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Dermatology
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7/17/2019 Case Herpes
http://slidepdf.com/reader/full/case-herpes-5690e8cd009f1 1/43
Oleh :Michael 04120072
Puti Ayu Tiara 04120094
Pembimbing :
Dr. Sri Lestari, Sp. KK
7/17/2019 Case Herpes
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Nama : Marwati Umur : 54 th Jenis elamin : Perem!uan Pe"er#aan : $%u rumah tan&&a
Alamat : 'ilalan& !an#an&!esisir selatan
(tatus !er"awinan : Meni"ah Ne&eri Asal : Pesisir (elatan
A&ama : $slam (u"u : Melayu Tan&&al !emeri"saan: 1) A&ustus 200*
7/17/2019 Case Herpes
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1. Keluhan Utama
+elem%un& %erisi cairan yan& terasa
!anas ,isertai nyeri ,i ,ahi "anan se#a" 5hari yan& lalu
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+elem%un& %erisi cairan yan& terasa !anas,isertai nyeri ,i ,ahi "anan se#a" 5 hariyan& lalu-
Awalnya %eru!a %erca" merah,i!er%atasan ram%ut se%esar uan& l.&am,an ,isertai nyeri-
Pa,a malam hari tim%ul &elem%un&
%er"el.m!." ) %uah %erisi cairan #ernihse%esar %i#i #a&un&
7/17/2019 Case Herpes
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+elem%un& ma"in lama ma"in %ertam%ah%anya" ,an mem%esar/ hanya ,i,ahi sisi"anan hin&&a meluas sam!ai "e "el.!a"
mata- +elem%un& lama "elamaan %eru%ah warna
men#a,i "eruh se#a" hari "e 2 !erawatan- e%era!a &elem%un& !ecah ,an men#a,i
"er.!en& %erwarna hitam Pasien menyan&"al a,anya ,emam/ sa"it
"e!ala ,an %a,an letih se%elum lesi muncul riwayat !ema"aian .%at ,alam #an&"a wa"tu
lama ,an se%elum "eluhan ti,a" a,a- iwayat ,i&i&it seran&&a ,isan&"al
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iwayat %er".nta" ,en&an !en,eritacacar air ,an !enya"it yan& sama
,isan&"al iwayat ter"ena %ahan iritan"imia
,isan&"al iwayat !en&.%atan se%elumnya ti,a"
a,a iwayat !ernah men,erita sa"it cacar air
se%elumnya ,isan&"al
3i,ah !el. ti,a" a,a/ &an&&uan!en,en&aran ti,a" a,a/ &an&&uan!en&eca!an ti,a" a,a
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Pasien #u&a men&eluh"an %erca" merah&atal ,i %awah li!atan "etia"/ li!atan!ayu,ara/ !erut/ li!at !aha/ %.".n&/!un&&un& "a"i/ tela!a" "a"i ,an!un&&un& tan&an
+atal ini ,irasa"an se#a" 2 tahun yan&lalu/ hilan& tim%ul/ le%ih terasa malam hari,an ,isaat !asien %er"erin&at
7/17/2019 Case Herpes
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Awalnya "eluhan ,irasa"an ,i ,aerah%.".n&/ se%esar uan& l.&am yan& ma"in
lama ma"in mele%ar/ ,aerah !in&&irnyale%ih merah/ lama "elamaan muncul !a,ali!at "etia"/ li!atan !ayu,ara/ !erut/ li!at!aha/ %.".n&/ !un&&un& "a"i/ tela!a" "a"i
,an !un&&un& tan&an- eluhan "ulit ti,a" %asah ,an ti,a" ,isertai
,en&an %erca"%erca"/ %inti"%inti" atau&elem%un& ,ise"itar "eluhan "ulit-
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Pasien telah men&.%atinya ,en&an .%at inayan& ,i.les"an !a,a saat &atal- O%at ini
telah ,i!a"ai "uran& le%ih selama 1 tahun,an ,irasa"an "eluhan %er"uran& Pasien #u&a men&ata"an "u"u #ari "a"i "anan
%eru%ah warna men#a,i "unin&/ ra!uh ,an
se!erti terle!as- eluhan ini ter,a!at !a,a u#un& "u"u- Pasien menyan&"al a,anya trauma "u"u
7/17/2019 Case Herpes
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eluhan cairan !utih ,ari "emaluan,isan&"al
iwayat memelihara %inatan& !eliharaanti,a" a,a
Pasien serin& %er"erin&at ,an mem!unyai"e%iasaan %er"e%un
7/17/2019 Case Herpes
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3.Riwayat Penyakit Dahulu
Ti,a" !ernah men,erita !enya"it ,en&an"eluhan yan& sama
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4. Riwayat penyakit keluarga/riwayatatopi/alergi
Ti,a" a,a "eluar&a !asien yan& men,erita cacarair
Ti,a" a,a "eluar&a !asien yan& men,erita
!enya"it se!erti ini Ti,a" a,a %ersin%ersin !a&i hari/ na6as
%er%unyi/ mata merah/ %erair ,an &atal Ti,a" a,a riwayat aler&i .%at
Ti,a" a,a riwayat aler&i ma"anan
7/17/2019 Case Herpes
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(tatus +eneralisea,aan umum : Tam!a" sa"it
esa,aran : .m!.s mentis
(uhu tu%uh : )*0
Pemeri"saan th.ra" : ,alam %atasn.rmal
Pemeri"saan a%,.men : ,alam %atasn.rmal
7/17/2019 Case Herpes
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$-3."asi : !eli!is "anan/ ,ahi "anan/
"el.!a" mata "anan/!unca" hi,un&istri%usi : unilateral ,ermat.malentu"susunan : ti,a" "has8esi"el
%er"el.m!."atas : Te&as ti,a" te&as
U"uran : Pla"at;.resensi : Pla" eritem/ 8esi"el %erisicairan "eruh/er.si/"rusta"ehitaman/
7/17/2019 Case Herpes
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$$-3."asi : li!atan "etia"/ li!atan
!ayu,ara/ !erut/ li!at!aha/ %.".n&istri%usi : terl."alisirentu"susunan : ti,a" "has!.lisi"li"
atas : te&asU"uran : Pla"at;.rensi : Ma"ula eritema
,en&an s"uamahalus ,iatasnya
7/17/2019 Case Herpes
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$$$
3."asi : !un&&un& "a"i/
se!erti&a ,istaltun&"ai %awah ,an!un&&un& tan&an "iri
istri%usi : terl."alisir
entu"susunan : ti,a" "has !.lisi"li"
atas : te&as
U"uran : Pla"at
;.resensi : Ma"ula eritema,en&an s"uama halus,iatasnya
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(tatus <enere.l.&i"us
3a%ia may.ra/ min.ra ,an 8ul8a ,alam
%atas n.rmalti,a" ter,a!at ,uh
ti,a" a,a !em%esaran + in&uinal
elainan sela!ut len,ir'anya ,itemu"an "elainan !a,a mata
%eru!a hi!eremis
7/17/2019 Case Herpes
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elainan "u"u
,is".l.risasi =>?
.ni".lisis =>?
.ni".,istr.@ =>?
leu".ni"ia =>?
elainan ram%ut Ti,a" ,itemu"an "elainan
elainan "elen#ar lim6e Ti,a" ,itemu"an !em%esaran +
7/17/2019 Case Herpes
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+elem%un& %erisi cairan yan& terasa!anas ,isertai nyeri ,i ,ahi "anan se#a"5 hari yan& lalu-
Awalnya %eru!a %erca" merah,i!er%atasan ram%ut se%esar uan&l.&am ,an ,isertai nyeri-
Pa,a malam hari tim%ul &elem%un&%er"el.m!." ) %uah %erisi cairan #ernihse%esar %i#i #a&un&
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+elem%un& ma"in lama ma"in %ertam%ah%anya" ,an mem%esar/ hanya ,i,ahi sisi
"anan hin&&a meluas sam!ai "e "el.!a"mata-
+elem%un& lama "elamaan %eru%ah warnamen#a,i "eruh se#a" hari "e 2 !erawatan-
e%era!a &elem%un& !ecah ,an men#a,i"er.!en& %erwarna hitam
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(tatus ermat.l.&i"us
$-
3."asi : !eli!is "anan/ ,ahi "anan/"el.!a" mata "anan
istri%usi : unilateral ,ermat.mal
entu"susunan : ti,a" "has8esi"el%er"el.m!."
atas : Te&as ti,a" te&as
U"uran : Pla"at
;.resensi : Pla" eritem/ 8esi"el %erisicairan "eruh/er.si/ "rusta"ehitaman/
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Pasien #u&a men&eluh"an %erca"merah &atal ,i %awah li!atan "etia"/li!atan !ayu,ara/ !erut/ li!at !aha/
%.".n&/ !un&&un& "a"i/ tela!a" "a"i,an !un&&un& tan&an
+atal ini ,irasa"an se#a" 2 tahun
yan& lalu/ hilan& tim%ul/ le%ih terasamalam hari ,an ,isaat !asien%er"erin&at
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Awalnya "eluhan ,irasa"an ,i ,aerah%.".n&/ se%esar uan& l.&am yan& ma"in
lama ma"in mele%ar/ ,aerah !in&&irnyale%ih merah/ lama "elamaan muncul !a,ali!at "etia"/ li!atan !ayu,ara/ !erut/ li!at!aha/ %.".n&/ !un&&un& "a"i/ tela!a" "a"i
,an !un&&un& tan&an- eluhan "ulit ti,a" %asah ,an ti,a" ,isertai
,en&an %erca"%erca"/ %inti"%inti" atau
&elem%un& ,ise"itar "eluhan "ulit-
Pasien serin& %er"erin&at ,an mem!unyai"e%iasaan %er"e%un-
7/17/2019 Case Herpes
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$$-
3."asi : li!atan "etia"/ li!atan
!ayu,ara/ !erut/ li!at!aha/ %.".n&
istri%usi : terl."alisir
entu"susunan : ti,a" "has!.lisi"li"
atas : te&as
U"uran : Pla"at
;.rensi : Ma"ula eritema ,en&an
s"uama halus ,iatasnya
7/17/2019 Case Herpes
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$$$
3."asi : !un&&un& "a"i/
se!erti&a ,istal tun&"ai%awah ,an !un&&un&tan&an "iri
istri%usi : terl."alisir
entu"susunan : ti,a" "has !.lisi"li"
atas : te&as
U"uran : Pla"at
;.resensi : Ma"ula eritema,en&an s"uama halus,iatasnya
7/17/2019 Case Herpes
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Pasien #u&a men&ata"an "u"u #ari "a"i "anan%eru%ah warna men#a,i "unin&/ ra!uh ,anse!erti terle!as-
eluhan ini ter,a!at !a,a u#un& "u"u sa#a- Pasien menyan&"al a,anya trauma "u"u
Kelainan kuku
,is".l.risasi =>?
.ni".lisis =>?
.ni".,istr.@ =>?
leu".ni"ia =>?
7/17/2019 Case Herpes
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'er!es B.ster O6talmi"us Tinea "ruris et ".r!.ris Tinea !e,is et manum
Tinea un&uium
7/17/2019 Case Herpes
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ermatitis 8enenata $nsect %ite
an,i,.sis Pitiriasis .sea
Oni".,istr.@ traumati"
Oni".,istr.@ "an,i,.sis Ps.riasis
7/17/2019 Case Herpes
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TCanc" test Pemeri"saan se,iaan lan&sun& O' 20D ultur #amur
7/17/2019 Case Herpes
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Tera!i 'er!es B.ster
Umum :◦ Men#elas"an !a,a !asien ti,a"men&&aru" tem!at "eluhan
◦ Menin&"at"an ,aya tahan tu%uh
◦ Men#elas"an !a,a !asien %ahwa nyeri,a!at meneta! untu" #an&"a wa"tuyan& lama walau!un !enya"it telah
sem%uh
7/17/2019 Case Herpes
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husus:
(istemi" :1- (im!t.mati" :
Anal&eti"Asam me6enamat
)E500m&2- Anti8iral:
Asi"l.8ir 5E*00 m& selama 7 hari
T.!i"al :.m!res Nal sam!ai "erin&
7/17/2019 Case Herpes
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Tera!i TineaUmum :◦ Men#a&a "e%ersihan tu%uh
◦ Mema"ai %a#u yan& menyera! "erin&at◦ Men&&anti !a"aian a!a%ila %er"erin&at
◦ Men#a&a "a"i harus %ersih ,an "erin&
◦
Men#elas"an !a,a !asien %ahwa!enyem%uhan ,ari !enya"it ini lama
7/17/2019 Case Herpes
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husus : T.!i"al :
"et."enaC.l "rim 2D
(istemi" :$tra".naC.l 1 F 200m&
TM )F 4 m&
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'er!es B.ster Gu. a, sanam : %.nam Gu. a, 8itam : %.nam
Gu. a, ".smeti"um : %.nam Gu. a, 6uncti.nam : %.nam