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7/24/2019 Uji Manual1

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UJI MANUALDERMATOLOGI


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Nikolsky's sign (Pyotr Nikolsky, Russian physician,18581940) :

a skin condition in which the top layers of the skin slipaway from the lower layers when slightly rubbed orpressure.

Proses patologis yang mendasari : hilangnya kohesikeratinosit epidermis sehingga lapisan atas epidermiseasily move laterallywith slight pressure or rubbing

Tujuan : untuk membuktikan adanya proses akantolisis(hilangnya kohesi antara sel keratinosit epidermis)

NIKOLSKY SIGN


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The lack of cohesion of the skin may also be

demonstrated with the bulla-spreadphenomenongentle pressure on an intact bulla

forces the fluid to spread under the skin away

from the site of pressure (AsboeHansen sign or

the indirect Nikolsky or Nikolsky II sign).

The extension of a blister to adjacent unblistered

skin when pressure is put on the top of the bulla


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4

Acantholytic

disorders

PemfgusStaphylococcal scalded skin syndrome

(SSSS)Steven Johnson SyndromeToxic epidermal necrolysis

Nikolsky positi


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5

apisan superfsial layerskulit terlepas dari lapisan

di!a"ahnya dgn gerakanmenekan # sedikit

menggosok$ Pengelupasankulit meninggalkan daerah!asah% merah% dan nyeri

Nikolsky&s sign


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6

'ara

melakukan


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7


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Diagnostic sign of psoriasis

Tujuan : membuktikan adanya papilomatosis Gentle scraping of the surface of a psoriasis plaquewith a glass slide will remove the loosely attachedscales and reveal a shiny surface with fine bleedingpoints. These bleeding points represent the dilated

and tortuous capillary blood vessels in the papillarydermis (papilomatosis)

ASPT* S+N


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Pada fenomena Auspitztampak serumatau darah berbintik-bintik yangdisebabkan oleh papilomatosis.

Cara : skuama berlapis dikerok, dengan

pinggir gelas alas/pisau bisturi. Setelahskuamanya habis, maka pengerokanharus dilakukan perlahan-lahan, jikaterlalu dalam tidak akan tampak

perdarahan yang berbintik-bintikmelainkan perdarahan yang merata.


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'ara

melakukan

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,enggunakanpinggiran gelas

o!-ek

Skuama dilepaslapis demi lapis

.scr lege artis lapakhir skuama

digores.

!intikperdarahan

(pint point!leeding)


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Auspit/ sign0point of bleeding

setelah skuama dilepas

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12


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Pint point !leeding


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12N3,2NA +342SAN N

(The candle-grease sign orTache de bouge)

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5iagnostic sign o psoriasis

6hen a psoriatic lesion is scratched"ith the point o a dissecting orceps%a candle7grease7like scale can !e

repeatedly produced even rom thenon7scaling lesions$

The scale appear more silver incolour !y introducing air8keratin

interaces$


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skuama yang berubah warnanya menjadi

putih pada goresan, seperti lilin yangdigores disebabkan oleh berubahnya

indeks bias. Cara menggores dapat

menggunakan pingir gelas alas/ujung

pisau bisturi.


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Pada lesi !erskuama pasien psoriasisdilakukan penggoresan menggunakan

tepi kaca o!-ek 9 u-ung pisau !isturisecara perlahan$

:emudian perhatikanlah peru!ahanyang ter-adi aki!at goresan terse!ut

nterpretasi 0 Positi ; -ika ter-adiperu!ahan "arna men-adi le!ih putihspt lilin yang digores

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melakukan


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The Koebner phenomenon (Heinrich Koebner, 1872) :

The development of isomorphic pathologic lesions inthe traumatized uninvolved skin of patients certainskin diseases, especially psoriasis

trauma is followed by new lesions in thetraumatized but otherwise normal skin, and these newlesions are clinically and histopathologically identicalto those in the diseased skin.

Fenomena Koebners

(Isomorphic reaction)


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PATHOGENESIS OF KOEBNER

RESPONSE


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TYPES OF KOEBNER PHENOMENON (Boyd and Neldner)

Classified of Koebner phenomenon into 4 different groups :

1. True isomorphic phenomenon: psoriasis, lichen planus and

vitiligo;2. Pseudoisomorphic phenomenon: infectious diseases, e.g. warts,molluscum contagiosum, Behcet's disease, & pyo gangrenosum

3. Occasionally occurring isomorphic phenomenon:diseasesoccasionally localize to sites of trauma, e.g. cancer (gastric,

testicular or mammary), Darier's disease, erythema multiforme,Hailey-Hailey disease, Kaposi's sarcoma, Kyrle's disease, lichensclerosus et atrophicus, pellagra, perforating folliculitis, reactiveperforating collagenosis, and

4. Questionable isomorphic phenomenon:many conditions thathave been associated with the Koebner phenomenon, includes :anaphylactoid purpura, bullous pemphigoid, dermatitisherpetiformis, discoid lupus erythematosus, etc.


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1enomena :oe!ner&s

(Isomorphic reaction)

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Trauma pada kulit penderita dapatmenye!a!kan kelainan yang

sama ; respon isomorfk

Tim!ul kisaran > 8 ?@ hari darisaat trauma

Trauma dapat !erupa garukan(scratching) atau gosokan

(rubbing)

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