LAPORAN KASUS neurodermatitis

LAPORAN KASUS

 NEURODERMATITIS  NEURODERMATITIS SIRKUMSKRIPTA SIRKUMSKRIPTA

DISUSUN OLEH: OLGA ADHITY ADHI TYA A 406162032

Dokter Pembimbing: Dr. Hendrik Kunt Ad!ie" S#.KK 

KEPANITERAAN ILMU PENYAKIT KULIT DAN KELAMIN FAKULTAS AKULTAS KEDOKTERAN KEDOKTE RAN UNIVERSITAS TARUMANAGARA

LAPORAN KASUS

A. ID$NTITAS PASI$N

 Nm

: N!" H

#eni$ Ke%min

: Perem&'n

Um'r

: () t*'n

A%mt

: Tmn$ri + DKI #krt

Pen,i,ikn

: SMA

Peker-n

: Ib' r'm* tngg

Stt'$ Pernik*n

: S',* menik*

Agm

: I$%m

%. ANA&N$SIS

A'tonmne$i$ ,i%k'kn &, tngg% ./ Mret 01/2 &'k'% /1"11 3I4 Ke'u(n Ut) *  Gt% %'t't knn ,n ,ib5* %'t't kiri" Ri+,t Pen,kit Sekrn- *

Seorng &$ien &erem&'n ber'm'r () t*'n ,tng ke &o%ik%inik k'%it ,n ke%min ,engn ke%'*n 'tm gt% ,i %'t't knn ,n ,i b5* %'t't kiri" Gt% ,ir$kn ter'$6 mener'$+ ter'tm -ik &$ien $e,ng ber$nti t' meng%mi $tre$$" Gt% br' ter$ m'%i meng*i%ng -ik &$ien menggr'kn! $m&i ter$ &eri*" Gt% $e%%' ter,&t ,i,er* !ng $m ,n ti,k ter,&t ,i,er* %in" Ti,k , ri5!t ,emm" Ke%'*n ini $',* ber'%ng k%i ,i&erik$kn ,n ,iobti o%e* &$ien" Sete%* men,&t  &engobtn mk ke%'*n membik+ nm'n ke%'*n kemb%i timb'% ketik obt $',* *bi$" P$ien mengg'nkn $b'n L'7" Ri+,t Pen,kit D(u'u

*

P$ien meng%mi *% ini $e-k ) t*'n !ng %%'" Ri5!t $m+ %ergi mknn+ %ergi obt ,n %ergi %inn! ,i$ngk%" Ri5!t ,ibete$ me%%it'$ ,n *i&erten$i ,i$ngk%

Ri+,t Pen,kit Ke'ur- *

P$ien ti,k menget*'i &k* ter,&t nggot ke%'rg t' orng $ekitr !ng meng%mi *% $er'&"

. STATUS G$N$RALIS

Ke,n Um'm

: 4ik  

Ke$,rn

: 8om&o$ menti$

S'*'

: Norm%

 N,i

: 91 k%imenit

Teknn ,r*

: /01;1 mmHg

Pern<$n

: /= k%imenit

4ert 4,n

: 21 kg

Tinggi 4,n

: /=1 >m

D. STATUS D$R&ATOLOGIKUS

Regio

: %'t't knn ,n ,i b5* %'t't kiri

Di$trib'$i

: %ok%i$t

E<%ore$en$i &rimer

: &%k 

3rn

: eritemto$

Uk'rn

: &%kt

#'m%*

: m'%ti&%e

E<%ore$en$i Sek'n,er : $k'm k$r ,n %ikeni
:6

$. P$&$RIKSAAN P$NUN/ANG

Ti,k ,i%k'kn

. R$SU&$

Te%* ,i&erik$ $eorng &$ien &erem&'n ber'm'r () t*'n ,engn ke%'*n 'tm gt% ,i %'t't knn ,n ,ib5* %'t't kiri" Gt% ,ir$kn ter'$6mener'$+ ter'tm -ik  &$ien $e,ng ber$nti t' meng%mi $tre$" Gt% br' ter$ m'%i meng*i%ng -ik  &$ien menggr'kn! $m&i ter$ &eri*" Gt% $e%%' ter,&t ,i,er* !ng $m ,n ti,k ter,&t ,i,er* %in" Ke%'*n ini $',* ber'%ng k%i ,i&erik$kn ,n ,iobti o%e* &$ien" Sete%* men,&t &engobtn mk ke%'*n membik+ nm'n ke%'*n kemb%i timb'% ketik obt $',* *bi$" Stt'$ ,ermto%ogik'$n! ,%* &, %'t't knn ,n ,ib5* %'t't kiri ter,&t &%k eritemto$ $o%iter ber'k'rn &%kt berbent'k  ireg'%er berbt$ teg$ ,engn %ikeni
G. DIAGNOSIS

Digno$i$ Ker-

: Ne'ro,ermtiti$ $irk'm$kri&t

Digno$i$ 4n,ing

: Dermtiti$ n'm'%ri$ kronik 

H. P$NATALAKSANAAN

/"

Non Me,ikmento$ " Men-e%$kn ke&, &$ien mengeni &en!kitn!"  b" Men>eg* gr'kn ,n go$okn &, ,er* !ng gt% >" I$tir*t !ng >'k'& ," Hin,ri $tre$$ &$iko%ogi$ e" Men-g keber$i*n k'%it ,engn mn,i <" Hin,ri ,ri gigitn $erngg

0"

Me,ikmento$ Si$temik: 8*%or&enirmine m%et ?8TM@ ( mg tb%et /7/ To&ik%: 8%obet$o% &ro&ionte >rem 1+1)

I. PROGNOSIS

A, Vitm

: bonm

A, F'n>tionm : bonm A, Sntionm : ,'bi et m%m A, Ko$metikm : ,'bi et m%m

TIN/AUAN PUSTAKA

A. Sinni)  Nm %in ,ri ne'ro,ermtiti$ $irk'm$kri&t ,%* %iken $im&%ek$ kronik'$+ i$ti%*

!ng &ertm k%i ,i&ki o%e* Vi,%+ o%e* kren it' ,i$eb't &'% %iken Vi,%"/ %. Pend(u'un  Ne'ro,ermtiti$ ,%* &er,ngn k'%it kroni$+ gt%+ $irk'm$kri& ,itn,i ,engn k'%it teb% ,n gri$ k'%it tm&k %ebi* menon-o% men!er'&i btng k!'+ kibt gr'kn t' go$okn !ng ber'%ng6'%ng kren berbgi rng$ngn &r'ritogenik" Pr'rit'$ meminkn &ern $entr% ,%m timb'%n! &o% rek$i k'%it ber'& %ikeni'% $ngt $'%it 'nt'k men*n keinginn 'nt'k menggr'k" Pen,erit mer$ enk $ete%* ,igr'k *ingg %'k $ete%* r$ gt% *i%ng ,igntikn ,engn r$ n!eri"0 . $#ide)i'-i

In$i,en ne'ro,ermtiti$ %ebi* $ering ter-,i &, 5nit ,ri&, &ri" Pen!kit ini $ering m'n>'% &, '$i ,e5$+ ter'tm '$i .1 *ingg )1 t*'n" P$ien ,engn koek$i$ten$i ,ermtiti$ to&i >en,er'ng memi%iki on$et 'm'r !ng %ebi* m', ?rt6rt /9 t*'n@ ,ibn,ingkn ,engn &$ien tn& to&i ?rt6rt (; t*'n@".+( D. $ti#t-enei

Etio%ogi &$ti ne'ro,ermtiti$ be%'m ,iket*'i+ nm'n &r'rit'$ meminkn &ern $entr% ,%m timb'%n! &o% rek$i k'%it ber'& %ikeni'% $ebgi ge-% ,ri &en!kit %inn! !ng men,$ri $e&erti gg% gin-% kroni$+ ob$tr'k$i $%'rn em&e,'+ %im
Fktor %ingk'ngn !ng ,&t mem&engr'*i gt% ntr %in &n$+ keringt+ ,n irit$i" Gt% $en,iri timb'% kibt ,n! &e%e&$n me,itor in<%m$i ,n ktiBit$ enCim  &roteo%itik" Ke,n ini menimb'%kn ,n! &ro$e$ in<%m$i &, k'%it+ !ng men!ebbkn &en,erit $ering menggr'k %e$i !ng terbent'k" Pro$e$ in<%m$i !ng  berke&n-ngn kn men!ebbkn &eneb%n k'%it+ ,imn &eneb%n k'%it ini $en,iri menimb'%kn r$ gt%+ $e*ingg merng$ng &enggr'kkn !ng kn $emkin mem&erteb% k'%it" 4eber& -eni$ k'%it %ebi* rentn meng%mi %ikenien,er'ng ekCemto$+ $e&erti ,ermtiti$ to&i ,n ,it*e$i$ to&i"/+(+)+= $. Ge!' K'ini

Pen,erit menge%'* gt% $ek%i+ bi% timb'% m%m *ri ,&t menggngg' ti,'r" Gt% memng ti,k ter'$ mener'$+ bi$n! &, 5kt' ti,k $ib'k+ ,n bi% m'n>'% $'%it ,it*n+ b*kn *r'$ ,igr'k $m&i %'k+ br' *i%ng gt%n! 'nt'k $ementr" Le$i bi$n! t'ngg%+ tet&i ,&t &'% %ebi* ,ri $t'" Lok$i !ng bi$ ,i tengk'k+ $i$i %e*er+ t'ngki b5*+ &erge%ngn kki+ $k%&+ &* bgin me,i%+ %engn bgin ek$ten$or+ $krot'm ,n B'%B" P, $t,i'm 5% ke%inn k'%it ber'& eritem ,n e,em t' ke%om&okn &&'%" Se%n-'tn! kren gr'kn !ng ber'%ng6'%ng+ bgin teb% meneb%+ kering ,n ber$k'm $ert &inggirn! *i&er&igment$i" Uk'rn %e$i %entik'%r $m&i &%kt+ bent'k 'm'mn! %on-ong"/ Gt% !ng bert mer'&kn ge-% ,ri %iken $im&%ek$ kronik'$" Menggo$ok ,n menggr'k m'ngkin ,i$eng- ,engn t'-'n menggntikn $en$$i gt% ,n n!eri+ t' ,&t $e>r ti,k $eng- !ng ter-,i &, 5kt' ti,'r"Ke&r*n gt% ,&t ,i&erb'r'k ,engn berkeringt+ $'*' t' irit$i ,ri &kin" Gt% -'g ,&t bertmb*  &r* &, $t ter-,i $tre$$ &$iko%ogi$"/+( P, ne'ro,ermtiti$+ &enggo$okn ,n &enggr'kn !ng ber'%ng men!ebbkn ter-,in! %ikeni
%mn! %e$i" Der* !ng ter-,i %ikeni%&+ tengk'k+ $m&ing %e*er+ %engn bgin ek$ten$or+ &'bi$+ B'%B+ $krot'm+ &erin%+ &*  bgin me,i%+ %'t't+ t'ngki b5* %ter%+ &erge%ngn kki bgin ,e&n+ ,n  &'ngg'ng kki" Ne'ro,ermtiti$ ,i ,er* tengk'k ?lichen nuchae@ 'm'mn! *n! &, 5nit+ ber'& &%k ke>i% ,i teng* tengk'k t' ,&t me%'$ *ingg ke $>%&" 4i$n! $k'mn! bn!k men!er'&i &$ori$i$".

Vri$i k%ini$ ne'ro,ermtiti$ ,&t ber'& &r'rigo no,'%ri$+ kibt gr'kn t' korekn tngn &en,erit !ng ber'%ng6'%ng &, $'t' tem&t" Le$i ber'& no,'$  berbent'k k'b*+ &erm'kn meng%mi ero$i tert't'& kr'$t ,n $k'm+ %mbt %'n men-,i ker$ ,n ber5rn %ebi* ge%&" Le$i bi$n! m'%ti&%e+ %ok%i$$i ter$ering ,i ek$tremit$ ber'k'rn m'%i beber& mi%imeter $m&i 0 >m"/ . Hit#t'-i

Gmbrn *i$to&to%ogik ne'ro,ermtiti$ ber'& ortokerto$i$+ *i&ergrn'%o$i$+

knto$i$ ,engn rete ri,ge$ memn-ng tert'r" 4er$eb'kn $e% r,ng %im*5nn ber&ro%i
G. Di-ni

Digno$i$ ne'ro,ermtiti$ $irk'm$kri&t ,i,$rkn gmbrn k%ini$" Digno$i$  bn,ing !ng ,&t timb'% ,%* &en!kit k'%it %in !ng memberikn ge-% &r'rit'$+ mi$%n! %iken &%n'$+ %iken mi%oi,o$i$+ &$ori$i$+ ,n ,ermtiti$ to&ik"/+) H. Di-ni %ndin-

K$'$6k$'$ &rimer !ng 'm'mn! men!ebbkn %ikenir %ng$'ng mer'$k k'%it ,n o%e* $en$itik eritemto'$ !ng berbt$ -e%$ kem',in ,iik'ti ,engn e,em+  &&'%oBe$ike%+ Be$ike% t' b'%%" Ve$ike% t' b'%% ,&t &e>* menimb'%kn ero$i ,n ek$',$i" P, <$e kronik k'%it ter%i*t kering+ $k'm+ &&'%+ %ikeni
!ng k$r+ ber%&i$6%&i$+ trn$&rn+ ,i$erti r &$ti+ tet&i beber& *i&ote$ te%* men,&tkn b*5  &en!kit ini ber$i<t 'toim'n+ ,n re$i,i<"( >" Dermtiti$ $eboroik   Dermtiti$ $eboroik mer'&kn gngg'n &&'%o$k'mo$ !ng ter,&t &, ,er* k! $eb'm $e&erti k'%it ke&%+ 5-* ,n &'ngg'ng" Dermtiti$ ini  ber*'b'ngn ,engn m%$$eCi+ bnorm%it$ im'no%ogi$+ ,n ktiB$i ,ri kom&%emen" 4er*'b'ngn ert ,engn kekti<n g%n,'% $eb$e" 4i$ ter-,i  &, b!i 'm'r b'%n &ertm ,n men>&i &'n>k &, 'm'r /;6(1 t*'n" Ke%inn k'%it ter,iri t$ eritem ,m $k'm !ng bermin!k ,n gk  kek'ningn+ bt$n! gk k'rng teg$"/ ," Liken P%n'$ Le$i !ng &r'riti$+ er'&$i &o&'%r !ng ,ikrkteritikkn ,engn 5rn kemer*n berbent'k &o%!gon%+ ,n k,ng berbt$ teg$" Sering ,item'kn  &, &erm'kn <%ek$or ,ri ek$tremit$+ genit%i ,n membrne m'k'$" Miri& ,engn rek$i me,i$i im'no%ogi$" Liken &%n'$ ,itn,i ,engn &&'%6&&'% !ng mem&'n!i 5rn ,n konir membrne b$% ,n $e% b$%" D&t &'% ,item'kn in
e" Dermtiti$ to&i Per,ngn k'%it kroni$ !ng re$i,i< ,i$erti gt%+ !ng 'm'mn! $ering ter-,i $e%m m$ b!i ,n nk6nk" Sering ber*'b'ngn ,engn &eningktn k,r  IgE ,%m $er'm ,n ri5!t to&i &, ke%'rg t' &en,erit" Ke%inn k'%it  ber'& &&'% gt%+ !ng kem',in meng%mi ek$kori$i ,n %ikeni
,ermtiti$ to&ik &, %i&t $ik' ,n %i&t %'t't ?<%ek$or@ *i%ng &, '$i 0 t*'n+  &, ne'ro,ermtiti$ $irk'm$kri&t &, $ik' ,n &'ngg'ng kki ?ek$ten$or@ ,n  ber%n-'t $m&i t'"( <" Tine >or&ori$ Ke%inn k'%it !ng berbt$ teg$+ ,engn &inggir kti< ,n bgin teng* re%tiBe tenng"0

I. Pent'knn

Per%' ,i-e%$kn ke&, &$ien 'nt'k $ebi$ m'ngkin meng*in,ri menggr'k %e$i %ren gr'kn kn mem&erb'r'k &en!kitn!" Lingkrn $etn ,ri gt%6gr'k  %ikenionto*n! *i,rok$iCin+ ,i%obet$o% &ro&ionte 1"1)" 8onto* kortiko$teroi,  &oten$i tinggi ?go%ongn II@ !it' momet$one <'rote 1"1/+ ,e$o7imet$one 1"1)" Kortiko$teroi, to&ik% ,i&ki 06. k%i $e*ri+ ti,k %ebi* ,ri 0 mingg' 'nt'k &oten$i k't" A&bi% ti,k ber*$i%+ ,iberikn $e>r $'ntikn intr%e$i / mg+ >onto*n! trim$ino%on $etoni," >" UV4 ?U%trBio%et 4@ t' PUVA ?P$or%en U%trBio%et A@"/+(

DATAR PUSTAKA

/" S'%r$ito SA" Dermtiti$"D%m: D-'n, A+ HmC* M+ Ai$* S" E,itor$" I%m' Pen!kit K'%it ,n Ke%min" E,i$i 2" #krt:FKUI" 01/)" &"/;.6) 0" Siregr RS" At%$ 4er5rn Sri&ti Pen!kit K'%it" E,i$i ke,'" EG8" #krt 011)"&" /096/.1 ." Hogn D#+Et %"Li>*en $im&%e7 >*roni>'$" ABi%b%e t: *tt&:eme,i>ine"me,$>&e">omrti>%e//0.(0.6oBerBie5= "A>>e$e, on ( A&ri% 01/2" (" Soter NA" N'm'%r E>Cem n, Li>*en Sim&%ek$ 8*roni>'$Pr'rigo No,'%ri$

in: Free,berg IM+ EiCen A+ 3o%%< K+ A'$ten KF+ Go%,$mit* LA+ KtC SI+ e,$" FitC&tri>k$ Dermto%og! in Gener% Me,i>ine" 2t* e," Ne5 York : M>" Gr5 Hi%% 011." &" /);6/=0" )" Hr*&+ M" Liken Sim&%ek Kronik in I%m' Pen!kit K'%it" Hi&okrte$" 0111" #krt" & /=62 =" Mn$-oer+ Arie<" ,kk" Ne'ro,ermtiti$ Sirk'm$kri&t in K&it Se%ekt Ke,oktern" Me,i Ae$>'%&i'$" 0111" #krt" & .+ ;9 2" R-%k$*mi R+ T*&& DM+ #i$nkr T#+ et %" 01//" Li>*en $im&%e7>*roni>'$ o<  nogenit% region: A>%ini>o6etio%ogi>% $t',!" Indian J Dermat ol Venereol Leprol Jan-Feb  22?/@ : & 0;6.="