

Pa%&a$#

P"r)u$#

Au$)u%ta$#

S#m"tr#$ $tat#$ G

(#am#$ r"tra)$# ;-=

St"m @r"m#tu$ 0rma%)aa )#r#

S00r $"%uruh %a&a'

&aru

SD&aru F"$#)u%"r ;


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Statu$ )#kali$

L0)a$# : S"%uruh 9a*ah

D#$tr#,u$# : R"'#0a%

K0@#'ura$# : T"r$",ar

M0r@0%0'# : Tam&a) &at7h "r#t"ma %ua$ ("'a ")$@0%#a$# (a "r0$#

L0)a$# : S"%uruh Ba(a

D#$tr#,u$# : U#F"r$a%

K0@#'ura$# : 6""ra%#$ata

M0r@0%0'# : Er#tr0("rma %ua$ ("'a ")$@0%#a$# (a "r0$# mu%t#&%"

PEMERIKSAAN PENUN*AN(

% H, : 85 'r+(% - B#%%#ru,# t0ta% : 581 'r+(%

% Er#tr0$#t : 4 52 +u# - B#%%#ru,# (#r"7t : 53 'r+(%% L"u)0$#t : 32 52 +u# - A%)a%# Ph0$&ata$" : 21 U+I

&


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% HT : 113 52 +u# - S6OT : 51 U+I

% Tr0m,0$#t : 1 52 +u# - S6PT : 1 U+I

- K6DS : 21 'r+(%

- Ur"um :43 'r+(% - Kr"at## :44 'r+(%

DIA(N+SIS ,ANDIN(

- ERITRODERMA E.C PEMJI6US /UL6ARIS

- ERITRODERMA E.C ERUPSI OBAT

- ERITRODERMA E.C DKA

DIA(N+SIS SEMENTARA

% ERITR+DERMA E.C PEM&I(US 'U)(ARIS

PENTA)AKSANAAN

% I/JD RL 5 'tt+ #

% I*. M"ty%&r"(#$0%0 1 'r + 14 *am

% I*. Ra#t#(# +1 *am

% It"rh#$t# ta, 1

% 6"tam#7# a%@ 1 ;(#,a'#a ya' "r0$# =

% K0m&r"$ NaCL 3 < Ka$$a

Pa'# : m"#t a*ah (a %"'a

S#a' : m"#t (# )a)#

Ma%am : m"#t a*ah (a ,a(a

% E!uka$i

. M"*a'a )","r$#ha (#r# ("'a ma(# t"ratur m"''ua)a $a,u

1. M"''at# &a)a#a ya' ,"r$#h

. M"m&"rhat#)a )","r$#ha t"m&at t#(ur

4. M"*a'a )","r$#ha %#')u'a $"t"m&at

. B#*a) (a%am m"''ua)a 0,at ? 0,ata

2. M"'h#(ar# ma)aa ya' ,#$a m"*a(# @a)t0r &"m#7u a%"r'h#

. M"')0$um$# ma)aa ,"r'## t"rma$u) ,aya) m#um a#r &ut#h (a

m"')0$um$# ,uah ya' m"'a(u' F#tam#.&+))+- UP

PERKEMBAN6AN PENATALAKSANAAN

7


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Raat

T'%.11+5

152

UKK:

-aah : Tam&a) &at7h "r#t"ma

%ua$ ("'a ")$@0%#a$# (a "r0$#

mu%t#&%" t"r$",ar

Seluruh tubuh : "r#tr0("rma

%ua$ ("'a ")$@0%#a$# (a "r0$#

mu%t#&%" t"r$",ar

)e$i ,aru : ;-= t#(a) (#t"mu)a

I/JD RL 5 'tt+ #

I*. M"ty%&r"(#$0%0 1 'r + 14 *am

I*. Ra#t#(# +1 *am

It"rh#$t# ta, 1

6"tam#7# a%@ 1

K0m&r"$ NaCL 3 < Ka$$a

Raat 1

T'%.1+5

152

UKK:

-aah : "r0t#F" ("'a

")$@0%#a$# $",a'#a tam&a)

"r0$# mu%t#&%"

Seluruh Tubuh : Er0$#

mu%t#&%" t"r$",ar ("'a

")$@0%#a$# '""ra%#$ata.

)e$i ,aru : /%0 T#(a)

(#t"mu)a

D#"t TKTP

I/JD RL 15 'tt+#

I*. M"ty%&r"(#$0%0 1 'r + 14 *am

I*. Ra#t#(# +1 *am

I*.C"@0ta#m" 'r+ 1 *am

I"r$0 7r 1

6"tam#7# a%@ 1 ;t"m&at %u)a=


Raat

T'%

14+5

152

UKK

Seluruh tubuh : "r0$# mu%t#&%"

t"r$",ar.

)eher : %"$# m"m,a$ah

L"$# %a#ya M"m,a#)

)e$i baru : ;-= t#(a) (#t"mu)a

D#"t TKTP

I/JD RL 15 'tt+#

I*. M"ty%&r"(#$0%0 1 'r + 14 *am

I*. Ra#t#(# +1 *am

I*.C"@0ta#m" 'r+ 1 *am

A$am J0%at ta, 1

I"r$0 7r 1

6"tam#7# a%@ 1 ;t"m&at %u)a=


PR+(N+SIS

. u0 a( /#tam : a( ,0am.

1. u0 a( Saam : a( ,0am

. u0 a( C0$m"t#7am : Du,#a a( ,0am

%


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,A, II. TIN*AUAN PUSTAKA

A. DE&INISI

Ku%#t a(a%ah 0r'a tu,uh ya' t"r%"ta) &a%#' %uar (a m"m,ata$#ya (ar# %#')u'a

h#(u& mau$#a. Ku%#t m"ru&a)a 0r'a ya' "$"$#a% (a F#ta% $"rta m"ru&a)a 7"rm#

)"$"hata (a )"h#(u&a. Sa%ah $atu )"%a#a )u%#t ya' (a&at m"y",a,)a @u'$# )u%#t

a(a%ah "r#tr0("rma.;=

Er#tr0("rma a(a%ah )"%a#a )u%#t ya' (#ta(a# ("'a a(aya )"m"raha atau

"r#t"ma ya' ,"r$#@at '""ra%#$ata ya' m"7a)u& 35 &"rmu)aa tu,uh ya' ,"r%a'$u'

(a%am ,","ra&a har# $am&a# ,","ra&a m#''u. D"rmat#t#$ ")$@0%#at#Fa (#a''a& $#0#m

("'a "r#tr0("rma.;1= Ba'a#maa&u #tu t#(a) (a&at m"("@##$#)a )ar"a &a(a 'am,ara

)%##) (a&at m"'ha$#%)a &"ya)#t ya' ,"r,"(a. Pa(a ,aya) )a$u$ "r#tr0("rma umumya

)"%a#a )u%#t ya' a(a $","%umya ;m#$a%ya &$0r#a$#$ atau ("rmat#t#$ at0)= cutaneous T-

cell lymphoma;CTCL= atau r"a)$# 0,at. M"$)#&u &"#')ata 5 &a$#" m"m&uya#

'


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r#ayat %"$# &a(a )u%#t $","%umya utu) 0$"t "r#tr0("rma #("t#@#)a$# &"ya)#t ya'

m"y"rta# m"''am,ar)a $atu (ar# $")#a ,aya) )"%a#a )u%#t.;4=

Pa(a "r#tr0("rma ya' )r0#) "r#t"ma t#(a) ,"'#tu *"%a$ )ar"a ,"r7am&ur ("'a

h#&"r'm"ta$#. S"(a')a $)uama a(a%ah %a$a $tratum )0r"um ya' t"r%"&a$ (ar# )u%#t.

S)uama mu%a# (ar# ha%u$ $am&a# )a$ar. Pa(a "r#tr0("rma $)uama t#(a) $"%a%u t"r(a&at

m#$a%ya "r#tr0("rma )ar"a a%"r'# 0,at $#$t"m#) &a(a mu%aya t#(a) (#$"rta# $)uama

$)uama )"mu(#a t#m,u% &a(a $ta(#um &"y"m,uha t#m,u%. B#%a "r#t"maya atara 5-35

(#ama)a &r"-"r#tr0("rma..;=

B. ETI+)+(I

Er#tr0("rma (a&at (#$",a,)a 0%"h a)#,at a%"r'# 0,at $"7ara $#$t"m#) &"r%ua$a

&"ya)#t )u%#t &"ya)#t $#$t"m#) t"rma$u) )"'aa$a.;2= P"ya)#t )u%#t ya' (a&at

m"#m,u%)a "r#tr0("rma (#ataraya a(a%ah &$0r#a$#$ 1 ("rmat#t#$ $&0'#0t#) 15

a%"r'# 0,at CTCL atau $#(r0m $"ary ;=

A. Er#tr0("rma ya' (#$",a,)a 0%"h a%"r'# 0,at $"7ara $#$t"m#)

K"a(aa ## ,aya) (#t"mu)a &a(a ("a$a mu(a. O,at ya' (a&at m"y",a,)a

"r#tr0("rma a(a%ah ar$"#) 0r'a#) "ma$ m"r)ur# ;*ara'= &"#$#%# ,ar,#turat. Pa(a

,","ra&a ma$yara)at "r#tr0("rma mu')# %",#h t#''# )ar"a &"'0,ata $"(#r# (a

&"'0,ata $"7ara tra(#$#0a%.;1= 9a)tu mu%a#ya 0,at )" (a%am tu,uh h#''a t#m,u% &"ya)#t

,"rFar#a$# (a&at $"'"ra $am&a# 1 m#''u. 6am,ara )%##$ya a(a%ah "r#t"ma u#F"r$a%. B#%a

a(a 0,at ya' ma$u) %",#h (ar# $atu ya' ma$u) )" (a%am tu,uh (#(u'a $",a'a# &"y",a,ya

#a%ah 0,at ya' &a%#' $"r#' m"y",a,)a a%"r'#.;=

$0


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D#)ut#& (ar# &u$ta)a

B. Er#tr0("rma ya' (#$",a,)a 0%"h &"r%ua$a &"ya)#t )u%#t

Er#tr0("rma et causa &$0r#a$#$ m"ru&a)a "r#tr0("rma ya' &a%#' ,aya)

(#t"mu)a (a (a&at (#$",a,)a 0%"h &"ya)#t &$0r#a$#$ mau&u a)#,at &"'0,ata

&$0r#a$#$ ya' t"r%a%u )uat.;=

D"rmat#t#$ $",0r0#) &a(a ,ay# *u'a (a&at m"y",a,)a "r#tr0("rma ya' *u'a

(#)"a% &"ya)#t L"#"r. Et#0%0'#ya ,"%um (#)"tahu# &a$t#. U$#a &"("r#ta ,"r)#$ar 4-15

m#''u.;2=Ptyr#a$#$ ru,ra %ar#$ ya' ,"r%a'$u' $"%ama ,","ra&a m#''u (a&at &u%a

m"*a(# "r#tr0("rma. S"%a# #tu ya' (a&at m"y",a,)a "r#tr0("rma a(a%ah &"m@#'u$

@0%#a$"u$ ("rmat#t#$ at0) (a %#)" &%au$.;=

C. Er#tr0("rma a)#,at &"ya)#t $#$t"m#)

B"r,a'a# &"ya)#t atau )"%a#a a%at (a%am t"rma$u) #@")$# @0)a% (a&at

m"m,"r# )"%a#a )u%#t ,"ru&a "r#tr0("rma. !a(# $"t#a& )a$u$ "r#tr0("rma ya' t#(a)

t"rma$u) a)#,at a%"r'# 0,at (a a)#,at &"r%ua$a &"ya)#t )u%#t haru$ (#7ar# &"y",a,ya

ya' ,"rart# &"r%u &"m"r#)$aa m"y"%uruh ;t"rma$u) &"m"r#)$aa %a,0rat0r#um (a

$#ar t0ra)$= utu) m"%#hat a(aya #@")$# &"ya)#t &a(a a%at (a%am (a #@")$# @0)a%.

A(a )a%aya t"r(a&at %"u)0$#t0$#$ amu t#(a) (#t"mu)a &"y",a,ya *a(# t"r(a&at

#@")$# ,a)t"r#a% ya' t"r$"m,uy# ;occult infection= ya' &"r%u (#0,at#. ;=

Haru$ %",#h (#&"rhat#)a )0m&%#)a$# $#$t"m#) a)#,at "r#tr0("rma $"&"rt#

H#&0t"rm#a "("ma &"r#@"r (a )"h#%a'a 7a#ra (a a%,um# ("'a ta)#)ar(#a a(

)"%a#a *atu' haru$ m"(a&at)a &"raata ya' $"r#u$. Pa(a "r#tr0("rma )r0#) (a&at

m"'a)#,at)a )a)")$#a a%0&"$#a &a%m0&%atar )"rat0("rma )"%a#a &a(a )u)u a(

")tr0.

;4=

C. EPIDEMI+)+(I

I$#("$ "r#tr0("rma $a'at ,"rFar#a$# m"urut &""%#t#a (ar# 53-5 (ar# 55.555

&0&u%a$#. P"ya)#t ## (a&at m"'"a# &r#a atau&u a#ta amu &a%#' $"r#' &a(a &r#a

("'a ra$#0 1 : $am&a# 4 : ("'a 0$"t u$#a rata-rata 45 tahu m"$)#&u "r#tr0("rma

(a&at t"r*a(# &a(a $"mua u$#a.;= I$#(" "r#tr0("rma ma)# ,"rtam,ah. P"y",a, utamaya

a(a%ah &$0r#a$#$. Ha% t"r$",ut $"#r#' ("'a m"#')atya #$#("$ &$0r#a$#$. ;=

$$


12/25

P"ya)#t )u%#t ya' $"(a' (#("r#ta m"m"'a' &"raa &"t#' %",#h (ar# $"t"'ah

)a$u$ (ar# "r#tr0("rma. I("t#@#)a$# &$0r#a$#$ m"(a$ar# &"ya)#t )u%#t %",#h (ar# $"&"r"m&at

)a$u$. D#(a&at)a %a&0ra ,aha t"r(a&at 8 (ar# 25 )a$u$ a(a%ah &$0r#a$#$ ,"rat. ;=

Aa)-aa) ,#$a m"("r#ta "r#tr0("rma (#a)#,at)a a%"r'# t"rha(a& 0,at. A%"r'#

t"rha(a& 0,at ,#$a )ar"a &"'0,ata ya' (#%a)u)a $"(#r# atau&u &"''uaa 0,at

$"7ara tra(#$#0a%.;1=

D. PAT+&ISI+)+(I

M")a#$m" t"r*a(#ya "r#tr0("rma ,"%um (#)"tahu# ("'a *"%a$. Pat0'""$#$

"r#tr0("rma ,"r)a#ta ("'a &at0'""$#$ &"ya)#t ya' m"(a$ar#ya ("rmat0$#$ ya'

$u(ah a(a $","%umya ,"r)"m,a' m"*a(# "r#tr0("rma atau &"r)"m,a'a "r#tr0("rma

#(#0&at#) (" 0F0 t#(a)%ah $"&"uhya (#m"'"rt#. P""%#t#a t"r,aru #mu0&at0'""$#$

#@")$# ya' (#m"(#a$# t0# m"u*u))a ,aha %0)u$ &at0'""$#ta$ $ta%07077u$

m"')0(")a $u&"rat#'". L0)u$-%0)u$ t"r$",ut m"'a(u' '" ya' m"')0(")a t0#

(ar# toxic shock syndrome (a staphylococcal scalded-skin syndrome. K0%0#$a$#

$ta&hy%07077u$ aur"u$ atau at#'" %a# m"ru&a)a t"0r# ya' mu')# $a*a $"&"rt# toxic

shock syndrome toxin-1 mu')# m"ma#)a &"raa &a(a &at0'""$#$ "r#tr0("rma. Pa$#"-

&a$#" &a(a ("'a "r#tr0("rma ,#a$aya m"m&uya# )0%0#$a$# S.aureus $")#tar 8 (a

&a(a )u%#t $")#tar ,a'a#maa&u *u'a haya a(a $atu (ar# 2 &a$#" m"m#%#)# t0#

S.aureus ya' &0$#t#@.;=

Da&at (#)"tahu# ,aha a)#,at $uatu a'" (a%am tu,uh ,a#) #tu 0,at-0,ata &"r%ua$a

&"ya)#t )u%#t (a &"ya)#t $#$t"m#) ma)a tu,uh ,"ra)$# ,"ru&a &"%",ara &"m,u%uh (arah

)a%"r ;"r#t"ma= ya' '""ra%#$ata. Er#t"ma ,"rart# t"r*a(# &"%",ara &"m,u%uh (arah ya'

m"y",a,)a a%#ra (arah )" )u%#t m"#')at $"h#''a )"h#%a'a &aa$ ,"rtam,ah.

A)#,atya &a$#" m"ra$a (#'# (a m"''#'#%. Pa(a "r#tr0("rma )r0#$ (a&at t"r*a(# 'a'a%

*atu'. !u'a (a&at t"r*a(# h#&0t"rm#a a)#,at &"#')ata &"r@u$# )u%#t. P"'ua&a 7a#ra

ya' ma)# m"#')at (a&at m"y",a,)a ("h#(ra$#. B#%a $uhu ,a(a m"#')at )"h#%a'a

$2


13/25

&aa$ *u'a m"#')at. P"'atura $uhu t"r'a''u. K"h#%a'a &aa$ m"y",a,)a

h#&"rm"ta,0%#$m" )0m&"$at0r (a &"#')ata %a*u m"ta,0%#$m" ,a$a%. K"h#%a'a 7a#ra

0%"h tra$ra$# m"#')at $",a(#' %a*u m"ta,0%#$m" ,a$a%. ;=

K"h#%a'a $)uama (a&at m"7a&a# 3 'ram+m1 &"rmu)aa )u%#t atau %",#h $"har#

$"h#''a m"y",a,)a )"h#%a'a &r0t"# H#&0&r0t"#"m#a ("'a ,"r)ura'ya a%,um#

("'a &"#')ata r"%at#@ '%0,u%# t"rutama 'amma'%0,u%# m"ru&a)a )"%a#a ya' )ha$.

E("ma $"r#' t"r*a(# )"mu')#a (#$",a,)a 0%"h &"r'"$ara 7a#ra )" rua'

")$traFa$)u%"r. ;=

Er#tr0("rma a)ut (a )r0#$ (a&at m"'a''u m#t0$#$ ram,ut (a )u)u ,"ru&a

)"r0t0)a ram,ut (a )u)u ,"ru&a )"r0t0)a ram,ut (#@u$ (a )"h#%a'a )u)u. Pa(a

"r#tr0("rma ya' t"%ah ,"r%a'$u' ,"r,u%a ? ,u%a (a&at t"r*a(# &"r,uru)a )"a(aa umum

ya' &r0'r"$#@. ;=

E. (AM,ARAN K)INIS

Mu%a-mu%a t#m,u% ,"r7a) "r#t"ma ya' (a&at m"%ua$ )" $"%uruh tu,uh (a%am a)tu

1-48 *am. D"$)uama$# ya' (#@u$ (#mu%a# (ar# (a"rah %#&ata )"mu(#a m"y"%uruh. Da&at

*u'a m"'"a# m"m,ra mu)0$a t"rutama ya' (#$",a,)a 0%"h 0,at. B#%a )u%#t )"&a%a $u(ah

t"r)"a (a&at t"r*a(# a%0&"$#a &"ru,aha )u)u (a )u)u (a&at %"&a$. Da&at t"r*a(#

%#m@a("0&at# (a h"&at0m"'a%#. S)uama t#m,u% $"t"%ah 1-2 har# $"r#' mu%a# (# (a"rah

%#&ata. S)uamaya ,"$ar &a(a )"a(aa a)ut (a )"7#% &a(a )"a(aa )r0#$. 9araya

,"rFar#a$# (ar# &ut#h $am&a# )u#'. Ku%#t m"rah t"ra' &aa$ )"r#' (a )a%au (#ra,a t",a%.

Pa$#" m"'"%uh )"(#'#a. ;8= P"'"(a%#a r"'u%a$# $uhu tu,uh m"*a(# h#%a' $"h#''a

$",a'a# )0m&"$a$# t"rha(a& )"h#%a'a &aa$ tu,uh $")u*ur tu,uh &a$#" m"''#'#% utu)

(a&at m"#m,u%)a &aa$ m"ta,0%#).;3= Dahu%u "r#tr0("rma (#,a'# m"*a(# &r#m"r (a

$")u("r. P"(a&at $")ara' $"mua "r#tr0("rma a(a &"y",a,ya *a(# "r#tr0("rma $"%a%u

$")u("r. Er#tr0("rma a)#,at a%"r'# 0,at $"7ara $#$t"m#) (#&"r%u)a aam"$#$ ya' t"%#t#

utu) m"7ar# 0,at &"y",a,ya. Umumya a%"r'# t#m,u% a)ut (a%am a)tu 5 har#. Pa(a

mu%aya )u%#t haya "r#t"m $a*a $"t"%ah &"y"m,uha ,aru%ah t#m,u% $)uama.;2=

Er#tr0("rma a)#,at &"r%ua$a &"ya)#t )u%#t $"r#')a%# &a(a &$0r#a$#$ (a ("rmat#t#$

$",0r0#) ,ay#. P$0r#a$#$ (a&at m"*a(# "r#tr0("rma )ar"a (ua ha% ya#tu : )ar"a &"ya)#tya

$"(#r# atau )ar"a &"'0,ata ya' t"r%a%u )uat.;2= P$0r#a$#$ ya' m"*a(# "r#tr0("rma ta(a

)ha$ya a)a m"'h#%a'. Pa(a "r#tr0("rma et causa &$0r#a$#$ m"ru&a)a "r#tr0("rma ya'

$


14/25

(#$",a,)a 0%"h &"ya)#t &$0r#a$#$ atau &"'0,ata ya#tu )0rt#)0$t"r0#( $#$t"m#) $t"r0#(

t0)a% )0m&%#)a$# @0t0t"ra $tr"$$ "m0$#0a% ya' ,"rat &"ya)#t t"r(ahu%u m#$a%ya

#@")$#.;5=

6am,ar . Er#tr0("rma &$0r#a$#$ ;D#)ut#& (ar# &u$ta)a =

D"rmat#t#$ $",0r0#) &a(a ,ay# ;&"ya)#t %"#"r=. U$#a &"("r#ta ,"r)#$ar 4-15 m#''u.

K"%a#a ,"ru&a $)uama ,"rm#ya) (a )")u#'a (# )"&a%a. Er#t"ma (a&at &a(a $"%uruh

tu,uh (#$"rta# $)uama ya' )a$ar.;2=

6am,ar 1. D"rmat#t#$ S",0r0#) ;(#)ut#& (ar# &u$ta)a 1=

Ptyr#a$#$ ru,ra %ar#$ ya' ,"r%a'$u' $"%ama ,","ra&a m#''u (a&at &u%a

m"*a(# "r#tr0("rma. Mu%a-mu%a t"r(a&at $)uama m0("rat &a(a )u%#t )"&a%a (##)ut#

&"r%ua$a )" (ah# (a t"%#'a &a(a $aat ## a)a m"y"ru&a# 'am,ara ("rmat#t#$

$",0r0#). K"mu(#a t#m,u% hy&"r)"rat0$#$ &a%m0 &%atar#$ ya' *"%a$. B"ra'$ur-a'$ur

m"*a(# &a&u% @0%#)u%ar#$ (#$")"%#%#' ta'a (a m"y",ar )" )u%#t ,"ram,ut.;2=

$/


15/25

6am,ar . Ptrya$#$ ru,ra %ar#$ ;(#)ut#& (ar# &u$ta)a =

P"m@#'u$ @0%#a$"u$ ,"rmu%a ("'a F"$#)"%+ ,u%a ,"ru)ura )"7#% ,"r(#(#'

)"(ur ya' )"mu(#a &"7ah m"*a(# "r0$# (a ")$u(at#@. Ya' )ha$ a(a%ah "r#t"ma

m"y"%uruh ya' (#$"rta# ,aya) $)uama )a$ar $"(a')a ,u%a )"(ur haya $"(#)#t.

P"("r#ta m"'"%uh 'ata% (a ,a(a m"*a(# ,au ,u$u).;2=

6am,ar 4. P"m@#'u$ J0%#a$#u$ ;(#)ut#& (ar# &u$ta)a =

D"rmat#t#$ at0 (#mu%a# ("'a "r#t"ma &a&u%-&a&u%a F"$#)"% $am&a# "r0$# (a

%#)"#@#)a$#. P"("r#ta tam&a) '"%#$ah 'ata% (a $a)#t ,"rat.

$


16/25

6am,ar 4. D"rmat#t#$ at0) ;(#am,#% (ar# &u$ta)a 1=

P"rmu%aa t#m,u%ya %#)" &%au$ (a&at m"(a(a) atau &"r%aha-%aha (a&at

,"r%a'$u' ,"rm#''u-m#''u atau ,"r,u%a-,u%a (a mu')# )am,uh %a'#. Ka(a'-

)a(a' m"*a(# )r0#). Pa&u% ("'a (#am"t"r 1-4 mm )"u'ua &u7a) m"')#%at

&0%#'0a%. Pa&u%a mu')# t"r*a(# &a(a ,")a$ 'aru)a ;@"0m"a K0","r=. B#%a (#%#hat

("'a )a7a &"m,"$ar &a&u% m"m&uya# &0%a 'ar#$ 'ar#$ ,"rara &ut#h ;9#7)ham$

$tr#a"= L"$# $#m"tr#) ,#a$aya &a(a &"rmu)aa @%")$0r &"r'"%a'a ta'a m"y",ar

)" &u''u' (a tu')a#. Mu)0$a mu%ut t"r)"a &a(a 5 &"("r#ta. Mu')# &u%a

m"'"a# '%a$ &"#$ (a mu)0$a Fa'#a. Ku)u )a(a'-)a(a' t"r)"a )u)u #"#$

(a ,"r%u,a'-%u,a'. Aa)-aa) *ara' t"r)"a t"ta ,#%a t"r(a&at ,"r7a) )"m"raha

mu')# t#(a) )ha$ (a (a&at )"%#ru ("'a &$0r#a$#$. S"r#' $a'at 'ata%. C"("ru'

m"y"m,uh ("'a $"(#r#ya. ;2=

6am,ar . L#)" P%au$ ;(#)ut#& (ar# &u$ta)a 1=

&. PEMERIKSAAN PENUN*AN(

Pemerik$aan )ab#rat#rium

$&


17/25

Pa(a &"m"r#)$aa (arah (#(a&at)a a%,um# $"rum ya' r"(ah (a &"#')ata

'amma'%0,u%#$ )"t#(a)$"#m,a'a "%")tr0%#t &r0t"# @a$" a)ut m"#')at %"u)0$#t0$#$

mau&u a"m#a r#'a.;=

1i$t#2at#l#i

Pa(a )",aya)a &a$#" ("'a "r#tr0("rma h#$t0&at0%0'# (a&at m"m,atu

m"'#("t#@#)a$# &"y",a, "r#tr0("rma &a(a $am&a# ("'a 5 )a$u$ ,#0&$# )u%#t (a&at

m"u*u))a 'am,ara ya' ,"rFar#a$# t"r'atu' ,"rat (a (ura$# &r0$"$ #@%ama$#. Pa(a

taha& a)ut $&0'#0$#$ (a &ara)"rat0$#$ m"0*0% t"r*a(# "("ma. Pa(a $ta(#um )r0#$

a)at0$#$ (a &"r&a*a'a r"t" r#('" %",#h (0m#a.;1=

Er#tr0("rma a)#,at %#m@0ma ya' #@#%tra$# ,#$a m"*a(# $"ma)# &%"0m0r@#) (a

mu')# a)h#rya m"m&"r0%"h @#tur (#a'0$t#) $&"$#@#) $"&"rt# bandlike limfoid #@#%trat (#

("rm#$-"("rm#$ ("'a $"% cerebriform m00u)%"ar at#)a% (a Pautrier's

microabscesses. Pa$#" ("'a $#(r0m S"ary $"r#' m"u*u))a ,","ra&a @#tur (ar#

("rmat#t#$ )r0#$ (a "r#tr0("rma *#a) mu')# )a(a'-)a(a' m"u*u))a ,","ra&a

'am,ara t#(a) *"%a$ &a(a %#m@0ma. ;1=

P"m"r#)$aa #mmu0@"0t#&" #@#%trat %#m@0#( *u'a mu')# $u%#t m"y"%"$a#)a

&"rma$a%aha )ar"a &"m"r#)$aa ## umumya m"m&"r%#hat)a 'am,ara $"% T mata' &a(a "r#tr0("rma *#a) mau&u 'aa$. Pa(a &$0r#a$#$ &a%0mat0$#$ (a 'am,ara clubbing

%a$a &a%"r (a&at t"r%#hat (a &a(a &"m@#'u$ @0%#a$"u$ a)at0$#$ $u&"r@#7#a% *u'a

(#t"mu)a. Pa(a "r#tr0("rma #)ht#$#0@0rm (a &t#r#a$#$ ru,ra %ar#$ ,#0&$# (#u%a' (ar#

t"m&at-t"m&at ya' (#%#h ("'a 7"rmat (a&at m"m&"r%#hat)a 'am,ara )ha$ya. ;1=

(. DIA(N+SIS

D#a'0$#$ a'a) $u%#t (#t"'a))a haru$ m"%#hat (ar# ta(a (a '"*a%a ya' $u(ah a(a

$","%umya m#$a%ya ara h#tam-)"m"raha (# &$0r#a$#$ (a )u#'-)"m"raha (# %ar#$

ru,ra tyr#a$#$ &"ru,aha )u)u )ha$ &$0r#a$#$ %#)"#@#)a$# "r0$# (a ")$)0r#a$# (#

("rmat#t#$ at0) (a ")$"ma m"y",ar r"%at#@ h#&"r)"rat0$#$ ta&a $)uama (a tyr#a$#$

ru,ra (#ta(a# ,"r7a) )u%#t (a%am "r#tr0("rma (# %ar#$ ru,ra tyr#a$#$ h#&"r)"rat0t#) $)a%a

,"$ar )u%#t )"&a%a ,#a$aya ta&a ram,ut r0t0) (# &$0r#a$#$ (a ("'a ram,ut r0t0) (#

CTCL (a tyr#a$#$ ru,ra ")tr0 mu')# t"r*a(#. D"'a ,","ra&a ,#0&$# ,#a$aya

(a&at m""'a))a (#a'0$#$.;14=

$7


18/25

1. DIA(N+SA ,ANDIN(

A(a ,","ra&a (#a'0$#$ ,a(#' &a(a "r#t0r("rma :

3. Dermatiti$ At#2ik

D"rmat#t#$ at0) a(a%ah &"ra(a'a )u%#t )r0#$ ya' t"r*a(# (# %a$a

"("rm#$ (a ("rm#$ $"r#' ,"rhu,u'a ("'a r#ayat at0) &a(a )"%uar'a a$ma

,r07h#a% rh##t#$ a%"r'# )0*u't#F#t#$. At0) t"r*a(# (#atara -1 &0&u%a$#

,"r)"m,a' (ar# $atu m"*a(# ,aya) )"%a#a (a m"m&r0(u)$# $#r)u%a$# at#,0(#

I'E ya' t#''# %",#h ,aya) )ar"a a%"r'# #ha%a$#.;4= D"rmat#t#$ at0) a(a%ah

&"ya)#t )u%#t ya' mu')# t"r*a(# &a(a u$#a ,"ra&a&u t"ta ,#a$aya t#m,u%

$","%um u$#a tahu. B#a$aya a(a t#'a taha& : ,a%#ta aa)-aa) (a ("a$a. ;=

D"rmat#t#$ at0) m"ru&a)a $a%ah $atu &"y",a, "r#tr0("rma &a(a 0ra'

("a$a (#maa (#(a&at)a 'am,ara )%##$ya t"r(a&at %"$# &ra-"#$t#' &rur#tu$

ya' &arah %#)"#@#)a$# (a &rur#'0 0(u%ar#$ $"(a')a &a(a 'am,ara h#$t0%0'#

t"r(a&at a)at0$#$ r#'a $&0'#0$#$ Far#a,"% ("rma% "0$#0@#% (a &ara)"rat0$#$. ;2=

$%


19/25

6am,ar . D#)ut#& (ar# &u$ta)a

6am,ar 8. D#)ut#& (ar# &u$ta)a

4. P$#ria$i$

Er#tr0("rma &$0r#a$#$ (a&at (#$",a,)a 0%"h )ar"a &"'0,ata t0)a% ya'

t"r%a%u )uat atau 0%"h &"ya)#tya $"(#r# ya' m"%ua$. K"t#)a &$0r#a$#$ m"*a(#

"r#tr0("rma ,#a$aya %"$# ya' )ha$ utu) &$0r#a$#$ t#(a) tam&a) %a'# )ar"a t"r(a&at

m"'h#%a' (#maa &%a)-&%a) &$0r#a$#$ m"yatu "r#t"ma (a $)uama t",a% u#F"r$a%.

;1= P$0r#a$#$ mu')# m"*a(# "r#tr0("rma (a%am &r0$"$ ya' ,"r%a'$u' %am,at (a

t#(a) (a&at (#ham,at atau $a'at 7"&at. Ja)t0r '""t#) ,"r&"ra. B#%a 0ra' tuaya

t#(a) m"("r#ta &$0r#a$#$ r"$#)0 m"(a&at &$0r#a$#$ 1 $"(a')a *#)a $a%ah$"$"0ra' 0ra' tuaya m"("r#ta &$0r#a$#$ r"$#)0ya m"7a&a# 4 ? 3.;=

P$0r#a$#$ (#ta(a# ("'a a(aya ,"r7a)-,"r7a) "r#t"ma ,"r,ata$ t"'a$

("'a $)uama ya' )a$ar ,"r%a$-%a$ (a tra$&ara (#$"rta# @"0m"a t"t"$a

%#%# Au$t (a K0,"r.;=

$'


20/25

6am,ar 8. D#)ut#& (ar# &u$ta)a

5. Dermatiti$ $eb#r#ik D"rmat#t#$ $",0r0#) a(a%ah &"ra(a'a )u%#t ya' )r0#$ (#ta(a# ("'a &%a)

"r#t"ma ya' $"r#' t"r(a&at &a(a (a"rah tu,uh ya' ,aya) m"'a(u' )"%"*ar

$",a$"a $"&"rt# )u%#t )"&a%a a%#$ %#&ata a$0%a,#a% ,"%a)a' t"%#'a 7u' h#(u'

)"t#a) (a(a atara $)a&u%a. ;2=D"rmat#t#$ $",0r0#) (a&at t"r*a(# &a(a $"mua umur

(a m"#')at &a(a u$#a 45 tahu.;= B#a$aya %",#h ,"rat a&a,#%a t"r*a(# &a(a %a)#-

%a)# (ar#&a(a a#ta (a %",#h $"r#' &a(a 0ra'-0ra' ya' ,aya) m"ma)a %"ma)

(a m#um a%)0h0%.;=

B#a$aya )u%#t &"("r#ta tam&a) ,"rm#ya) ("'a )uma pityrosporum

ovale ya' h#(u& )0m"$a% (# )u%#t ,"r)"m,a' %",#h $u,ur. Pa(a )"&a%a tam&a)

"r#t"ma (a $)uama ha%u$ $am&a# )a$ar ;)"t0m,"=. Ku%#t tam&a) ,"rm#ya) (a

m"'ha$#%)a $)uama &ut#h ya' ,"rm#ya) &u%a. P"("r#ta a)a m"'"%uh ra$a 'ata%

ya' h",at.;=DS (a&at (#a)#,at)a 0%"h &%0r#@"ra$# "("rm#$ ya' m"#')at $"&"rt#

&a(a &$0r#a$#$. Ha% ## (a&at m""ra')a m"'a&a t"ra ("'a $#t0$tat#) (a&at

m"m&"r,a#)#ya. Pa(a 0ra' ya' t"%ah m"m&uya# @a)t0r &r"(#$&0$#$# t#m,u%ya

DS (a&at (#$",a,)a 0%"h @a)t0r )"%"%aha $t"r$$ "m0$#0a% #@")$# atau ("@#$#"$#

#mu. ;1=

20


21/25

D#)ut#& (ar# &u$ta)a

I. TERAPI

Pr#$#& &r#$#& :

. Kar"a ,aya) )"h#%a'a 7a#ra )#ta haru$ m"m&"rhat#)a )"$"#m,a'a

7a#raya. D#,"r#)a 7a#ra @#$#0%0'#$.;8=

1. At# h#$tam# (a&at m"'h#%a')a ra$a 'ata%. ;8=

. Em0%#".;8=

4. H"t#)a $"mua 0,at ya' m"m&uya# &0t"$# m"y",a,a)a t"r*a(#ya &"ya)#t

##.;3=

. Raat &a$#" (#rua'a ya' 7u)u& $#ar matahar#. ;3=

2. P"rhat#)a )"mu')#a t"r*a(#ya ma$a%ah m"(#$ $")u("r ;m#$a%ya : ("h#(ra$#

'a'a% *atu' (a #@")$#=. ;3=

. B#0&$# )u%#t utu) m""'a))a (#a'0$#$ &a$t#. ;3=

8. B"r#)a $t"r0#( $#$t"m#) *a')a &"(") ; ,#%a &a(a &"rmu%aa $u(ah (a&at

(#(#a'0$#$ a(aya &$0r#a$#$ ma)a mu%a#%ah m"''at# ("'a 0,at-0,at at#

&$0r#a$#$. ;3=

3. Mu%a#%ah &"'0,ata ya' (#&"r%u)a utu) &"ya)#t ya' m"%atar ,"%a)a'#ya;3=

!. K+MP)IKASI

. 6a'a% *atu'

1. 6a'a% '#*a%.. K"mat#a m"(a(a) a)#,at h#&0t"rm#a $"tra%. ;3=

2$


22/25

K. PR+(N+SIS

Q Pr0'0$#$ "r#tr0("rma t"r'atu' &a(a &r0$"$ &"ya)#t ya' m"(a$ar#ya.

Q Ka$u$ )ar"a &"y",a, 0,at (a&at m"m,a#) $"t"%ah 0,at &"''uaa 0,at (#h"t#)a

(a (#,"r#)a t"ra ya' $"$ua#.

Q Pr0'0$#$ )a$u$ a)#,at 'a''ua $#$t"m#) ya' m"(a$ar#ya $"&"rt# %#m@0ma a)a

t"r'atu' &a(a )0(#$# )","rha$#%a &"'0,ata .

Q Er#tr0("rma (#$",a,)a 0%"h ("rmat0$a a)h#rya (a&at (#ata$# ("'a &"'0,ata

t"ta mu')# t#m,u% )")am,uha.

Q Ka$u$ #(#0&at#) a(a%ah )a$u$ ya' t#(a) t"r(u'a(a&at ,"rtaha (a%am a)tu ya'

%ama $"r#' )a%# (#$"rta# ("'a )0(#$# ya' %"mah.

Q Er#tr0("rma ya' t"rma$u) '0%0'a I ya)# )ar"a a%"r'# 0,at $"7ara $#$t"m#)

&r0'0$#$ya ,a#). P"y"m,uha '0%0'a ## #a%ah ya' t"r7"&at (#,a(#')a

("'a '0%0'a %a#.

Q Pa(a "r#tr0("rma ya' ,"%um (#)"tahu# $",a,ya &"'0,ata ('a )0rt#)0$t"r0#(

haya m"'ura'# '"*a%aya &a$#" a)a m"'a%am# )"t"r'atu'a )0rt#)0$t"r0#(.

;8=

22


23/25

,A, III.

PENUTUP

A. KESIMPU)AN

Er#tr0("rma a(a%ah )"%a#a )u%#t ya' (#ta(a# ("'a "r#t"ma (# $"%uruh+ hamr $"%uruh tu,uh (a ,#a$aya (#$"rta# $)uama. K"%a#a ## %",#h ,aya) (#(a&at)a &a(a &r#a

t"rutama &a(a u$#a rata rata 45-25 tahu. P"y",a, $"r#' "r#tr0("rma a(a%ah a)#,at

&"r%ua$a &"ya)#t )u%#t $","%umya r"a)$# 0,at a%"r'# 0,at (a a)#,at &"ya)#t $#$t"m#)

t"rma$u) )"'aa$a.

6am,ara )%##) "r#tr0("rm# ,"ru&a &rur#tu$ "r#t"ma (a $)uama ya' ,"r$#@at

'""ra%#$ata. P"ata%a)$aaa "r#tr0("rma ya#tu &"m,"r#a )0rt#)0$t"r0#( (a &"'0,ata

t0a% ("'a &"m,"r#a "m0%#" $"rta &"m,"r#a 7a#ra (a &"raata (#rua'a ya'

ha'at.

Pr0'0$#$ "r#tr0("rma ya' (#$",a,)a 0,at 0,ata r"%at#@ %",#h ,a#) $"(a')a

"r#tr0("rma ya' (#$",a,)a 0%"h &"ya)#t #(#&at#) ("rmat#t#$ (a&at ,"r%a'$u' ,"r,u%a

,u%a ,ah)a ,"rtahu tahu (a 7"("ru' utu) )am,uh.

2


24/25

DA&TAR PUSTAKA

. 9a$#taatma(*a Syar#@ M. Aat0m# Ku%#t. D*ua(a A. I%mu P"ya)#t Ku%#t (a

K"%am#. 4th "(. !a)arta : Ja)u%ta$ K"(0)t"ra U#F"r$#ta$ I(0"$#a. 155.& .

1. Cham RH. E7"ma L#7h"#@#7at#0 Prur#'0 a( Erythr0("rma. I : Cham

RH "($. R00)$ T"t,00) 0@ ("rmat0%0'y th "(. 9a$h#'t0 B%a7)"%% S7#"t#@#7

Pu,%#7at#0$. 331.& .48-.43.

. Umar H $au$#. Erythr0("rma ;'""ra%#"( "@0%#at#F" ("rmat#t#$=; 0%#" =155.

AFa#%a,%" Jr0m ."m"(#7#".70m

4. St"rry 9 A$$a@ Cha%#(. Pa&u%0$uam0u$ a( E7"mat0u$ D"rmat0$"$. Erythr0("rma.

I : B0%0'#a !L !00 !L. Ra# RP H0r TD Ma$7ar0 !M Saurat !H Ma7##

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