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EKSEMA HERPETIKUM
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Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw Hill Companies;2012
Eczema herpeticum (EH) /erupsi kaposi varicelliform timbul akibat inokulasi infeksi yg menyebar luas dari kerusakan kulit akibat eksim, biasanya merupakan manifestasi primer dari infeksi HSV-1
Bbrp pustaka EH dpt disebabkan inf. HSV-2
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Eczema herpeticum sering tjd pd pasien riwayat atopik
Gejala klinik EH diawali dg lesi berupa vesikel umbilikasi, pustul & bula di atas dasar eritematosa, serta polimorfik. Lesi biasanya simetris timbul pd ekstremitas atas & bawah, terkadang sampai mengenai akral & menyebar ke seluruh tubuh
Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York: McGraw Hill Companies;2012
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Penyebaran EH yg luas dpt menjadi eksimatisasi dg gejala akhir lesi brp erosi & krusta diskret yg mrpkn tanda dx
Pasien biasanya tampak sakit berat & disertai gejala konstitusi brp demam, malaise, menggigil & adenopati
Sepuluh besar kelompok penyakit kulit. Edisi 1. FK UNSRI: palembang; 2011
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Gambaran histopatologi eksema herpetikum vesikel ( ); spongiosis ( ); eosinofil ( ); Limfosit ( ).
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Hurwitz Clinical Pediatric Dermatology
Eczema herpeticum umumnya menyerang bayi & anak2, ttp dpt trjd pd setiap usia
Lesi kulit kdg menjd hemoragik & krusta serta lesi sembuh tanpa skar
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Kaposi varicelliform eruption (eczema herpeticum). Dermatologi Journal Online. 2008
Pulasan Tzanck tidak sensitif & tidak spesifik utk infeksi HSV
Pem. fluoresen direk dg pewarnaan antibodi memungkinkan diagnosis cepat & akurat hasil dlm bbrp jam
Biakan virus sensitif & spesifik utk infeksi HS, ttp memerlukan waktu lebih lama
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Eczema herpeticum selalu disertai DADA peny. kulit kronik residif yg mulai tjd tu
pd masa bayi & anakDA biasanya tjd pd org yg memiliki riw. atopi
personal/dlm keluarga, sprt asma, rinitis alergik, & konjungtivitis alergik
DA ditandai dg kulit kering, eritem, papul kadang vesikel disertai gatal
Kulit kering pada pasien DA mengakibatkan kelainan fgs sawar kulit
Pasien rentan thd iritan, alergen, mikroba &infeksi
Sepuluh besar kelompok penyakit kulit. Edisi 1. FK UNSRI: palembang; 2011
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Fitzpatrick, 2012
Gambar eksema herpetikum
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DERMATITIS ATOPIKAtopic dermatitis is a chronic inflammatory
skin disease associated with cutaneous hyperreactivity to environmental triggers and is often the first step in the atopic march that results in asthma and allergic rhinitis.
The clinical phenotype that characterizes atopic dermatitis is the product of interactions between:
Susceptibility genes,Environment, Defective skin barrier functionImmunologic responses
New insights into atopic dermatitisDonald Y.M. Leung,1 Mark Boguniewicz,1 Michael D. Howell,1 Ichiro Nomura,1 and Qutayba A. Hamid2
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PATOGENESIS DAJ. Clin. Invest.2004;113:651–657
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Kemokin DA
The Journal of Clinical Investigation http://www.jci.org Volume 113 Number 5 March 2004
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5 pilar penatalaksanaan DA
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Penatalaksanaan DA Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific perspective. Journal of Dermatology 2013; 40: 160–171
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Penatalaksanaan DA Consensus guidelines for the management of atopic dermatitis: An Asia–Pacific
perspective. Journal of Dermatology 2013; 40: 160–171
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16Clinical and basic immunodermatology
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Clinical and basic immunodermatology
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BARRIER KULIT1. Gangguan gen envelope (filagrin
dan lorikrin)2. Level seramid ↓3. Trans Epidermal Water Loss me↑4. Me ↑kan protease endogen, me↓
inhibitor protease
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DERMATITIS ATOPIKInteraksi kompleks1. Kerentanan gen filiagrin dan
lorikrin level seramid rendah barier kulit terganggu
2. Defek sistem imun innate3. Respon imunologi yang
me↑terhadap alergen dan mikroba
4. Stress emosional
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KRITERIA MAYOR DA HANIFIN-RAJKA1. Pruritus2. Dermatitis kronik dan
rekuren3. Morfologi, predileksi dan
usia yang khas4. Riwayat atopi pada diri
sendiri atau keluarga
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Kriteria Minor DA Hanifin_Rajka - Xerosis- ikhtiosis / hiperlinearis
palmaris / keratosis pilaris- RIeaksi tes kulit cepat (tipe
1)- Peningkatan IgE serum- Usia awitan dini- Kecenderungan infeksi kulit- Kecenderungan
dermatitis tangan atau kaki non spesifik
- Eksim nipple- Cheilitis- Konjungtivitis rekuren- Garis Dennie-Morgan- Keratokonus
- Katarak subkapsular anterior
- Orbital darkening- Pucat/eritema fasial- Pitiriasis alba- Lipatan leher anterior- Gatal saat berkeringat- Intoleransi terhadap wol dan
pelarut lemak- Perifolikular aksentuasi- Intoleransi makanan- Perkembangan penyakit
dipengaruhi faktor lingkungan dan emosional
- Dermografisme putih / delayed blanch
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DERMATITIS ATOPIK
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DERMATITIS ATOPIK
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DENNIE MORGANFOLD
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SUPERINFEKSI DERMATITIS ATOPIK
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Predominant TH2 profile J Allergy Clin Immunol 2008;121:652-8
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Distribusi lesi tergantung usia pasien◦Bayi: wajah, skalp, permukaan ekstensor ekstermitas & daerah popok
◦Anak: lipatan fleksural ekstermitas (antekubiti, fossa poplitea, koli posterior) pergelangan tangan, tangan, pergelangan kaki dan kaki
◦Dewasa: fleksural, dpt mengenai daerah > luas
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MANIFESTASI KLINIS DALesi KulitAkut: papul eksematosa, ekskoriasi
& vesikel di atas kulit yg eritem & eksudat serosa
Subakut: papul eritematosa, ekskoriasi & skuama
Kronik: plak menebal, likenifikasi & papul fibrotik
Innunology Abbas