DERMATOVENEROLOGY DEPARTMENT

MEDICAL FACULTY
HASANUDDIN UNIVERSITY

1. Gabriella S. Rering 200983002

2. Deandles Wattimury 200983022
3. Dio Ocev Pratama 200983023
4. Indah Z. Wattiheluw 200983024
5. Triani F.D Alyanto 200983025
6. Ditta S. Wulandari 200983040
7. Aisyah A. Z. R. Wattimena 200983043
8. Isna Mustika CIII II 2013
9. Nur Nazmi Selan CIII II 08366
10. A. Tien Hartini CIII II 08366
11. Sari Ristiyanti CIII II 08366
 PATIENT IDENTITY

Name : Bakarang
Gender : Male
D.O.B : 8 December 1960
Age : 56 years old
Medical Record : 226974
Marrital Status : Married
Religion : Christian
Admision Date : 23 December 2015
 ANAMNESIS

Anamnesis : (Aloanamnesis)
Chief complaint : Itching
Further Anamnesis :
Patients came with itching in the head since one month ago,
itchy become heavy during the day and when sweating, at the
beginning itching from the top of the head and then spreads
throughout the head, with the scalp grayish color, thickened,
and the like dandruff.
Past illness : The same complaints (-), patients
suffering brain tumors.
Family History : (-)
Allergic History : (-)
 PHYSICAL EXAMINATION
General condition : Severe illness / Compos Mentis
Vital sign
Blood pressure : 130/70 mmHg
Pulse : 88 x/m
Respiratory Rate : 17 x/m
Temperature : 36,5 C
Height : 170 cm
Weight : 53 kg
BMI : 18,33
Head : no abnormality
Eyes : anemic conjunctiva (-), icteric sclera (-),
ENT: no abnormality
Thorax :
Pulmo-
Inspection : symetris dextra et sinistra
Palpation: no significant finding
Percussion: sonor
Auscultation: vesiculer
COR :
Inspection : ictus cordis (+)
Palpation: thrill (-)
Percussion: deaf
Auscultation: S1/S2 reguler
Abdomen:
Inspection : flat
Palpation: tenderness(-)
Percussion: tympani
Auscultation: peristalti (+) normal

Genitals : Catheterized

Extremities: Hemipharese sinistra

 DERMATOLOGICAL STATUS

Location Efflorescense
Scalp Papul eritema,
krusta, pustul,
skuama
Thorax anterior regio Papul eritema, pustul
colli
 LABORATORY
Hematology :

RBC : 3,70 3,50 - 5,50

HGB : 12,2 11,0 16,0 dL
HTC : 33,5 37,0 54,0 %
MCV : 90,8 80,0 100,0 fl
MCH : 32,9 27,0 34,0 Pg
MCHC : 36,4 32,0 36,0 dL
PLT : 267 x 109 150 400 L
WBC : 11,3 x 103 4,o 10,0 uL
MPV : 7,7 6,5 12,0 fl
PCT : 0,205 0,108 0,282 %
 LABORATORY

Chemistry
Blood glucose : 91 80 125 mg/dl
Cholestrol : 234 < 200 mg/dl
Trigliserida : 87 < 150 mg/dl
Uric Acid : 7,5 L 3,4 7,0 mg/dl
Natrium : 138 64 306 U/L
Kalium : 3,52 3,5 5,1 mmol/L
Chlorida : 110,3 98 106 mmol/L

Immunoserology
HbsAg : Non Reactive
Anti-HCV : Non Reactive
 ASSESSMENT

Seborrheic dermatitis
Furunkulosis
 DAY 1
PATIENTS FOTO 20-1-2016
 DAY 1
PATIENTS FOTO 20-1-2016
 THERAPY
Dermato therapy :
Ceterizin 10 mg/24 hour

Metilprednisolone 2 mg/12 hour

Ciprofloxaxin 500 mg/ 12 hour

Desoxymethasone cream + gentamicin

cream apply in morning
 DIFFERENTIAL
DIAGNOSIS

Psoriasis
Dermatitis atopi
 RESUME
Patient, man, 56 y.o present with complaints of itching in the head
since one month ago, itchy become heavy during the day and when
sweating, itching initially on top of the head and then spreads
throughout the head. complaint along with the scalp grayish color,
thickened, and the like dandruff. Patients suffering brain tumors.
Patient was savere illness, compos mentis. vital signs are normal, BMI:
normal. General status : Hemipharese sinistra. Dermatology status:
location scalp with efflorescence papul eritema, krusta, pustul,
skuama; thoraks ant. Regio colli: Papul eritema, pustul.
From laboratory data : Leucositosis, hipercholesterolemia,
Hiperuricemia
Therapy :Ceterizin 10 mg/24 hour, Metilprednisolone 2 mg/12 hour,
Ciprofloxaxin 500 mg/ 12 hour, Gentamicin +..
SEBORRHEIC
DERMATITIS
 INTRODUCTION
Seborrheic dermatitis is a chronic dermatosis
characterized by redness and scaling, often in
areas which sebaceous glands are most active, such
as the face and scalp, the presternal area and the
body folds.

Although its pathogenesis is not fully elucidated,

there is a link to sebum overproduction and the
commensial yeast Malassezia.
 EPIDEMIOLOGY

Neonatus

Males > Females

Adults or older people (20-50 years old)

Etiology Unknown

Malassezia furfur
Free fatty acids released from sebaceous triglycerides.
The lipid layer of malassezia can also modulate
proinflammatory cytokine production by keratinocytes.

HIV
Seborrhoeic dermatitis is now established as a possible
marker of early HIV infection and exacerbations
 Extremes weather
long spells of wet weather and sunlight exposure causes SD
to flare

Infrequent shampoo
exacerbate existing cases and precipitate latent disease
 PATHOGENESIS

increase
Over
the growth
secretion
of P. ovale
Unknown of
make
sebaceous
inflamatory
glands
reaction.
CLINICAL MANIFESTATION

The lesions yellow color, mild to

severe erythema, mild inflamatorry
infiltrate, and oily, thick scales and
crusts.

Predilection : scalp, eyebrows, eyelids,

nasolabial creases, lips, ears, sternal
area, axillae, submammary folds,
umbilicus, goins and gluteal creases.
 Seborrheic Dermatitis Seborrheic dermatitis
in infant: scalp (Cradle Cap) in infants: body
Eff : yellow scales Eff : yellow scales and severe erythema
Seborrheic dermatitis
Seborrheic dermatitis
at postauricularry at forehead
Eff : yellow scales and erythema
Eff : erythema
Seborrheic dermatitis in chest
DIAGNOSIS

History talking

Physical Examination

Histopathology
Examination
HISTOPATHOLOGY

Mild spongiosis in
indifundibulum with scale
crust (shoulder parakeratosis)
in the follicular ostium and
formation of a keratinous plug.
Dermis presenting
mononuclear infiltrat.
Detail image of spongiosis in
the infundibulum and scale
crust (shoulder parakeratosis)
in the follicular ostium.
Dermis presenting
mononuclear inflammatory
infiltrate.
 In acute state:
Epidermis ekonthoik, limphocyte infiltrat,

histiocyte, spongiosis, hyperplasia

psoriasiform, ortokeratosis, parakeratosis,
neutrophyl within squama and crusta in
foliculer ostium.
In chronic state:

Plexus superficial Capilary and vein

dilatation
 KOH 10% exclution of fungi
Patch test, (for exclution of Contact
dermatitis)
Serological test (for exclution of dermatitis
atopik)
DIFFERENTIAL DIAGNOSIS

Psoriasis Dermatitis atopi

 THERAPY
T Hygiene education

E
Topical
R
Hidrocortison 1 %
A Ketoconazole cr 2%
P
Sistemic
H
Prednison 20-30mg/day
Y Isotretinoin 0,1-0,3/kgBW/day
ketokonazole 200 mg/day
CONTINUE.
Shampoo
Shampoo keratolitik tar-sulfur
or salicyl acid
Zinc pyrithione
Selenium sulfida 2,5%
Ketokonazole 2%

Phototherapy
Narrow band UVB 3x/weeks
 Seborrheic dermatitis can heal itself and the
condition usually responds well to treatment.
It often relapses, so maintenance or intermittent

treatment may be required.

But in some cases have a constitutional factors,

the disease is rather difficult to be cured,

although controlled.

PROGNOSIS
 COMPLICATION

Leiner
Eritroderma
Disease
THANK YOU