dr. suci widhiati, msc, sp - pediatricfkuns.ac.id skin disease in children...•tinea corporis,...

Curriculum Vitae

dr. Suci Widhiati, MSc, Sp.KK Pendidikan

1. Dokter Umum FK UNS, lulus tahun 2004

2. Master of Science FK UGM, lulus tahun 2010

3. Dokter Spesialis Kulit Kelamin FK UGM, lulus tahun 2010

Pekerjaan

Dosen Univ. Setia Budi tahun 2004 – 2006

Kepala Komite Mutu dan Keselamatan Pasien RSUD Moewardi

Kepala subdivisi pediatri Departemen Kulit Kelamin RSUD Moewardi

Sekretaris Program Studi Departemen Kulit Kelamin RSUD Moewardi

Dosen Bagian Kulit Kelamin FK UNS – RSUD Moewardi 1

Pediatric common skin infection in daily

practice

Suci Widhiati, Endra Yustin

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Outlines

• Diagnosis pada Dermatologi • Melihat UKK dahulu diikuti dengan anamnesis • UKK • Penunjang

• Papul, plak • Pyodermal superficialis, Scabies • Tinea corporis, Tinea capitis • Veruca vulgaris

• Vesikel, bula • Varicella, HFMD • Impetigo bulosa

• Makula • Candidiasis

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What is the diagnosis?

C A B

Siemens (1891–1969) wrote, “he who studies skin diseases and fails to study the lesion will never learn dermatology.”

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The Art and Science of Dermatologic Diagnosis

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Dermatologic Physical Diagnostic

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Manifestation Lesions of the Skin

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How to diagnose in dermatology

• History taking prior to, during, after physical examination

• Brief history

• Physical examination

• Detailed questions

• Morfology lesion

• Assesment

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Dermatologic Algorithm

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Itchy

macules and papules

verucous papules

Veruccae vulgaris

flat top papules/ plaque

Tinea korporis

Tinea kapitis

Dome shaped papules

Moluscum contagiosum

miliar papules in specific area

Scabies

VERUCCA VULGARIS

Itchy, macules and papules

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Etiology

• HPV

History

• Can persist several years if not treated

• Common in children

• Extensor extremities

Transmission

• Fomites, skin to skin contact

Morfology

• Verucous firm papules, cleft surface with vegetations

• Patognomonic: red or brown dots

• Isolated lession, scattered discrete lesion.

https://www.childrens.com

Verucca vulgaris

Treatment:

• Therapies for children must be

safe and preferably painless

• Destructive Methods

• Salicylic acid 30-40%

• Cantharidin 0,7%

• Cryotherapy

• Phototherapies

• Laser (CO2 and pulsed dyle lasers)

• Photodynamic Therapy

• Immunotherapies

• Cimetidine 25-40 mg/kg/day

• Zinc 10 mg/kg

• Injected Immunotherapies

• Interferon

• Imiquimod

• Antimitotic Therapies

• Bleomycin

• Podofilin

• Retinoids

Pediatric Dermatology Vol. 28 No. 3 May ⁄ June 2011 12

MOLUSCUM CONTAGIOSUM

Itchy, macules and papules

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• Etiology • Molluscipox virus

• Transmission • Skin to skin contact • Children: common

on exposed skin sites

• Resolved spontaneously within 6 moth

• Physical examination

• Papules, nodules, pearly white or skin-colored. Round, oval, hemisphrical, umbilicated

• Distribution

• anysite

https://wikem.org/wiki/Molluscum_contagiosum

Molluscum contagiosum

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TINEA

Itchy, macules and papules

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• Definition: group of fungi capable of infecting nonviable keratinized cutaneous structures

• Chidren common: • Tinea capitis • Tinea corporis

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• Age of onset: toddlers and school-age children,6-10 yo

• Etiology: • 90% T. tonsurans and M. audounii

• Transmission: • Person-to-person, animal-to-person, via

fomites.

• Classification • Ectothrix infection gray patch • Endothrix infection black dot, kerion,

favus

Tinea capitis

Tinea Capitis

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Gray patch Black dot Kerion

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Always requires systemic treatment

Topical therapies act as adjuvant therapy

Topical therapy: • Selenium sulfide shampoo • Ketokonazole shampoo twice

weekly for 2-4 weeks • Topical fungisidal cream/lotion

applied to the lesion once daily for 2-4 weeks

SCABIES

Itchy, macules and papules

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Etiology: S. Scabiei var. hominis.

Transmission: skin to skin contact

Clinical manifestation

http://pediatric-house-calls.djmed.net/scabies/

http://wordinfo.info/results/scabies

www.drscabies.com 20

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Dermatologic Algorithme

Pain and/or fever

macules and papules

patch erythema with satelit

lesion

Candidiasis cutaneous

papul erythema with pus inside

Follicullitis

vesicles and bullae

teardrop vesicles

Varicella

hipopion bullae

Impetigo bullosa

"football-shaped" vesicles

HFMD

MUCOCUTANEOUS CANDIDIASIS

Etiology: most frequently Candida albicans

Age of onset: children, geriatric

Courtesy: IK.KK FK UNS

Diaper dermatitis can cause secondary by candida

Pain and/or fever, papules and macules

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Gambaran klinis yang ditemukan khas dengan adanya papul eritem multipel terutama daerah sekitar lesi yang disebut lesi satelit vesikopustulosa, menyerupai gambaran “hen and chicken’, Pustula ini membesar dan pecah, meninggalkan dasar eritem dan skuama kolaret yang cepat berubah dan menyebabkan maserasi dan fissura

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Treatment

• Topical antifungi: • Imidazol

• 2 x sehari pada area lesi, dioleskan dengan radius 2 cm dari batas luar lesi

• Lanjutkan pengobatan sampai 1 minggu setelah penyembuhan klinis

• Poliene (Nistatin) • Suspensi atau pasta 4-5 kali sehari dalam 2 minggu

• Oral antifungi • Nistatin oral suspensi 100.000 U/ml 4 kali sehari

• Fluconazol oral suspensi 3mg/kgBB/hari selama 7 hari

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FOLLICULITIS, FURUNCLE, CARBUNCLE • EtiologyStaphylococcus aureus

Folliculitis: is a pyoderma that begins hin the hair follicle, and is classified according the depth of invasion (superfacial and deep)

Pain and/or fever, papules and macules

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Pain and/or fever, papules and macules

FOLLICULITIS, FURUNCLE, CARBUNCLE Furuncle or boil: is a deep-seated inflammatory nodule that develops around a hair follicle, usually from a preceding, more superficial folliculitis and often evolving into an abscess.

A carbuncle is a more extensive, deeper, communicating, and infiltrated lesion that develops when suppuration occurs in thick inelastic skin when multiple, closely set furuncles coalesce.

Treatment

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Simple furunculosis may be aided by local application of moist heat

A systemic antibiotic (as for MRSA impetigo). For severe infections or

infections in a dangerous area, maximal antibiotic dosage should be employed by

the parenteral route. Vancomycin (1.0–2.0 g intravenously daily in divided doses) or

other systemic parenteral agents that have anti-CA-MRSA activity are indicated

for these patients for at least 1 week

When the lesions are large, painful, and fluctuant, then incision and drainage are

the most important actions that one should take in a timely manner. If the

infection is recurrent or complicated by comorbidities, a culture can be sent. Draining lesions should be covered to

prevent autoinoculation and diligent hand washing performed

IMPETIGO

Pain and/or fever, papules and macules

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Pain and/or fever, papules and macules

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VARICELLA

Pain and/or fever, papules and macules

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Hand, foot and mouth disease

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