Kegawatdaruratan Dalam Bidang Dermatologi

7/25/2019 Kegawatdaruratan Dalam Bidang Dermatologi

1/36

KEGAWATDARURATAN

DALAM BIDANGDERMATOLOGI

YULI KURNIAWATI

1


2/36

Tujuan Pembelajaran Mengetahui mengenai penyakit

kedaruratan dalam dermatologi Mampu melakukan penanganan dan

melakukan rujukan pada kasuskedaruratan dalam dermatologi

2


3/36

PENDAHULUAN Kegaatdaruratan dalam Dermatologi!

Nekrolisis Epidermal "#indroma #te$en%ohnson "##%&' Toksik EpidermalNekrolisis "TEN&' "##% TEN o$erlap&Erupsi Alergi (bat

3


4/36

KEGAWATDARURATAN DALAMBIDANG DERMATOLOGI

DEFINISI : SUATU KEADAAN PENYAKIT

KULIT MENGANCAM JIWA PENDERITAPERLU TINDAKAN CEPAT DAN TEPAT

DALAM PENANGANANNYA

PENYAKIT YANG SERING DIJUMPAI a.l : Toksik Epi!"#al N!k"olisis $ TEN %&

Si'"o#a S(!)!'s Jo*'so'& E"+psi al!",i o-a(

4


5/36

TOKSIK EPIDERMAL NEKROLISIS $TEN% Si'o'i#! #indroma Lyell Penyakit akut ) berat ditandai dgn

epidermolisis yang luas disertai eritema'$esikel' bula' erosi ataupun purpura*

E(iolo,i ! terutama disebabkan oleh alergi obat'obat dengan risiko tinggi! +ol #ul,a' alupurinol'barbiturat' Ne$irapine' (-i.am N#A/D

P!'!-a- lai' ! in,eksi' neoplasma'transplantasi sum0sum tulang

5


6/36

Ga#-a"a' kli'is: G!/ala p"o"o#al : !#a#& #alais!& #+al&

"aa', paa ko'/+',(i)a& #+l+(& ,!'i(al ala#-!-!"apa /a# 0 *a"i

Ti#-+l k!lai'a' k+li( -!"+pa !"i(!#a& p+"p+"aa', 1!pa( #!l+as )!sik!l& -+la a', #+a*p!1a* #!l+as

Ta'a NIKOLSKY$2% -ila k+li( i,!s!klapisa' !pi!"#is aka' (!"k!l+pas a"i asa"'as!*i',,a (a#pak !"#is a', !"i(!#& '!"i $2%

6


7/36

L!si apa( #!',!'ai #+kosa #+l+(&ko'/+',(i)a #a(a& ,!'i(al& a'+s K!aaa' +#+# : /!l!k is!"(ai

p!'+"+'a' k!saa"a'

Ko#plikasi :-"o'kop'!+#o'ia&o-s("+ksi

/ala' 'a3as&k!-+(aa'& p!"a"a*a',as("oi'(!s(i'al& !!#a pa"+& ,a',,+a'k!s!i#-a',a' !l!k("oli(& ,a,al ,i'/al&s!psis k!#a(ia'

7


8/36

Toksik !pi!"#al '!k"olisis :

8


9/36

PEMERIKSAAN PENUNJANG: La-o"a(o"i+# : a"a*& +"i' "+(i'&

+"!+#& k"!a(i'i'& ,+la a"a*& SGOT&

SGPT& Na("i+#& Kali+#& BJ plas#a

Fo(o (*o"ak& so3( (iss+! l!*!"

EKG

9


10/36

PENATALAKSANAAN S(op o-a( p!'!-a-4 a', iko's+#siala# 5067 *a"i (!"ak*i"

P!'!"i(a i"a8a( i "+a', ICU&

p!"a8a(a' -!"sa#a #!li-a(ka' ok(!"ICU& P!'aki( ala#& K+li( 9 K!la#i'&TT& Ma(a

P!',a(+"a' k!s!i#-a',a' 1ai"a' a'

!l!k("oli( s!p!"(i p!'!"i(a l+ka -aka"(!"api 1ai"a' a', #!',a'+', !l!k("oli(&plas#a 9 al-+#i'

10


11/36

Ko"(ikos(!"oiDi-!"ika' *a'a paa 3as! a8alp!'aki( !',a' osis s!(a"aPREDNISON ;0< #, 4 K, BB 4ARI

a(a+ DE=AMETASON I'("a >!'a


12/36

P!'1!,a*a' i'3!ksi* L!si k+li(! sil$ernitrate 1'23' mandi larutan kaliumpermanganas 4!41*111* M+kosa #+l+(!kumur0kumur betadin' gargarisma Khan'#+kok+(a'! gentian $iolet 435kenalogin oralbase

< a'(a,o'is(: .imetidine atau

ranitidine i$ 6-4 ampul567 jam Lis( 1o'("ol

12


13/36

A'(i-io(ika $s!s+ai k+l(+"%

I'ikasi: l!kop!'ia p!"sis(!'& (a'a a8al i'3!ksia' s!psis. Misal: S!3o(ai#


14/36

PROGNOSIS

Ka(a,o"i SCORTEN

67 KEMATIAN

14


15/36

A prognosti. #.oring #ystem ,orPatients ith Epidermal Ne.rolysis

15


16/36

Mortality 8ate

16


17/36

SINDROMA STE>ENS JONSON

D!3i'isi : s+a(+ si'"o#a a', i(a'ai

!',a' aa'a l!si paa k+li(& s!lap+(l!'i" o"i3isi+# 9 #a(a is!"(ai k!aaa'+#+# -!")a"iasi a"i "i',a'-!"a(

E(iolo,i : al!",i o-a(& i'3!ksi& '!oplas#a

17


18/36

Ga#-a"a' Kli'is : K!aaa' +#+# : "i',a' p!'+"+'a'

k!saa"a'

K+li( : !"i(!#a& pap+l& )!sik!l& -+la&p+"p+"a& !"osi M+kosa o"i3isi+# : #+l+( ;77 &

,!'i(al ?7 & *i+',& a'+s 50

!"osi Ma(a : 7 ko'/+',(i)i(is& k!aaa'lai' +lk+s ko"'!a& i"i(is -+(a

18


19/36

Si'"o#a S(!)!'s Jo*'so'

19

A. Erupsi aal* Makula eritem dusky red "Lesi targetatipikal&* B* Presentasi aal $esikel dan bula


20/36

#indroma #te$ens %ohnson***

20

9* Erupsi lanjut* D* Nekrolisis epidermal luasdengan karakteristik area erosi luas


21/36

21

A* Erosi ekstensi, dan nekrosis bibir baah serta mukosaoral* B. Erosi masi, ditutupi krusta pada bibir dansheddingbulu mata

#indroma #te$ens %ohnson***


22/36

Ko#plikasi : -"o'kop'!+#o'ia& o-s("+ksi sal.

'a3as& ,a',,+a' k!s!i#-a',a' 1ai"a' 9!l!k("oli( sok & s!psis k!#a(ia'

PENATALAKSANAAN S(op o-a( p!'!-a-4a', iko's+#si 5067

*a"i (!"ak*i" Ra8a(& #o'i(o" k!aaa' +#+#& 1ai"a' 9

!l!k("oli( lak+ka' p!#!"iksaa' la-o"a(o"i+#9 "o'(,!' 3o(o s!p!"(i paa p!'!"i(a TEN

Ko"(ikos(!"oi li3! sa)i',& osis 9 1a"ap!#-!"ia' sa#a ,' (!"api TEN

22


23/36

pasa', i'3+s #!',a(+" k!s!i#-a',a'1ai"a' 9 !l!k("oli(& #!#as+kka' '+("isi 9o-a(

P!#-!"ia' a'(i-io(ika -!"sp!k("+# l+as& 9

/a"a', #!'i#-+lka' al!",i Lak+ka' ko's+l k! Ba,ia' P!'aki( ala#&

TT& Ma(a #o'i(o" ko#plikasi

PROGNOSIS:s!s+ai S1o"(!'

23


24/36

DRUG ERUPTION 4 ERUPSIALERGI OBAT E"+psi al!",i o-a( : !3!k sa#pi',

o-a( a', -!"#a'i3!s(asi paa k+li(9 #+kosa "!aksi al!",ik Ma'i3!s(asi kli'is : )a"iasi "i',a'

-!"a( #ak+la !"i(!#&p+"p+"a

#o"-ili3o"#is& +"(ika"ia& a',io!!#a&3i! "+, !"+p(io'& !"i("o!"#a&si'"o#a s(!)!'s Jo*'so'& TEN

24


25/36

DIAGNOSIS : A'a#'!sis a', (!li(i "i8aa( #i'+#o-a(

Ti#-+l ak+(

-!-!"apa /a#

#i',,+

K!l+*a' s+-!k(i3 lai' !#a#& ,a(al K!lai'a' k+li( si#!("is& s!l+"+*

(+-+* O-a( a', sa#a apa( (i#-+l

k!lai'a' a', -!"-!a !#ikia' /+,as!-alik'a

25


26/36

KOMPLIKASI : R!aksi al!",i -!"/ala' (!"+s s!*i',,a

ko'isi p!'aki( s+li( i+,a

ko#plikasi Ko#plikasi a', #+',ki' (i#-+l0 p!'aki( -!"(a#-a* pa"a* TEN

0 O-s("+ksi /ala' 'a3as paa

a',io!!#a ol!* ka"!'a +!#a la"i',

26


27/36

Makula eritem' morbili,ormis

27


28/36

Fi! "+, !"+p(io' !"+psi al!",i o-a(

-!"+la', paa (!#pa( l!si a', sa#a

28


29/36

U"(ika"ia 4 Kali,a(a 4 Bi+"a'

29


30/36

A',io!!#a 9 +"(ika"ia

30


31/36

E"i("o!"#a

31


32/36

PEMERIKSAAN PENUNJANG P!#!"iksaa' p!'+'/a', +'(+k #!',!(a*+i a(a+ #!#as(ika'

p!'!-a- !"+psi al!",i o-a( Dilak+ka' paa saa( k!aaa'

p!'aki( (!'a', 4 s!#-+*

J!'is P!#!"iksaa' : U/i (+s+k $ P"i1k4s1"a(1* (!s( % U/i (!#p!l $ Pa(1* (!s( % U/i p"o)okasi $ +s!4 !pos+"! (!s( %

32


33/36

U/i (+s+k4 p"i1k (!s(

33


34/36

U/i (!#p!l 4 pa(1* (!s(

34


35/36

PENATALAKSANAAN P!',o-a(a' ka+sal : -ila ki(a (!la* #!'+,ao-a( p!'!-a- *!'(ika' p!#akaia' o-a((!"s!-+(& s!la'/+('a (iak #!#akai o-a((!"s!-+( #a+p+' !"i)a( o-a( (!"s!-+(

P!',o-a(a' si#(o#a(ik :

0 Ko"(ikos(!"oi !',a' osis s!(a"a

PREDNISON ;0< #,4k,BB4*a"i (,( -!"a(0"i',a' p!'aki(.

0 a'(i *is(a#i'

35


36/36

36

Kegawatdaruratan Dalam Bidang Dermatologi

Documents

Transcript of Kegawatdaruratan Dalam Bidang Dermatologi