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ROAD TO
OSCE
HE
RT
HY A
NI N
G P
– G
1A
01
30
67
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Seorang laki laki 50 thn datang dengan keluhan lenting-lenting di pipi sejak 2 hari yang lalu. Sebelumnya pasien merasa tidak enak badan, demam, dan nyeri. Sebelumnya pasien pernah merasakan gejala yang sama
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UKK : lesi dengan dasar eritem, vesikel ,bula, pustul multiple diatas kulit yang eritema, bersifat unilateral sesuai dermatom
DD : herpes simpleks, Varisela, Impetigo bulosa
Penyebab : Virus varisela-zoster
Obat : asiklovir 5x800mg (7hr)
HERPES ZOSTER FASCIALIS REKUREN
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UKK : vesikel / papul milier sampai lentikuler disertai eskoriasi. Kanalikuli. Dasar eritema. Skuama halus.
Etiologi : Sarcoptes Scabiei
DD : creeping eruption, Prurigo, Gigitan serangga, Folikulitis
Obat : Scabicide cream 10mg tube 3
CTM 3 x 4 mg
Krim permetrin 5%
SKABIES
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UKK : makula hiperpigmentasi disertai skuama halus
Etologi : malasezia furfur, p. Orbiculare, p. Ovale
Obat : salep whitfield, ketokonazole 200mg (10hr), imidazole krim 1-2%
DD : ptiriasis rosea, eritrasma
PP : lampu wood -> kuning keemasan ; kerokan kulit + KOH 10% : hifa pendek bersepta dengan sporan bulat (spageti meatball)
PTIRIASIS VERSICOLOR
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UKK : plak eritema dengan lembaran krusta kuning kecoklatan, pustule milier, vesikel / bula lentikuler
Etiologi : Streptokokus B hemolitikus
DD : varicella, ektima, impetigenisasi
Obat : kloramfenikol 2%, eritromisin 30-40mg/kgBB/hr
Komplikasi : glomerulonefritis, jantung rematik
IMPETIGO KRUSTOSA
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UKK : makula eritema dengan batas tegas, tepi aktif, central healing, disekitarnya ada vesikel/ papula eritema
DD : dermatitis numuler, MH tipe TT BT, psoriasis
Etiologi : T. Rubrum, Epdermophyton flocossum
PP : KOH 20% + kerokan kulit : hifa panjang bercabang, bersepta dan berspora
Obat : griseofulvin 15-20mg/kgBB/hari ; dewasa 500 mg/hr
CTM 4mg x 3
Ketokonazol 200 mg/hr (3 minggu)
Itrakonazol 100mg/hr (2 minggu)
Salep whitfield
Ketokonazol
TINEA KORPORIS
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UKK : plak eritema, tersebar, papul kehitaman, urtika, makula coklat kemerahan
Etiologi :hipersensitivitas tipe I
DD : prurigo mitis
Obat : Loratadine 10 mg x 1
URTIKARIA
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UKK : makula hiperpigmentasi dengan skuama halus, erosi numuler hingga plakat, eritematous numuler, papul/ vesikel milier,likenifikasi
DD : dermatofitosis, dermatitis seboroik, kandidiasis
Obat : Loratadine 1 x 10 mg
Hidrokortison 1-2%
Etiologi : Hipersensitivitas tipe 4
DERMATITIS KONTAK ALERGI
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UKK : makula eritema dengan papul milier batas tak tegas, skuama halus putih, sebum positif, ada erosi dengan krusta yg sudah mengering kekuningan
DD : psoriasis, tinea barbae, tine kapitis
Obat : CTM 4mg x 3
Hidrokortison 1-2%
Metilprednisolon 4mg x
DERMATITIS SEBOROIK
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UKK : lesi eritem, di lipat paha menyebar hingga pantat dan anorektal, central healing, tepi peradangan nyata, berbatas tegas, tepi lebih aktif, terdiri dari papul atau pustul
DD : eritrasma, kandidiasis, psoriasis intertriginosa
PP : KOH 10% + lesi kulit : tampak elemen jamur seperti hifa dan miselium
Obat : Asam salisilat, asam benzoat, Griseofulvin 500-1000mg (2minggu), ketokonazol 100mg (1 bulan)
TINEA KRURIS
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UKK : OUE merah, edema, duh uretra kekuningan
Etio : Neisseria Gonorrhoeae
DD : Uretritis nonspesifik, kandidiasis
PP : pemeriksaan thayer martin, pewarnaan gram, tes oksidasi atau fermentasi
Obat : Sefiksim 400mg SD, Azitromisin 1gr SD
GONORE
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Ulkus durum, ulkus yg tdk nyeri pd proksimal
glans penis
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UKK : ulkus durum : kecil tidak nyeri, dasar bersih, tepi tidak menggaung, ada indurasi
kondiloma lata : papul atau plak yang ditutupi krusta bewarna coklat, basah, datar, lunak
Guma : nodul atau ulkus yang dalam bentuk serpiginosa mengeluarkan sekret seropurulen dan nekrosis
DD : ulkus pada herpes simpleks, kondiloma akuminata, psoriasis, ptiriasis rosea
PP : VDRL, TPHA
Obat : benzatin penisilin 2,4 juta IU IM SD
SIFILIS
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UKK : papul multipelhiperkeratotik verukosus berbentuk bunga kol
Etiologi : Human papiloma virus
DD : kondiloma lata, moluskum kontangiosum
Obat : laser, pembekuan, tingtura podofilin 20%
KONDILOMA AKUMINATA
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UKK : makula eritema dikelilingi papul eritema disekitarnya atau lesi satelit dengan korimbiformis
DD : DKA, DKI, dermatitis atopik, eritrasma
Obat : mikonazole 1-2%, ketokonazole 400mg/hr (5hr)
KANDIDIASIS
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UKK : kuku rapuh, rusak, warna suram, permukaan kuku menebal, dibawah kuku ada detritus
Klasifikasi : Onikomikosis Subungual Distal Lateral
Onikomikosis Subungual Proksimal
Onikomikosis Distrofik Totalis
Lekonikia Trikofita
PP : Kerokan kuku + KOH 40 -> koloni jamur
Obat : Itrakonazole 2 x 200mg (7hr)
TINEA UNGUIUM
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UKK : ada fisura, vesikel milier, vesikopustul milier, hiperkeratotik, sisik halus putih kecoklatan
DD : kandidiasis interdigitalis, akrodermatitis perstant
Etiologi : lembab, sepatu sempit, jarang memakai alas kaki
Klasifikasi : interdigitalis, vesikobulosa, hiperkeratotik
Obat : griseofulvin 500 mg (1-2bulan)
Salep whitfield 1/2
TINEA PEDIS
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UKK : papul milier di sekitar muara rambut, rambut mudah lepas, meninggalkan alopesia bewarna coklat
Etiologi : T. Rubrum, T. Mentagrophytes, T. Tonsuran, M.audoini, M.
gypseum
DD : black dot ring worm, tinea favosa, korion celci
Obat : griseofulvin 10-25 mg/kgBB/hr ; dewasa 500 mg/hr
Itrakonazol 5-10mg/kgBB/hari ; dewasa 200mg
TINEA KAPITIS TIPE GREY PATCH RING WORM
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UKK : rambut putus tepat pada folikel rammbut, makula coklat bintik hitam, warna rambut sekitarnya menjadi suram
Etiologi : T. Rubrum, T. Mentagrophytes, T. Tonsuran, M.audoini, M. gypseum
DD : grey patch ring worm, tinea favosa, korion celci
Obat : griseofulvin 10-25 mg/kgBB/hr ; dewasa 500 mg/hr
Itrakonazol 5-10mg/kgBB/hari ; dewasa 200mg
TINEA KAPITIS TIPE BLACK DOT RING WORM
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UKK : bintik merah kuning ditutupi krusta berbentuk cawan, rambut diatasnya mudah
putus
Etiologi : T. Rubrum, T. Mentagrophytes, T. Tonsuran, M.audoini, M. gypseum
DD : black dot ring worm, grey patch ring worm, korion celci
Obat : griseofulvin 10-25 mg/kgBB/hr ; dewasa 500 mg/hr
Itrakonazol 5-10mg/kgBB/hari ; dewasa 200mg
TINEA KAPITIS TIPE TINEA FAVOSA
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UKK : terdapat bisul bisul kecil dengan skuamasi, rambut mudah putus
Etiologi : T. Rubrum, T. Mentagrophytes, T. Tonsuran, M.audoini, M. gypseum
DD : black dot ring worm, tinea favosa, korion celci
Obat : griseofulvin 10-25 mg/kgBB/hr ; dewasa 500 mg/hr
Itrakonazol 5-10mg/kgBB/hari ; dewasa 200mg
TINEA KAPITIS TIPE KERION CELCI
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UKK : makula eritem dengan batas tegas, edema
DD : selulitis, urtikaria, furunkolosis
Komplikasi : abses subkutan, sepatikemia, nefritis, elefantiasis
Etiologi : Streptokokus B hemolitikus
Obat : Sefalosporin 4 x 400mg (5hr)
Kompres dengan asam borat 3 %
ERISIPELAS
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UKK : bula hipopion, erosi, makula eritema, vesikel / pustul
Etiologi : Staphylococcus aureus
Obat : kloramfenikol 2%, ertromisin 3%, penisilin 30-50mg/kgBB/hr
IMPETIGO BULOSA
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UKK : makula dan papul ertiem disertai lesi satelit didaerah vulva dan lipat paha
DD : BV, trikomoniasis vaginalis
Obat : flukonazol 150 mg SD
KANDIDIASIS VULVOVAGINITIS
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UKK : papul milier sampai lentikuler, berbrntuk kubah dengan cekungan ditengahnya, ada badan moluskum, seperti lilin, bewarna seperti kulit
Etiologi : POX virus
DD : varicella, impetigo bulosa, karsinoma sel basal, veruka vulgaris, keratokantoma
Terapi : kuretase tajam, bedah beku, mengeluarkan badan moluskum
MOLUSKUM KONTANGIOSUM