Dermatomikosis Dr Wyd Edit
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DERMATOMIKOSIS
dr. Satya Wydya Yenny, Sp.KK
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Klasifikasi
• Mikosis profunda
• Mikosis superfisialis
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MIKOSIS PROFUNDA• Mikosis yang mengenai alat dalam dan kulit
• Etiologi :
– Jamur dimorfik – Suhu 37°C → Ragi
kamar → Miselium• Patogenesis
• Inhalasi + luka• Reaksi radang kronis
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GEJALA KLINIS1. RADANG KRONIS
2. MUNCULAN:
Granuloma – Tumor – Fistel – Ulkus
3. PERABAAN KERAS1. MYCETOMA → KAKI
2. CHROMOMYCOSIS → LENGAN & TUNGKAI
3. SPOROTRICHOSIS → LIMFE
4. ACTYNOMYCOSIS → LEHER
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GAMBAR
KROMOMIKOSIS
MISETOMA
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Misetoma
Penyakit kronis, supuratif dan granulomatosa
• Pembengkakan, abses, sinus, dan fistel multiple. Didalam sinus ditemukan butir-butir (granules) yang berpigmen yang kemudian dikeluarkan melalui eksudat
• Dapat menyerang subkutis, fasia, otot, dan tulang
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Sporotrikosis
• Infeksi kronis yang disebabkan Sporotrichium schenkii
• Pembesaran KGB, kulit dan jaringan subkutis diatas nodus melunak dan pecah membentuk ulkus yang indolen.
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Kromomikosis
• Penyakit jamur yang disebabkan bermacam-macam jamur yang berwarna (dematiaceous).
• Nodus verukosa kutan yang perlahan-lahan membentuk vegetasi papilomatosa yang besar.
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DIAGNOSIS & TERAPI
• Diagnosis : Klinis + Pemeriksaan penunjang
• DD/ :– TBC kutis, lepra, sifilis, tumor
• Terapi– Amfoterisin B, Yodium, Azol
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MIKOSIS SUPERFISIALIS DERMATOFITOSIS
NON DERMATOFITOSIS:
PITIRIASIS VERSIKOLOR
PIEDRA
KANDIDIASIS = KANDIDOSIS
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DERMATOFITOSIS• Infeksi jamur yang mengenai epidermis
kulit, rambut dan kuku
• Habitat : – antropofilik, zoofilik, geofilik
• Klinis : – Tinea + lokasi (WHO 1992)– T. KAPITIS T. KORPORIS– T. BARBE T. KRURIS– T. PEDIS T. UNGUIUM
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PREDISPOSISI
1. Temperatur tinggi2. Kelembaban tinggi3. Pekerjaan,
sering berkontak dengan tanah, air, binatang
4. Pakaian berlapis/ tidak menyerap keringat5. Higiene dan gizi kurang6. Sistim imun tubuh7. Adanya penyakit dasar8. Pengobatan
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GEJALA KLINIS
1. Bentuk bulat/melingkar, Polisiklik,
Polimorfik
2. Batas tegas
3. Pinggir aktif
4. Keratinofilik (sentral healing)
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TINEA KAPITIS
Klinis• Infeksi jamur pada kulit , rambut
kepala, alis & bulu mata• Etiologi
– Trichophyton, Microsporum
• Diagnosis:– Anamnesis – Klinis:
• Grey patch ring worm, kerion, black dot, favus
– Lab: • Lampu Wood, KOH, kultur
jamur,
• Terapi– Griseofulvin, Gol.Azol,
Terbinafin
Gambar
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• GGGH
Mikroskopik T.rubrum Mikroskopik M.cani
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Wood’s Lamp
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TINEA KRURIS• Infeksi jamur dermatofita
pada daerah pubis & sela paha
• Etio:– E. floccosum– T. rubrum – T. mentagrophytes
• Skrotum sangat jarang menunjukkan gambaran klinis
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TINEA KORPORIS
• Infeksi jamur dermatofit pada badan, tungkai, lengan
• Etio :– Trichophyton– Microsporum– Epidermophyton
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TINEA PEDISInfeksi dermatofit pada kaki, terutama di sela jari
dan telapak kaki
Etiologi :
T.rubrum, T.mentag, E.floccosum
Patogenesis:
Jamur – Host – Lingkungan
Predisposisi:
Lama pakai sepatu, panas, lembab
Atlit, lantai, kolam
Alat mandi, sepatu bersama
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TINEA UNGUIUM• Kelainan kuku akibat infeksi
jamur• Etio :
– T. rubrum, – T. mentagrophytes
• Diagnosis:– A/– Klinis : OSD, OSP, OSPP– Lab: KOH, kultur, PA
• Terapi:– Topikal amorolfin,
siklopirosolamin– Terbinafin, gol. Azol– Bedah
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LABORATORIUM
KOH• Kerokan kulit, potongan
kuku, rambut• + KOH 10-20%
Hifa panjang+ spora
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PITYRIASIS VERSIKOLOR
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GAMBARAN KLINIS
• Gatal +/-
• Makula dimulai di
sekitar folikel rambut
• Bermacam-macam
warna
• Skuama halus
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PITIRIASIS VERSIKOLOR
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LABORATORIUM
Pemeriksaan
• Pemeriksaan dengan lampu
Wood
• Kerokan kulit , selotip
+ KOH
Meat ball and spaghetti
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Penatalaksanaan
• Hindari faktor pencetus
• Topikal :
– Gol. Azol ( krim, sampo)
– Sampo Selenium sulfida
• Oral:
– Gol. Azol
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KANDIDIASIS
• Infeksi jamur yang disebabkan oleh Candida,
terutama C. albicans
• Jamur saprofit pada lipatan kulit, mulut,
tenggorok, sal. cerna, vagina
• Jamur dimorfik : pengaruh lingkungan
• Mekanisme imun humoral & seluler
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Kandidiasis oral/ Oral trush
FISSURA
MERAH
PSEUDOMEMBRAN
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Kandidiasis Intertriginosa
Mengenai lipatan kulit
Kandidiasis terbanyak
Gatal hebat
Makula eritem, batas
tegas, basah,
lesi satelit
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KANDIDOSIS VULVOVAGINALIS
• Definisi: infeksi vagina / vulva yang disebabkan
oleh Candida• Fc. Predisposisi :
1. DM2. Wanita hamil3. IUD
• Gejala klinis: Gatal Duh tubuh sedikit Labia mayora,kulit → erosi & lesi satelit Mukosa vagina → eritema Bercak-bercak seperti susu/bubuk,lengket sukar lepas
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Kandidiasis vulvovaginalis
Sangat gatal dan pedih
Keluar cairan putih
mirip susu/ keju
Pseudomembran putih
Sangat eritem
Lesi satelit
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Kandidiasis vaginalis
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LABORATORIUM
pemeriksaan
• Kerokan kulit + larutan
KOH 10 -20 %
• Pewarnaan Gram
• Kultur
• Pemeriksaan histopatologi
blastospora
Pseudohifa
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PENATALAKSANAAN
• Umum :– Mengurangi faktor predisposisi
• Topikal:– Nistatin, gentian violet, mikonazol
• Sistemik– Gol. Azol
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PENGOBATAN Klotrimazol vaginal 500 mg dosis tunggal Klotrimazol 200 mg 3 hari
Ketokonazol 2 x 200 mg p.o 5 hari
Itrakonazol 2 x 200 mg dosis tunggal
Flukonazol 150 mg dosis tunggal