Dr Danny A. Hermawan Dip.Derm.

Dept. Ilmu Kesehatan Kulit & Kelamin

FK.- UKRIDA
MUCO-CUTANEUS
VIRAL INFECTION
Papel/nodule Rash Vesicles Systemic

Verruca vulgaris Rubeola Varicella * Hepatitis B/C

( Common warts ) (Measles; Morbilli) ( Chicken-pox ) ( Gianotti-crosti
Et/. HPV. Et/. Pox virus Et/. VZV. Syndr.)
Et/. Hepatitis vi.
B/C
Condyloma Rubella * Herpes Zoster * AIDS
accuminatum (German Measles) (Shingles ) Et/. HIV
Et/. HPV. 6,11,16 & 18 Et/. Parapox vi Et/. VZV.

Molluscum ExanthemaSu * Herpes Simplex

contagiosum bitum (HS.
Et/. Pox virus Et/. HHV. 6 & 7 Labialis/Genitalis)
Et/. HSV.
Orf Erythema * Variola (Small Pox)
Et/. Parapox vi. infectiosum Et/. Pox virus
Et/. Hpar.Vi B 19

Kawasakis H.F. & M. D

Disease Et/. Coxsackie vi. A16
Et/. Idiopathic ?
VARICELLA
( Chicken Pox; Water-pokken; Varisela: Cacar air )

Infeksi primer akut oleh virus Varicella-

DefinisiDDE
Zoster, yg menyerang kulit & mukosa,
desertai dgn gejala konstitusi, kelainan kulit
khas erupsi kemerahan disertai vesikel2
terut. Bagian sentral tubuh.
 PATOGENESIS
Infeksi primer penderita rentan
* Penularan : - Aerogen tract. Respiratorius &
oropharing
- Kontak langsung ke kulit
 Manifestasi KLINIK
Incubation : - 14 Ds ( range 10 23 Ds )
Prodromal : - cephalgia & myalgia,
( 2-3 ds) - malaise + febris
(anak kecil ringan, anak besar/dewasa lebih nyata)
Efloresensi : - makula-papula eritema vesikulae (+ delle)
pustul krusta Sikatriks
* Gejala : Bila panas / Infeksi sekunder (+KGB>)
Furunkulosis; Erysipelas; Selulitis
 Varicella
Diagnosis gamb. klinis Diagnosis banding
* Distribusi : - anak & remaja Variola ( Small Pox )
- org tua sakit
Disseminated HSV
berat
infection
Prodromal ringan
Sumber infeksi (+);MT 10 - 20 Disseminated H. Zoster
hr Eczema herpeticum
Morfologi : Impetigo vesiko-bulosa
- vesikel2 kecil; drops of
D.itis Herpetiformis
water
Duhring
- timbul vesikel bergelombang
- penyebaran SENTRIFUGAL
- telapak tangan & kaki (-)
Varicella
LABORATORIUM bantu Diagnosis
Preparat TZANCK : - sel Datia + inti >
( S.A. Kerokan dasar vesikel + Giemsa stain )
Mikroskop Elektron: - partikel VZV
Kultur virus VZV Penelitian
TES Serologik

HISTOPATOLOGI
Vesikel intra-epidermal/unilokuler o.k. Deg. balon
Sel Datia + badan inklusi Lipschutz
Varicella
KOMPLIKASI
- Infeksi sekunder atrophic scarrs
- Ensefalitis
- Pneumonia
- Glomerulo-nefritis
- Karditis
- Hepatitis
- Keratitis & Vesicular Conjunvtivitis
- Orchitis
 TERAPI MEDIKAMENTOSA
cegah vesikel pecah.
Terapi umum Topikal - bedak Salisil
Istirahat
- losio kalamin
Diet TK / TP
ORAL: - Anti piretik
Higiene kulit
- Anti histamin
mandi air P.K.
- Antibiotik
Disinfektan
alcohol-betadin - Anti Viral
* Asiklovir
* Adenin arabinosin
PROGNOSIS
Baik, kecuali penderita gangguan Imunitas
( Lekemia, Limfoma, AIDS )
Perawatan baik & telaten jar. Parut minimal
 PERBEDAAN
VARICELLA VARIOLA
Et/. Virus Pox Variolae Virus varicella-Zoster
KLINIK. (+/-) 2- 3 mgg
M.T. ( +/-) 10 23 hari Akut, hiperpireksia, sakit berat
Gej.K.: Prodrom 2-3hr, lesu, subfebris Sentripetal (muka; extrimitas)
Erupsi : Sentrifugal,badan ke luar jarang pd lipatan
sering dilipatan selalu telapak tgn & kaki
jarang telapak tgn & kaki monomorf + umbilikasi (+)
Eflo. Polimorf; kdg2 delle (+)
selalu Pustel
+ infeksi sec. pustel
selalu parut bopeng
sikatriks + / -
sekitar lesi eritem
oedem sekitar lesi
P.A. Vesikel unilokuler vesikel Multilokuler
pd nukleus Lipshutz body sitoplasma Guarneri body
Involusi 1-2 mgg rawat di rumah 1 bln rawat Karantina
Variola
HERPES ZOSTER
 Herpes Zoster
( Shingles; Cacar saraf / ular; PehTjoa )
DEFINISI
Radang kulit akut ditandai lesi khas vesikel
berkelompok di atas dasar kulit eritematus, sepanjang
persarafan sensorik sesuai dermatom; unilateral (Zona
Zoster )

Etiologi:
Virus Varicella- Zoster
Penularan aerogen / kontak langsung
 EPIDEMIOLOGY`

Cosmopolit Tropis; Epidemi in Winter & Spring

Tanpa perbedaan Ras & Gender M = F.
Insidens : - 90% anak2 < 10 thn;
- < 5% anak pubertas > 15 thn
Etiologi : - virus Varicella-Zoster (WCD. Berlin, 1999)
(virus DNA, gol. Herpes Virus )
 Patogenesis

Reinfeksi : imunitas menurun

Reaktivasi : virus laten Tumor/ TBC

( radiks dorsalis ganglion medula spinalis )

Infeksi langsung = Dermatom

 Prodromal 3-5 hari, lesu ;
subfebril, hiperestesi, panas &
nyeri ( 7 hari) tusuk-tusuk
dermatom

Klinis
Eritema + papel vesikel
berkelompok bula pecah
infeksi sekunder erosi & ulcus
 KGB biasanya membesar

Predileksi : muka & badan, unilateral, kadang

bilateral herpes zoster aberantes

Klinis

Khas !!! Lesi 1 dermatom: POLIMORF

Lesi 1 kelompok: MONOMORF

 Bentuk klinis
1. H.Z. Varicelliformis :
a. Herpes Zoster + Varisela = H.Z Generalisata/
Diseminata

2. H.Z. Haemoragic :
a. orang tua + KU jelek
b. penyakit kronis (leukemia, limfoma)

3. H.Z. Thoracalis : TERSERING

 Bentuk klinis
4. N. Trigeminus : - H.Z. Opthalmicus MRS,
- H.Z.Maxillaris,
- H.Z. Mandibularis

5. N. Facialis : N. Spinalis C2 & L2

6.Ganglion Geniculatum (N. VII)

 Bentuk Klinis
RAMSAY HUNT Syndrome
( Ggl. Geniculatum )
a. Vesikel liang telinga luar & palatum post & uvula
b. Paresis/paralysis N. VII ( Bell Palsy); paresthesia
c. Lagofthalmus
d. Tinitus, vertigo, pendengaran
e. Nausea - vomitus
Diagnosis
Gambaran klinis khas mudah
Diagnosis banding:
1. Dermatitis kontak toxic D.itis venenata
2. Herpes simpleks zosteriformis
Hasil Lab
TZANCK test (+) : kerokan dasar vesikel + giemsa sel
datia berinti banyak.
Terapi
Umum: Lokal:

Istirahat.
Simtomatis. Cegah Antiseptik
Infeksi sekunder. Salicyl Talc,
Obat anti virus Zalf antibiotik
Prognosis
Ad Vitam : - Baik
Ad Sanationam : - baik, sembuh
Kecuali Orang tua/lemah : kematian
Dr Danny A. Hermawan Dip.Derm.
Medical Faculty of UKRIDA
JAKARTA.
 VERRUCA VULGARIS
Synonims: Common wart; Veruka vulgaris; Kutil.

DEFINITION
Warts are discrete benign epithelial proliferations caused
by Human Papilloma Virus (HPV).
Different HPV types cause different clinical manifestations
EPIDEMIOLOGY
Incidence : - Common cosmopolit
- Schoolchildren, > age 25 Ys
- Gender F > M
ETIOLOGY : - Human Papilloma Virus (HPV )
Type 2,4,7,27 & 29 Common warts
3,10,28 & 41 Flat warts
1, 2 & 4 Plantar warts
CLINICAL MANIFESTATION
Duration of lesions
- Can persist several years if no treated
Symptoms
- Cosmetic disfigurement.
- Painfull in Plantar warts as foreign body
- After cryosurgery painfull scars
- Bleeding especially after shaving
 CLINICAL MANIFESTATI0N
1. VERRUCA VULGARIS ( Common Wart )
- Firm hyperkeratotic papules, 1 10mm clefted surface
- red or brown dots(thrombosed capillary loops)
- Shape round polycyclic
- Isolated or scattered discrete lesions
- Linear form: inocculation by scratching (Koebner)
- Annular warts: after therapy
- Predilection: hands, fingers & knees ( trauma )
VERRUCA VULGARIS
Butchers warts :
- large cauliflower-like lesions (NODULE) on
hands of meat handlers
Filiformis warts :
- vegetation form of warts with small base,
extending out + elongated cap
Butchers warts
Verruca filiformis
2. Verruca Plana ( Flat wart )
- Flat papules ( 1-5 mm), 1-2mm thickness
- Skin-colored or light brown.
- Round, oval, polygonal & linear lesions.
- Occur on face, beard area, dorsa of hands &
shins
 VERRUCA VULGARIS
3. VERRUCA PLANTARIS PEDIS (= Plantar Wart )
- Early small, shiny, sharp marginated papule
plaque + hyperkeratotic surface.
- single-multiple (confluence) Mozaic warts
- Kissing warts, on opposing of 2 toes.
- Tenderness (+) due to pressure over lesions
- Palmar warts disrupted Dermatoglyphics
- Therapy : - cryo-/ electro-surgery scars
4. CONDYLOMATA ACUMINATA
(= Venereal warts, anogenital warts )
 Usually no symptom Anxiety to STD/STI.
Mild itching, burning, bleeding
Vaginal & urethral discharge, + dyspareunia.
Cauliflower tumor, small- large, single multiple.
Obstruction by large mass Giant condyloma
( Tumor Busche-Lovensteins)
Location : - M preputium, glans/corpus penis,
urethral
- F vulva, labium minora/mayora
DD./ : - Condyloma lata ( Sy II )
- Moluscum contagiosum
MOLLUSCUM CONTAGIOSUM
SYNONIMS : Moluskum Kontagiosum, Kutil bulat

DEFINITION :
Molluscum contagiosum is a common viral
infection of childhood, characterized by
discrete, umbilicated, pearly white papules,
which contend white mass (Molusccum body)
 EPIDEMIOLOGY
Infection to Children, between age 3 16 yrs
Incidence common in young children, boys > girls
Transmission: Skin to skin contact
Auto-inocculation
S.T.D./S.T.I. IN ADULT
Risk Factors : - swimmer, bathe together
- Immuno-suppressed persons
ETIOLOGY: - Pox virus moluscip0x
( DNA virus; size max 300 nm)
 CLINICAL MANIFESTATION
Incubation 14 Ds to 6 Mos
Autoinocculation spreading + self-resolve In Mos
Asymptomatic lesions or mild pruritic
IF Look inflamed prior to spontaneous involution
Single or multiple lesions pearly-white papules to
nodules + central umbilication,
Shape rounded or oval, size 2-5 cm
Rarely size > 10-15 cm GIANT MOLUSCUM
Predilection : - axilla, antecubital & crural fold
HERPES SIMPLEX
SYNONYMS
* COLD SORE
* FEVER BLISTER
* HERPES FEBRILIS
* HERPES LABIALIS
* HERPES GENITALIS
 DEFINITION
Acute infection of herpes simplex virus (HSV) humanus,
characterized by vesicular lesions in erythematous area in
surrounding muco-cutaneus junctions.
Self limited disease and tend to recurens

ETIOLOGY
2 type HSV 1 & HSV 2 DNA viruses
Type 1 Herpes Simplex Labialis
Type 2 Herpes Simplex Genitalis/Progenitalis
EPIDEMIOLOGY
Prevalence: - 1/3 population USA (+) HSV
Incidence : - by adulhood > 85%, serologic (+)
Age : - any age, most common in young Adult.
Gender : - M = F.
Transmision : - skin to skin contact
- Skin to mucosa
- mucosa to mucosa
Precipitating fact.:
Sun light, Stress, illness, local trauma blistering
 CLINICAL MANIFESTATIONS
1. HERPES SIMPLEX LABIALIS
a. Primary Infection: - M.T. 3-7 Ds after contact
- constitutional low-fever, headache, myalgia, pain
- grouped vesicles +erythema in vermilion border
ulcerated + crust (48 Hs)
- uncomfortable Lips + unpleasant to eat
- lesions last 2-4 Ws heal + NO scarring
b. Recurrent stage: fatique, stress, menses, trauma &
UV
- Prodrome symptom mild & short-time
- Clinical signs mild & Short onset
2. HERPES SIMPLEX GENITALIS

S.T.D./ S.T.I.
Adolescens & young Adult
Neonatus from Mother (+)
Immunologic factors mild / severe
Sexual practise : - Genital/Oral/Anal sex
Predilection:
Male : - preputium, glan-penis, scrotum
- Urethritis & Proctitis (Homosex)
Female : - vulva, vagina, servix & urethra
- mouth oro-genital
Herpes
Simplex
Genitalis
 2. HERPES SIMPLEX GENITALIS
a. Primary Infection: 2-3 Weeks
- Incubation : - 2 5 Ds
- Eflr. : - group of vesicles in erythematous skin
- Painfull spf ulcers + sec. Infection (F.)
b. Reccurent stage: 7-10 Days
- Mid clinical manifestation + short onset
- Recurent due to: - Physic/Psychological trauma
- hot/spicy food & drinks
 HERPES SIMPLEX
DIAGNOSIS
ANAMNESIS
Clinical Manifestation
Tzanck smear ( Giemsa/Wright)
HSV antibody ( IgM ; IgG )
Isolation & Identification Virus
Culture virus
DIFERENTIAL DIAGNOSIS
Ulkus mole ( Chancroid )
Ulkus durum ( Syphilis )
Primary affect of LGV
Impetigo vesico-bulosa
Dermatitis venenata
 HERPES SIMPLEX
THERAPY &
Lokal : - antiseptik (Alcohol/Betadin) Sec
- Idoxysuridin ( Virunguent )
- Tromantadine ( Viru-merz )
- Acyclovir ( Zovirax; Clinovir etc. )
Oral : - Acyclovir 5 x 200-400mg/ 5-7 Ds
- Valacyclovir 3 x 500-1000mg/5-7 Ds
- adenin-arabinosa ( Vitarabin )
* Par-enteral : - Acyclovir
PROGNOSIS
Ad Vitam : - baik
Ad Sanationam : - Dubia ad malam
Ad Fungsionam: - Dubia ad bonam
Danke-well om een tante