minor ulser-recurrent aphthous stomatitis-puspita160112140002
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7/23/2019 Minor Ulser-recurrent Aphthous Stomatitis-Puspita160112140002
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MAKALAH LAPORAN KASUS MINOR ILMU PENYAKIT MULUT
RECURRENT APHTHOUS STOMATITIS (RAS)
Disusun oleh:
PUSPITA HAJARDHINI16011210002
Dosen !e"#i"#in$:
Ri%ni Se&i%'hi( ')$*( S!* PM*
UNI+ERSITAS PADJADJARAN
,AKULTAS KEDOKTERAN -I-I
.ANDUN-
201/
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JUDUL : RECURRENT APHTHOUS STOMATITIS (RAS)
NAMA : PUSPITA HAJARDHININPM : 16011210002
.%n'un$( A!)il 201/
Mene&uui :
Dosen !e"#i"#in$
Ri%ni Se&i%'hi( ')$ *( S!* PM*
NIP* 1/102 13004 2 002
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DA,TAR ISI
.A. I PENDAHULUAN…………………………………………………… 1
.A. II LAPORAN …………………………………………………………. 3
2.1 Laporan Kasus …………………………………………………………… 3
2.2 Laporan Kontrol........................................................................................... 9
2.2.1 Laporan Kontrol 1………………………………………………………. 9
2.2.2 Laporan Kontrol 2 ……………………………………………………… 13
.A. III TINJAUAN PUSTAKA …………………………………………… 17
3.1 Recurrent Aphthous Stomatitis (RAS) ……………………………………. 17
3.1.1 Tinjauan Umum Recurrent Aphthous Stomatitis (RAS) ……………… 17
3.1.2 Etioloi ……………………………………………………………….. 17
3.1.3 !ani"#stasi Klinis …………………………………………………….. 21
3.1.4 Klasi"i$asi …………………………………………………………….. 21
3.1.4.1 Uls#r A"tosa !inor …………………………………………………… 21
3.1.4.2 Uls#r A"tosa !a%or …………………………………………………… 22
3.1.4.3 Uls#r &#rp#ti"orm …………………………………………………….. 23
3.1.' ianosis an*in ……………………………………………………. 23
3.1.'.1 Uls#r Traumati$ ………………………………………………………. 23
3.1.'.2 +n"#$si &#rp#s Simpl#$s……………………………………………… 24
3.1.'.3 Behcet’s Syndrome ................................................................................. 27
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3.1.'.4 Hand-Mouth and Foot Disease ……………………………………….. 29
3.1.'.' Erythema Multiforme (E!) …………………………………………… 3,
3.1.- T#rapi *an #natala$sanaan …………………………………………... 31
.A. I+ PEM.AHASAN …………………………………………………… 3'
.A. + KESIMPULAN ……………………………………………………... 4,
.A. +I DA,TAR PUSTAKA ……………………………………………… 41
.A. I
PENDAHULUAN
Recurrent aphthous stomatitis (RAS) a*ala/ sala/ satu in"lamasi
uls#rati" mu$osa oral %an $ronis *an 0#rsi"at *apat s#m0u/ *#nan
s#n*irin%a ( self-limiting disease) pa*a /ampir s#mua $asus (Sl#0io*a et al
2,13 uallar et al 2,14). Lo$asi l#si umumn%a pa*a ar#a *#nan mu$osa
oral ti*a$ 0#r$#ratin s#p#rti 0i0ir pipi *asar mulut *an #sti0ulum
palatum luna$ *an $#ras. 5%#ri %an s#rin m#nanu 0i6ara *an
m#n#lan *apat m#n%#rtai p#r$#m0anan l#si ini (Sl#0io*a et al 2,13).
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Etiopato#n#sis RAS 0#lum *i$#ta/ui s#6ara pasti. a$tor p#n6#tus
pot#nsial m#liputi $#6#n*#runan #n#ti$ in"#$si irus *an 0a$t#ri al#ri
ma$anan *#"isi#nsi itamin *an mi$ro#l#m#n p#n%a$it sist#mi$
p#nin$atan str#ss p#naru/ /ormonal trauma m#$anis r#a$si
imunolois *an r#a$si o0at (oras an* Saa# 2,,7 Sl#0io*a et al
2,13). RAS m#mili$i tia am0aran $linis utama %aitu tip# minor ma%or
*an /#rp#ti"orm (S6ull% an* #li8 2,,').
Sala/ satu *ianosis 0an*in %an palin m#n%#rupai l#si ini
a*ala/ traumati$ uls#r 0iasan%a *is#0a0$an ol#/ ii %an pata/ atau
tajam tam0alan %an $uran 0ai$ instrum#n *o$t#r ii t#riit iritasi
ii tiruan atau 0#n*a asin lain (Las$aris 2,,-).
R#n6ana p#raatan %an *ila$u$an m#m0utu/$an p#n#a$an
*ianosis %an t#pat. ianosis *ila$u$an 0#r*asar$an anamn#sis *an
am0aran $linis. !a$ala/ laporan $asus ini m#m0a/as m#n#nai
Recurrent Aphtous Stomatitis Minor pa*a s#oran pasi#n la$i:la$i %an
*atan $# Ruma/ Sa$it ii *an !ulut a$ultas K#*o$t#ran ii
Uni#rsitas a*ja*jaran pa*a 0ulan Austus 2,14.
.A. II
LAPORAN
2.1 Laporan Kasus
D%&% U"u" P%sien
5ama ; Tn. Sn
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Umur ; 24 Ta/un
Alamat ; <alan Siliani an Ar*asi$ 5omor 3-=1''A an*un
<#nis K#lamin ; La$i:la$i
Status ; #lum !#ni$a/
5o. R#$am !#*is ; 2,14:,>39,
#$#rjaan ; ?irausa/a
Tanal #m#ri$saan ; 1' Austus 2,14
An%"nes%
T#r*apat sariaan pa*a 0i0ir 0aa/ s#ja$ tia /ari %an lalu.
T#rasa sa$it saat ma$an. a*a saat #mpat /ari s#0#lumn%a pasi#n
m#njalan$an i0a*a/ puasa ti*a$ ma$an sa/ur *an 0#r0u$a ma$an
ma$anan p#*as. asi#n m#na$u saat ini s#*an m#mpun%ai 0an%a$
p#$#rjaan *an $uran ti*ur. asi#n t#la/ m#nonsumsi *ua ta0l#t /isap
itamin @ untu$ m#nurani $#lu/an sariaan namun sariaan ti*a$
$unjun s#m0u/. #rna/ m#nalami sariaan s#0#lumn%a $uran l#0i/
#nam 0ulan %an lalu *an *ii$uti *#mam. Ti*a$ a*a ria%at $#luara.
asi#n inin $#lu/ann%a *io0ati.
Ri5%%& Pen%i& Sis&e"i
#n%a$it jantun ; T+AK
&ip#rt#nsi ; T+AK
ia0#t#s !#litus ; T+AK
Asma=Al#ri ; Al#ri *#0u *inin s#rana s#ja$ umur 14 ta/un.
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#n%a$it &#par ; T+AK
K#lainan +T ; T+AK
#n%a$it injal ; T+AK
K#lainan ara/ ; T+AK
&amil ; T+AK
Kontras#psi ; T+AK
Lain:lain ; T+AK
Ri5%%& Pen%i& Te)'%hulu ; iar# *an *#mam 0#r*ara/ *ua ta/un %an lalu *i
RS. an%uasi/ ura$arta.
Kon'isi U"u"
K#a*aan Umum ; ai$ T#nsi ;12,=>,mm&
K#sa*aran ; @ompos !#ntis #rna"asan ; 1> 8 = m#nit
Su/u ; A"#0ris 5a*i ; -, 8 = m#nit
Pe"e)is%%n Es&)% O)%l
K#l#njar Lim"#
Su0man*i0ula Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a ti*a$ sa$it
Su0m#ntal Kiri ; ti*a$ t#ra0a ti*a$ sa$it
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Kanan ; ti*a$ t#ra0a ti*a$ sa$it
S#ri$al Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a sa$it
!ata ; S$l#ra non:i$t#ri$ Konjuntia non:an#mis upil iso$or
T!< ; Kli$in *an #iasi $anan
i0ir ; TAK
?aja/ ; Sim#tri
Sir$um ral ; TAK
Lain:lain ; TAK
Pe"e)is%%n In&)% O)%l
K#0#rsi/an !ulut ; S#*an
Kal$ulus (B) pa*a linual ant#rior R
la$ (B)
Stain (B) pa*a ii 11 21
inia ; im#ntasi 6o$#lat $#/itaman pa*a inial la0ial *an
0u$al RA *an R s#rta $#m#ra/an *i r#ion 14
!u$osa u$al ; T#r*apat t#raan iitan s#tini *ataran o$lusal pa*a
mu$osa 0u$al $anan *an $iri
!u$osa La0ial ; T#r*apat uls#r *#nan *asar 0#rarna $#$uninan 6#$un
*an$al t#rtutup ps#u*om#m0ran 0#r0#ntu$ 0ulat marin
0#raturan *#nan /alo #rit#m *an *iam#t#r $uran l#0i/ 3
mm
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alatum urum ; TAK
alatum mol# ; TAK
r#nulum ; TAK
Li*a/ ; TAK
asar !ulut ; TAK
S&%&us $i$i
UKAL
Amalam @S ma/$ota pasa$ @S @S @S @S amalam
L+5UAL
@S @S @S @S @S $omposit
UKAL
Pe"e)is%%n Penun%n$
Ra*ioloi ; TL
ara/ ; TL
atoloi Anatomi ; TL
!i$ro0ioloi ; TL
Di%$nosis
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1. = Susp#$ Recurrent Aphtous Stomatitis pa*a mu$osa la0ial R #.6.
$#$uranan nutrisi *an str#s
= Traumati6 ulcer in"#$si irus /#rp#s simpl#$s Behcet’s Syndrome
2. = Chee Biting pa*a mu$osa 0u$al $anan *an $iri
= Lin#a al0a
3. = im#ntasi "isiolois pa*a inial la0ial *an 0u$al RA *an R
= Smo$#r m#lanosis
Ren7%n% Pe)%5%&%n
1. +nstru$si ma$an ma$anan %an m#nan*un itamin 12 # asam "olat
s#p#rti sa%ur 0a%am $an$un $unin t#lur ati a%am *an $a6an /ijau *an
minum air puti/
2. #m0#rian multiitamin
R= ultraita ta0 5o. C+
S 1 ** 1 p.o. p.6.
3. +nstru$si m#nuna$an 0#ta*in# solution 1, D *iol#s s#lama 4 /ari
4. Kontrol 4 /ari %an a$an *atan
'. +nstru$si m#mp#r0ai$i pola ti*ur.
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am0ar 2.1 T#r*apat uls#r *#nan *asar 0#rarna $#$uninan 6#$un *an$al
t#rtutup ps#u*om#m0ran 0#r0#ntu$ 0ulat marin 0#raturan *#nan /alo #rit#m
*an *iam#t#r $uran l#0i/ 3 mm *an pim#ntasi 6o$#lat $#/itaman pa*a inia
la0ial *an 0u$al R
am0ar 2.2 (A) t#raan iitan s#tini *ataran o$lusal pa*a mu$osa 0u$al $anan.
() t#raan iitan s#tini *ataran o$lusal pa*a mu$osa 0u$al $iri
BA
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am0ar 2.3 m#nunju$$an pim#ntasi 6o$#lat $#/itaman pa*a inia (A) la0ial
R () la0ial RA (@) 0u$al R () 0u$al RA:R
2.2 Laporan Kontrol
2.2.1 Laporan Kontrol 1
Tanal p#m#ri$saan ; 1> Austus 2,14
5ama ; Tn. Sn
Umur ; 24 Ta/un
<#nis K#lamin ; La$i:la$i
An%"nes%
A B
C
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asi#n *atan #mpat /ari s#t#la/ $unjunan p#rtama *an m#na$u
sariaann%a pa*a 0i0ir 0aa/ t#la/ s#m0u/ sa$it saat ma$an su*a/
/ilan. asi#n t#la/ m#nonsumsi multiitamin s#suai anjuran *an
p#tunju$ *o$t#r.
Pe"e)is%%n Es&)% O)%l
K#l#njar Lim"#
Su0man*i0ula Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a ti*a$ sa$it
Su0m#ntal Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a ti*a$ sa$it
S#ri$al Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a sa$it
!ata ; S$l#ra non:i$t#ri$ Konjuntia non:an#mis upil iso$or
T!< ; Kli$in *an #iasi $anan
i0ir ; TAK
?aja/ ; Sim#tri
Sir$um ral ; TAK
Lain:lain ; TAK
Pe"e)is%%n In&)% O)%l
K#0#rsi/an !ulut ; S#*an
Kal$ulus (B) pa*a linual ant#rior R
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la$ (B)
Stain (B) pa*a ii 11 21
inia ; im#ntasi 6o$#lat $#/itaman pa*a inial la0ial *an
0u$al RA *an R s#rta $#m#ra/an *i r#ion 14
!u$osa u$al ; T#r*apat t#raan iitan s#tini *ataran o$lusal pa*a
mu$osa 0u$al $anan *an $iri
!u$osa La0ial ; !a$ula #rit#m s#*i$it m#n%#0ar *#nan sisa
ps#u*om#m0ran *#nan *iam#t#r 1 mm pa*a 0i0ir 0aa/
alatum urum ; TAK
alatum mol# ; TAK
r#nulum ; TAK
Li*a/ ; TAK
asar !ulut ; TAK
H%sil Pe"e)is%%n Penun%n$
Ra*ioloi ; TL
ara/ ; TL
atoloi Anatomi ; TL
!i$ro0ioloi ; TL
Di%$nosis
1. = Chee Biting pa*a mu$osa 0u$al $anan *an $iri
= Lin#a al0a
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2. = im#ntasi "isiolois pa*a inial la0ial *an 0u$al RA *an R
= Smo$#r m#lanosis
Ren7%n% Pe)%5%&%n
1. +nstru$si untu$ m#njaa pola ma$an 0#rii t#rutama ma$anan %an
m#nan*un # itamin 12 asam "olat s#p#rti sa%uran *an 0ua/:0ua/an
*an 0an%a$ minum air puti/.
2. !#n%aran$an ti*a$ m#nonsumsi ma$anan p#*as *an panas $#ripi$=$#rupu$
*an minuman 0#r$ar0onasi aar sariaan ti*a$ t#rpi6u tim0ul $#m0ali.
3. !#n%aran$an untu$ m#natur manaj#m#n a$tu *an $#iatan *#nan 0ai$
aar *apat m#minimalisir str#ss.
4. Si$at ii s#6ara t#ratur s#rta m#nuna$an antis#pti$ s#p#rti o0at $umur
$lor/#$si*in untu$ m#nin$at$an $#0#rsi/an rona mulut saat sariaan
s#/ina *apat m#n6#a/ in"#$si l#0i/ lanjut.
am0ar 2.3 Kon*isi mu$osa la0ial saat $ontrol 4 /ari
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2.2.2 Laporan Kontrol 2
Tanal p#m#ri$saan ; 22 Austus 2,14
5ama ; Tn. Sn
Umur ; 24 Ta/un
<#nis K#lamin ; La$i:la$i
An%"nes%
asi#n *atan tuju/ /ari s#t#la/ $unjunan p#rtama *an m#na$u
sariaann%a pa*a 0i0ir 0aa/ t#la/ s#m0u/ sa$it saat ma$an su*a/
/ilan. Ta0l#t multiitamin su*a/ /a0is *an *iminum s#suai anjuran *an
p#tunju$ *o$t#r.
Pe"e)is%%n Es&)% O)%l
K#l#njar Lim"#
Su0man*i0ula Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a ti*a$ sa$it
Su0m#ntal Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a ti*a$ sa$it
S#ri$al Kiri ; ti*a$ t#ra0a ti*a$ sa$it
Kanan ; ti*a$ t#ra0a sa$it
!ata ; S$l#ra non:i$t#ri$ Konjuntia non:an#mis upil iso$or
T!< ; Kli$in *an #iasi $anan
i0ir ; TAK
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?aja/ ; Sim#tri
Sir$um ral ; TAK
Lain:lain ; TAK
Pe"e)is%%n In&)% O)%l
K#0#rsi/an !ulut ; S#*an
Kal$ulus (B) pa*a linual ant#rior R
la$ (B)
Stain (B) pa*a ii 11 21
inia ; im#ntasi 6o$#lat $#/itaman pa*a inial la0ial *an
0u$al RA *an R s#rta $#m#ra/an *i r#ion 14
!u$osa u$al ; T#r*apat t#raan iitan s#tini *ataran o$lusal pa*a
mu$osa 0u$al $anan *an $iri
!u$osa La0ial ; !a$ula #rit#m pa*a mu$osa la0ial 0i0ir 0aa/
alatum urum ; TAK
alatum mol# ; TAK
r#nulum ; TAK
Li*a/ ; TAK
asar !ulut ; TAK
H%sil Pe"e)is%%n Penun%n$
Ra*ioloi ; TL
ara/ ; TL
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atoloi Anatomi ; TL
!i$ro0ioloi ; TL
Di%$nosis
1. = Chee Biting pa*a mu$osa 0u$al $anan *an $iri
= Lin#a al0a
2. = im#ntasi "isiolois pa*a inial la0ial *an 0u$al RA *an R
= Smo$#r m#lanosis
Ren7%n% Pe)%5%&%n
1. +nstru$si untu$ m#njaa pola ma$an 0#rii t#rutama ma$anan %an
m#nan*un # itamin 12 asam "olat s#p#rti sa%uran *an 0ua/:0ua/an
*an 0an%a$ minum air puti/.
2. !#n%aran$an ti*a$ m#nonsumsi ma$anan p#*as *an panas $#ripi$=$#rupu$
*an minuman 0#r$ar0onasi aar sariaan ti*a$ t#rpi6u tim0ul $#m0ali.
3. !#n%aran$an untu$ m#natur manaj#m#n a$tu *an $#iatan *#nan 0ai$
aar *apat m#minimalisir str#ss.
4. Si$at ii s#6ara t#ratur s#rta m#nuna$an antis#pti$ s#p#rti o0at $umur
$lor/#$si*in untu$ m#nin$at$an $#0#rsi/an rona mulut saat sariaan
s#/ina *apat m#n6#a/ in"#$si l#0i/ lanjut.
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am0ar 2.4 Kon*isi mu$osa la0ial saat $ontrol 7 /ari
am0ar 2.' Kon*isi mu$osa la0ial saat $ontrol 14 /ari
am0ar 2.- Kon*isi mu$osa la0ial saat 21 /ari
.A. III
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TINJAUAN PUSTAKA
3.1 Recurrent Aphthous Stomatitis (RAS)
3.1.1 Tinjauan Umum
Recurrent apthous stomatitis (RAS) a*ala/ sala/ satu p#n%a$it mulut palin
umum *i s#luru/ *unia. r#al#nsi 0#r$isar *ari 2D sampai --D *i populasi %an
0#r0#*a. RAS a*ala/ p#n%a$it uls#r %an 0#rulan *an *apat s#m0u/ *#nan
s#n*irin%a m#n#nai mu$osa oral ti*a$ 0#r$#ratin tanpa a*an%a tan*a *ari
p#n%a$it lain (Ko%0asi et al 2,,- allo et al 2,,9). RAS *i$ara$t#risti$$an
*#nan 0#ntu$ l#si uls#r 0ulat atau oal 0#r*iam#t#r $uran *ari 1 s#ntim#t#r
*#nan t#pi #rit#m *an jarinan n#$roti$ *i t#na/n%a. Uls#r ini s#rin *ii$uti rasa
sa$it %an m#m0#ri$an *ampa$ n#ati" t#r/a*ap $ualitas /i*up pasi#n (&ullin et
al 2,12).
3.1.2 Etioloi
Etioloi 0#lum j#las t#tapi t#r*apat 0#0#rapa "a$tor %an *i$#ta/ui *apat
m#mi6u t#rja*in%a RAS (uallar et al 2,14). Sain et al (2,12)
m#n#lompo$$an m#nja*i lima "a$tor %an *apat m#mi6u RAS *iantaran%a
s#0aai 0#ri$ut.
!" a$tor #n#ti$
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r#al#nsi l#0i/ tini pa*a pasi#n *#nan ria%at $#luara positi"
$/ususn%a ji$a $#*ua orantuan%a jua t#r$#na. a$tor #n#ti$
m#m0#ri$an p#naru/ ons#t p#n%a$it m#n%#ran l#0i/ aal *an l#0i/
s#rin *aripa*a $asus tanpa "a$tor #n#ti$. a$tor #n#ti$ *ip#r$uat
a*an%a i*#nti"i$asi tip# histocompati#ility antigen (&LA) t#rt#ntu pa*a
0#0#rapa $#lompo$ pasi#n a"tosa.
$" a$tor +munolois
#ru0a/an r#a$si imun m#mp#naru/i p#nurunan p#rta/anan mu$osa.
#n#litian s#rolois %an m#m0an*in$an pasi#n RAS *an $ontrol ti*a$
t#r$#na m#nunju$$an p#nuranan rasio sir$ulasi s#l /#lp#r @4B
t#r/a*ap s#l suppr#ssor @>B. RAS *ip#naru/i 0#0#rapa anti#n non
sp#si"i$ *an s#l T:mediated r#spon imun %an t#rli0at *alam jalur lo$al
lim"ositi$. #n#litian m#nunju$$an 0a/a s#luru/ pros#s uls#rasi a"tosa
*ari inisiasi sampai pror#si %an *ili/at m#lalui s#l #pit#l oral *it#mu$an
ti*a$ /an%a anti#n &LA $#las + t#tapi jua anti#n &LA $#las ++. &al ini
m#m0uat s#l:s#l s#6ara anti#n *ianap 0#n*a asin *an m#nja*i tar#t
cell-mediated r#spon imun ol#/ lim"osit *an s#l Lan#r/ans. &al ini *apat
t#rli/at pa*a pasi#n stomatitis a"tosa t#r*apat tinin%a #"#$
lim"ositoto$si$ m#laan s#l #pit#l oral *i0an*in$an *#nan $ontrol ti*a$
t#r$#na.
#namatan pa*a jarinan 0iopsi 0a/a uls#r a"tosa %an 0aru #rupsi
m#nunju$$an p#n#lompo$$an lim"osit T pa*a p#ri"#r l#si s#*an$an a"tosa %an
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su*a/ matur l#0i/ *i*ominasi @4B /#lp#r= s#l supr#sor *an *ianti$an ol#/
sitoto$si$ lim"osit @>B.
3. a$tor !i$ro0a
!#nurut r##ti et al (2,11) 0#0#rapa mi$rooranism# %an 0#rp#naru/
t#r/a*ap pat/o#n#sis RAS %aitu ;
1) RAS *an Str#pto$o$us ral
a$t#ri str#pto$o$us oral t#rli0at s#6ara lansun *alam pat/o#n#sis l#si atau
a#n %an 0#rp#ran s#0aai stimulus anti#n %an m#ransan pro*u$si anti0o*i
mu$osa oral. #ntu$ L str#pto$o$us al"a /#moliti$us Streptococcus sanguis %an
$#mu*ian *is#0ut Streptococcus mitis a*ala/ a#n p#n%#0a0 *ari p#n%a$it ini.
2) RAS *an Helio#acter pylori
H" p%lori a*ala/ 0a$t#ri ram n#ati" 0#r0#ntu$ S %an 0#r/u0unan *#nan
astritis *an uls#r in"#$si *uo*#num s#6ara $ronis. a$t#ri ini jua *ilapor$an
0an%a$ t#rli/at pa*a $#pa*atan pla$ ii %an tini.
3) Cirus
#n#litian ol#/ Sun et al pa*a ta/un 199> %an *i$utip ol#/ r##ti et al (2,11)
m#nunju$$an a*an%a #nom /uman 6%tom#aloirus (&@!C) m#lalui r#a$si
rantai polim#rasi pa*a jarinan pra uls#rasi a"tosa oral. <i$a in"#$si t#rja*i pa*a
s#l:s#l #pit#l oral m#nunju$$an $ompl#$s mol#$#l $#las ++ (!&@:++) r#spon s#l T
s#6ara int#ns $#luar m#laan irus %an t#r$an*un pa*a s#l:s#l #pit#l. #n#litian
t#rs#0ut jua m#nunju$$an a*an%a $#mun$inan /u0unan Epstein-#arr %irus
pa*a l#si oral pra uls#rasi pasi#n RAS.
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4. a$tor 5utrisi
RAS *is#0a0$an *#"isi#nsi 0#0#rapa "a$tor nutrisi *iantaran%a at 0#si "olat
*an itamin 12. asi#n RAS %an m#nunju$$an tan*a "isi$ *an #jala *#"isi#nsi
nutrisi atau *is$rasia *ara/ *ip#rlu$an p#m#ri$saan untu$ m#n*apat$an /itun
*ara/ l#n$ap *an s#rum "olat itamin 12 *an "#rritin.
'. a$tor Lin$unan
1) Str#s
2) Trauma lo$al
3) !#ro$o$
4) &ip#rs#nsitiitas ma$anan
#0#rapa ma$anan %an 0#r/u0unan *#nan ons#t uls#r *iantaran%a susu
sapi lut#n 6o$#lat $a6an $#ju p#arna ao a#n p#rasa *an p#na#t.
') 0at:o0atan
#0#rapa o0at s#p#rti anti in"lamasi non st#roi* s#p#rti asam propionat asam
"#nilas#ti$ *an *i$lo"#na$ *apat m#mi6u t#rja*in%a uls#r oral. #0#rapa uls#r
0iasan%a t#rja*i s#0aai #"#$ sampin *an m#n/ilan *#nan p#n/#ntian o0at.
r#$u#nsi RAS m#nin$at pa*a p#nunaan sodium lauryl sulfate %an
t#r$an*un pa*a pasta ii.
3.1.3 !ani"#stasi Klinis
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RAS 0#r0#ntu$ 0ulat atau oal *#nan *asar $unin $#a0uan 0#r0#ntu$
$aa/ *i$#lilini /alo #rit#matus *ari mu$osa %an t#rin"lamasi. S#lama 24
sampai 4> jam s#0#lum t#rja*i uls#r $#0an%a$an pasi#n m#rasa$an s#nsasi
t#r0a$ar pa*a *a#ra/ %an t#r$#na. Uls#r 0iasan%a t#rja*i pa*a mu$osa oral ti*a$
0#r$#ratin *iantaran%a 0i0ir mu$osa 0u$al *asar mulut palatum luna$ *an
p#rmu$aan #ntral li*a/ (Sain et al 2,12).
3.1.4 Klasi"i$asi
RAS *i$lasi"i$asi$an *alam 3 $#lompo$ 0#r*asar$an %aitu uls#r a"tosa
minor uls#r a"tosa ma%or *an /#rp#ti"orm (S6ull% an* #li8 2,,').
3.1.4.1 Uls#r A"tosa !inor
Uls#r a"tosa minor *i$#nal jua s#0aai Miculi& aphthous atau
uls#r a"tosa rinan. A"tosa minor t#rja*i t#rutama pa*a $#lompo$ usia 1,:
4, ta/un m#mpun%ai #jala %an minim *an 0#r0#ntu$ uls#r 0ulat atau
oal *an$al 0#rarna $unin:$#la0u *#nan *iam#t#r s#$itar 2:4 mm
marin /alo #rit#matosus *an *is#rtai o*#ma *an *it#mu$an t#rutama
pa*a mu$osa non:$#ratin s#p#rti pa*a mu$osa la0ial mu$osa 0u$al *asar
mulut sul$us atau #ntral li*a/ *an jaran t#rja*i pa*a mu$osa 0#r$#ratin
s#p#rti inia palatum *an *orsal li*a/. L#si s#m0u/ *alam 7 sampai 1,
/ari *an 0#rulan pa*a int#ral 1 sampai 4 0ulan m#ninal$an jarinan
parut s#*i$it atau ti*a$ sama s#$ali (S6ull% an* #li8 2,,' r##ti et al
2,11) .
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am0ar 3.1 Uls#r a"tosa minor (S6ull% an* #li8 2,,')
3.1.4.2 Uls#r A"tosa !a%or
Uls#r a"tosa ma%or *i$#nal jua s#0aai Sutton aphthous atau
periadenitis mucosa necrotica recurrens m#mpun%ai *urasi l#0i/ lama
*an l#0i/ m#n%a$it$an *i0an*in$an uls#r minor. Uls#r a"tosa ma%or
0#r0#ntu$ 0ulat atau ooi* s#p#rti uls#r minor t#tapi u$uran l#0i/ 0#sar
0iasan%a 0#r*iam#t#r s#$itar 1 6m atau 0a/$an l#0i/ *an *i$#lilini
o*#ma. Uls#r *it#mu$an pa*a mu$osa oral s#p#rti *orsal li*a/ atau
palatum t#rja*i /an%a 0#0#rapa uls#r (1 sampai -) pa*a satu a$tu *an
s#m0u/ *#nan lam0at s#lama 1, sampai 4, /ari. Uls#r *apat s#rin
0#rulan $#mun$inan s#m0u/ m#ninal$an jarinan parut (S6ull% an*
#li8 2,,').
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am0ar 3.2 Uls#r a"tosa ma%or (S6ull% an* #li8 2,,')
3.1.4.3 Uls#r &#rp#ti"orm
Uls#r /#rp#ti"orm s#*i$it *it#mu$an pa*a $#lompo$ lanjut usia
*i0an*in$an 0#ntu$ RAS lainn%a *an *it#mu$an t#rutama pa*a anita.
Uls#r *iaali *#nan #si$#l %an 0#r$#m0an 6#pat m#nja*i 0#0#rapa
uls#r $#6il s#u$uran jarum m#n%#0ar *an m#nalami p#nin$atan u$uran
*an m#n%atu m#nja*i uls#r 0#sar 0ulat ti*a$ 0#raturan %an s#m0u/ *alam
1, /ari atau l#0i/ tanpa m#ninal$an jarinan parut s#rin
m#nim0ul$an rasa sa$it *an 0#rulan. Uls#r jua m#li0at$an *a#ra/ oral
t#rmasu$ mu$osa 0#r$#ratin (S6ull% an* #li8 2,,').
am0ar 3.3 Uls#r /#rp#ti"orm (Las$aris 2,,-)
3.1.' ianosis an*in
ianosis 0an*in *ari RAS a*ala/ uls#r traumati$ Behcet’s Syndrome'
hand-mouth and foot disease erythema multiforme (E!) (Las$aris 2,,-).
("!")"! Uls#r Traumati$
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Uls#r traumati$ a*ala/ l#si oral umum %an *is#0a0$an ol#/ ii
%an pata/ atau tajam tam0alan %an $uran 0ai$ iritasi ii tiruan iritasi
$aat ort/o 0#n*a asin lain atau *is#0a0$an ol#/ *iri s#n*iri (t#riit
saat ma$an $#0iasaan 0uru$) (Las$aris 2,,-).
!ani"#stasi $linis l#si 0#raam t#tapi 0iasan%a t#rli/at tunal
m#nim0ul$an rasa sa$it *#nan p#rmu$aan m#ra/ /alus atau $unin
$#puti/an *an /alo #rit#matus %an tipis. L#si s#m0u/ tanpa m#nim0ul$an
jarinan parut s#lama - sampai 1, /ari s#6ara spontan atau s#t#la/
p#n%#0a0 *i/ilan$an. T#mpat pr#*il#$si pa*a li*a/ 0i0ir *an mu$osa
0u$al (Las$aris 2,,-).
am0ar 3.4 Uls#r traumati$ pa*a 0i0ir 0aa/ (Las$aris 2,,-)
3.1.'.2 +n"#$si rim#r Cirus &#rp#s Simpl#$s
+n"#$si prim#r &SC t#rja*i pa*a pasi#n %an ti*a$ m#mili$i imun *ari $onta$
s#0#lumn%a *#nan irus ini. +n"#$si &SC ini *apat m#n%#0ar s#6ara
asimptomati$ m#lalui s#$r#si salia. S#6ara umum in"#$si &SC *is#0a0$an ol#/
&SC:1 t#tapi in"#$si prim#r &SC:2 *apat t#rja*i a$i0at $onta$ oral:#nital
(r##n0#r an* li6$ 2,,3).
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P%&o$enesis Pen%i&
&SC:1 *an &SC:2 0#rsi"at n#urotropi$ m#nin"#$si s#ra0ut sara" s#nsoris *an
*apat 0#r#pro*u$si *alam s#l #pit#l. &SC:1 *an &SC:2 a$an mati t#r/a*ap s#l
#pit#l manusia *an 0#rsi"at *orman (lat#n) *alam jarinan sara" pa*a *a#ra/
tri#minal anlion. iasan%a s#6ara inisial irus m#masu$i tu0u/ m#lalui
p#rusa$an int#ritas m#m0ran# mu$osa. Kasus lainn%a transmisi 0#rasal *ari
$onta$ mu$o$utan#us *#nan s#$r#si %an t#rin"#$si *an u*ara. K#ti$a r#a$tiasi
irus a$an 0#rjalan m#lalui a$son sara" $# p#rmu$aan s#l #pit#l *an m#n%#0a0$an
mun6uln%a /#rp#s #pit/#lial r#$ur#n (Tillis an* !6*o#l 2,,2).
S#t#la/ in"#$si inisial irus a$an m#masu$i masa *orman sampai a$ti"
$#m0ali. Cirus a$ti" $#m0ali *is#0a0$an 0#0#rapa "a$tor *iantaran%a str#s
trauma *#mam paparan sinar mata/ari $#l#la/an #$strim *an si$lus m#nstruasi
(Tillis an* !6*o#l 2,,2).
-e%l% P)o'o)"%l
#jala pro*ormal *apat t#rli/at m#m0inun$an pa*a pasi#n saat
"as# inisial t#tapi p#nalaman %an s#rin t#rs#0ut m#rupa$an mun6uln%a
l#si /#rp#s. Tan*a p#rtama mun6uln%a /#rp#s r#$ur#n $#mun$inan tim0ul
s#nsasi ti*a$ 0iasa pa*a jarinan %an t#r$#na %an m#nunju$$an
/ilann%a ta$til atau s#nsori p#rs#psi. &al ini 0#rlanjut m#nja*i s#nsasi
#li (tingling ) t#r0a$ar atau 0#r*#n%ut. Tan*a sist#mi$ lain m#liputi
*#mam sa$it $#pala malais# mual *an munta/. #r$#m0anan #si$#l
*alam 24:4> jam a$an m#m0antu m#nilai t#rja*in%a $#mun6ulan /#rp#s
r#$ur#n. K#ti$a m#nunju$$an tan*a sist#mi$ #jala *an l#si #si$#l
intraoral *an p#rioral t#rs#0ut /al itu *apat *i$ata$an s#0aai
iniostomatitis /#rp#ti$a prim#r (Tillis an* !6*o#l 2,,2). +n"ormasi
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ini m#m0antu m#m0#*a$an in"#$si irus *ari stomatitis al#ri$a atau
#rit#ma multi"orm# %an l#si lo$al *an #jala sist#mi$ t#rli/at 0#rsama
(r##n0#r an* li6$ 2,,3).
Pe)io'e Inu#%si
#rio*# in$u0asi antara a$tu in"#$si atau r#a$tiasi *an
$#mun6ulan #si$#l s#$itar 7:> /ari t#tapi *apat 0#r$isar *ari 1:2- /ari.
S#lama p#rio*# s#0#lum $#mun6ulan #si$#l *an s#lama ta/ap #si$#l
s#$r#si sanat m#nular (Tillis an* !6*o#l 2,,2).
M%ni8es&%si Klinis C#si$#l $#6il t#rli/at pa*a mu$osa oral s#$itar 1 atau 2 /ari s#t#la/
#jala pro*ormal #si$#l 0#r*in*in tipis *i$#lilini *asar %an
t#rin"lamasi. C#si$#l *apat 6#pat ruptur m#ninal$an uls#r 0ulat *an$al.
L#si t#rja*i pa*a s#luru/ 0aian mu$osa. #n%a$it ini m#nin$at *#nan
a*an%a 0#0#rapa l#si 0#ra0un m#m0#ntu$ l#si ir#ul#r %an l#0i/ 0#sar
(r##n0#r an* li6$ 2,,3).
ianosis p#ntin untu$ p#n%a$it ini %aitu a*an%a iniitis marinalis a$ut
*imana s#luru/ inia m#nalami #*#matus *an in"lamasi %an $a*an *is#rtai
uls#r. #m#ri$saan post#rior "arin m#nunju$an in"lamasi *an no*us lim"ati$us
pa*a su0man*i0ular *an s#ri$al m#m0#sar. K#a*aan t#rt#ntu in"#$si prim#r
&SC *apat m#n%#0a0$an l#si *i $ulit 0aian la0ial atau "asial tanpa l#si intra oral
(r##n0#r an* li6$ 2,,3).
+n"#$si ini 0ila t#rja*i pa*a ana$ s#/at *apat /ilan *#nan s#n*irin%a. #mam
a$an /ilan s#lama 3 atau 4 /ari *an l#si mulai s#m0u/ *alam 1 minu /ina
1, /ari alaupun &SC *apat t#tap a*a *alam salia s#lama 1 0ulan s#t#la/ ons#t
p#n%a$it (r##n0#r an* li6$ 2,,3).
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am0ar 3.'
iniostomatitis /#rp#ti$a prim#r m#n%#0a0$an #si$#l *an uls#r *i$#lilini
in"lamasi (r##n0#r an* li6$ 2,,3).
am0ar 3.- +n"#$si prim#r &SC *#nan $ara$t#risti$ iniitis marinalis a$ut
(r##n0#r an* li6$ 2,,3).
3.1.'.3 Behcet’s Syndrome
Behcet’s Syndrome a*ala/ anuan in"lamasi multisist#mi$
$ronis. !ani"#stasi $linis ma%or *iantaran%a uls#r oral uls#r #nital l#si
$utan#us mani"#stasi o$ular ($/ususn%a u#itis). !ani"#stasi $linis minor
*iantaran%a atritis $#t#rli0atan as$ular *an paru:paru jantun
astroint#stinal uro#nital *an mani"#stasi n#urolois (&a/i/i 2,,4).
Uls#r oral m#n%a$it$an *an$al atau *alam oal atau 0ulat
*#nan pusat *asar n#$roti$ $#$uninan atau $#puti/an *an /alo #rit#m.
U$uran 0#r$isar *ari 1 sampai 2, mm. Uls#r oral Behcet’s syndrome
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multip#l *an t#r*apat pa*a lo$asi %an ti*a$ umum s#p#rti palatum luna$
*an oro"arin (&a/i/i 2,,4).
Uls#r #nital 0iasan%a l#0i/ 0#sar l#0i/ *alam l#0i/ ta/an lama
*an l#0i/ sa$it *i0an*in$an oral uls#r. Uls#r ini 0iasan%a m#ninal$an
0#$as. Uls#r 0#r$#m0an pa*a s$rotum *an s#*i$it l#0i/ s#rin pa*a
p#nis. S#*an$an pa*a anita t#mpat palin s#rin pa*a la0ium aina
*an s#ri$s (&a/i/i 2,,4).
!ani"#stasi $utan#us pa*a p#n%a$it ini *iantaran%a #rit#ma
no*osum ps#u*o"oli$#l *an "oli$#litis trom0opl#0itis as$ulitis
$utan#us l#si papulopostular r#a$si /ip#rs#nsitiitas. R#a$si pat#ri
s#0aai tan*a /ip#ra$tiitas $ulit %an *iin*u$si ol#/ inj#$si jarum
intra*#rmal m#nunju$$an /asil positi" (&a/i/i 2,,4).
!ani"#stasi o$ular a*ala/ $ompli$asi *ari p#n%a$it ini *an *apat
0#r$#m0an *#nan 6#pat m#nja*i $#0utaan. !ani"#stasi o$ular Behcet’s
disease *iantaran%a u#itis as$ulitis r#tina n#uritis opti$us lau6oma
$atara$ uls#r $orn#a $onjuntiitis /#mora# su0$onjuntia *an
$#ratitis (&a/i/i 2,,4).
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am0ar 3.7 Uls#r a"tosa major pa*a mu$osa 0u$al (Las$aris 2,,-).
am0ar 3.> Uls#r multipl# pa*a la0ium major (Las$aris 2,,-).
am0ar 3.9 Konjuntiitis *an iritis (Las$aris 2,,-).
3.1.'.4 Hand-Mouth and Foot Disease
Hand-mouth and foot disease a*ala/ p#n%a$it in"#$si irus a$ut %an
*itransmisi$an *ari satu in*ii*u $# %an lain %an *is#0a0$an irus @o8sa6$i#
A1-. !ani"#stasi $linis p#n%a$it ini a*ala/ a*an%a uls#r oral 0#rupa #si$#l $#6il
0#rjumla/ ':3, %an 6#pat ruptur# m#ninal$an rasa sa$it uls#r *an$al
(*iam#t#r 2:- mm) *i$#lilini ol#/ /alo #rit#m. T#mpat %an s#rin t#r$#na a*ala/
mu$osa 0u$al li*a/ *an mu$osa la0ial. L#si $ulit ti*a$ s#lalu *an t#rli/at 0#rupa
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#si$#l $#6il *#nan /alo #rit#m. T#mpat %an s#rin t#r$#na %aitu p#rmu$aan
lat#ral *an *orsal jari:jari *an $a$i. #n%a$it 0#rlansun s#lama ' F > /ari
(Las$aris 2,,-).
am0ar 4., Uls#r *an$al pa*a mu$osa 0u$al (Las$aris 2,,-)
3.1.'.' Erythema multiforme r#$ur#n (E!)
Erythema multiforme a*ala/ p#n%a$it a$ut atau su0a$ut *apat s#m0u/ *#nan
s#n*irin%a %an m#li0at$an $ulit *an m#m0ran mu$osa. Etioloi p#n%a$it ini
0#lum j#las $#mun$inan *ipi6u ol#/ /#rp#s simpl#8 atau Mycoplasma
pneumoniae o0at:o0atan ra*iasi atau $#anasan. !ani"#stasi $linis p#n%a$it ini
a*an%a a0unan #si$#l $#6il %an ruptur *alam 2:3 /ari m#ninal$an #rosi
ti*a$ 0#raturan sa$it %an *itutupi ol#/ ps#u*om#m0ran n#$roti$. T#mpat %an
s#rin t#r$#na a*ala/ 0i0ir mu$osa 0u$al li*a/ palatum luna$ *an *asar mulut.
L#si $ulit t#r*iri *ari ma$ula 0ulat papula atau pla$ #rit#m *atar #rit#m 0iasan%a
sim#tris. Kara$t#risti$ l#si $ulit a*ala/ l#si tar#t:m#n%#rupai iris. #n%a$it ini
umumn%a 0#rulan (Las$aris 2,,-).
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am0ar 4.1 Erosi multipl# pa*a 0i0ir *an li*a/ (Las$aris 2,,-)
3.1.- T#rapi *an #natala$sanaan
!#nurut uallar et al 2,14 0#ri$ut a*ala/ t#rapi *an p#natala$sanaan *ari
RAS ;
1. Ealuasi $linis aal *an p#raatan non "arma$olois
#0#rapa p#n#liti m#r#$om#n*asi$an p#m#ri$saan p#l#n$ap s#p#rti /itun
*ara/ l#n$ap m#liputi /itun #ritrosit asam "olat "#rritin *an itamin 12
*#nan tujuan untu$ m#n#sampin$an a*an%a $#mun$inan p#n%#0a0 sist#mi$
s#p#rti p#n%a$it astroint#stinal *#"isi#nsi itamin #/6#tGs s%n*rom# *an
*#"isi#nsi imun. #r*asar$an /u0unan antara RAS *an *#"isi#nsi itamin
0#0#rapa p#n#liti s#p#rti Col$o et al %an *i$utip ol#/ uallar et al (2,14)
m#lapor$an 0a/a p#raatan *#nan itamin 12 t#r0u$ti #"#$ti" m#no0ati
RAS.
Kor#$si *#"isi#nsi /#matini$ *ila$u$an *#nan anjuran p#ru0a/an pola ma$an
aar asupan ii t#r6u$upi *an p#m0#rian supl#m#n multiitamin. #n#litian ol#/
?ulan*ari *an S#t%aati (2,,>) m#n%#0ut$an p#nunaan multiitamin *alam
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p#natala$sanaan RAS t#r0u$ti #"#$ti" %an *itan*ai m#lalui $#a*aan uls#r %an
t#la/ s#m0u/ pa*a $unjunan satu minu.
2. #raatan "arma$olois lo$al
ili/an p#raatan aal m#liputi o0at antis#pti$ *an antiin"lamasi atau
anal#si$ s#p#rti ,2D $lor/#$si*in 0#rupa o0at $umur atau #l tia $ali s#/ari
s#lama l#si masi/ a*a. Tri6losan jua *apat *iuna$an *alam 0#ntu$ #l atau o0at
$umur tia $ali s#/ari s#lama l#si masi/ a*a. i$lo"#na$ topi$al 3D *#nan asam
/ialuronat 2'D *apat *i0#ri$an untu$ m#nurani n%#ri. Aml#8ano8 'D %an
m#mpun%ai #"#$ jan$a p#n*#$ s#6ara $/usus *iuna$an ji$a *alam "as#
pro*ormal *iapli$asi$an 2:4 $ali s#/ari. 0at ini *apat m#mp#r6#pat
p#n%#m0u/an a"tosa *an m#nurani n%#ri #rit#ma *an u$uran l#si. Anti0ioti$
topi$al s#p#rti t#trasi$lin *an turunann%a (*o$sisi$lin *an minosi$lin) *alam #l
atau o0at $umur *apat m#n/am0at r#spon in"lamasi collagenases and
metalloproteinase"
Korti$ost#roi* topi$al *apat *iuna$an untu$ m#no0ati RAS. Korti$ost#roi*
*apat m#nurani #jala s#/ina pasi#n *apat ma$an 0#r0i6ara *an m#njaa
$#0#rsi/an mulutn%a m#nurani *an m#n#$an n%#ri *an m#mp#rp#n*#$ a$tu
p#n%#m0u/an uls#r. 0at %an *isaran$an %aitu triam6inolon# a6#toni*#
"luo6inoni*# ointment atau 6lo0#tasol ointment . 0at ini *apat 0#ri$an *alam
0#ntu$ topi$al 0#rupa pasta a*/#si# *an o0at $umur. asta adhesi%e *apat
*i0#ri$an ji$a l#si lo$al *an o0at $umur ji$a l#si *i"us atau 0an%a$. Triam6inolon#
a6#toni*# pasta oral ,.1D *iapli$asi$an 3:1, $ali s#/ari s#lama 3:' m#nit untu$
pasi#n *#nan l#si #rosi $#6il *an rinan. luo6inoni*# ointment ,.,'D
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*iapli$asi$an ':1, $ali s#/ari s#lama 3:' m#nit m#m0#ri$an pot#nsi s#*an
/ina tini *iuna$an pa*a pasi#n *#nan l#si l#0i/ ar#si". @lo0#tasol
ointment ,.,'D $orti$ost#roi* topi$al palin pot#n *iuna$an untu$ am0aran
$linis s#*an sampai 0#rat.
Ta0#l 1. #raatan "arma$olois lo$al
#raatan "arma$olois lo$al
Antis#pti$ antiin"lamasi *an anal#si$ ; $lor/#$si*in ,2D o0at $umur atau #l
3 $ali s#/ari tri6losan #l 3 $ali s#/ari *i$lo"#na$ topi$al 3D sal#p aml#8ano8
'D 4 $ali s#/ari
Anti0ioti$ ; *o$sisi$lin #l pa*a *osis r#n*a/
Korti$ost#roi* topi$al ; pasta oral triam6inolon# a6#toni*# ,.1D 3:1, $ali s#/ari
"luo6inoni*# ointment ,.,'D ':1, $ali s#/ari 6lo0#tasol ointment ,.,'D
Asam /ialuronat ; ,2D #l 2 $ali s#/ari s#lama 2 minu
An#st#si topi$al ; li*o$ain topi$al 2D spra% atau #lLainn%a ; Las#r 0a/an:0a/an alam (rosa damascene' *uercetin' myrtle)
3. #raatan "arma$olois sist#mi$
#raatan *#nan o0at sist#mi$ *iin*i$asi$an ji$a uls#r t#rli/at
$onstan *an ar#si" a"tosa major n%#ri int#ns *an p#raatan topi$al ti*a$
mampu untu$ m#n/ilan$an #jala. #raatan o0at s#6ara sist#mi$
*i0aa/ ini m#mpun%ai #"#$ sampin s#/ina *alam p#nunaann%a
s#0ai$n%a *i0#ri$an ol#/ *o$t#r ii sp#sialis p#n%a$it mulut (S6ull% et al
2,,3).
Ta0#l 2. #raatan "arma$olois sist#mi$
#raatan "arma$olois sist#mi$
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Antio0ioti$ ; #nisilin potassium ', m 4 $ali s#/ari s#lama 4 /ari
Korti$ost#roi* ; *osis inisial pr#*nison# oral 2' m p#r /ari *an *osis s#6ara
0#rta/ap *i$urani s#lama 2 0ulan
@ol6/i6in# ; ,' m p#r /ari s#lama 7 /ari 1 m p#r /ari s#lama 7 /ari *an *osis
p#naturan 1' m p#r /ari
apson ; 2' m p#r /ari s#lama 3 /ari ', m p#r /ari s#lama 3 /ari 7' m p#r
/ari s#lama 3 /ari *an *osis p#naturan 1,, m p#r /ari
@lo"aimin# ; 1,, m s#tiap /ari s#lama - 0ulan
#nto8i"%llin# ; 4,, m 3 $ali s#/ari s#lama 1 0ulan
Hin$ sul"at ; 1', m p#r /ari
+munomo*ulatin ; t/ali*omi*# ',:1,, m p#r /ari l#amisol# 1', m 3 $ali
s#minu s#lama - 0ulan
a/an /om#opat/i6 ; m#r6urius solu0ilis natrum muriati6um p/osp/orus asam
sul"at asam nitrit *alam 1,, ml air p#r oral s#tiap 12 jam s#lama - /ari
.A. I+
PEM.AHASAN
ianosis %an *apat *isimpul$an t#r/a*ap p#n%a$it %an *i*#rita pasi#n
a*ala/ recurrent aphthous stomatitis (RAS). RAS %an %an *i*#rita pasi#n
t#rmasu$ uls#r a"tosa minor. ianosis t#rs#0ut *apat *itunju$$an m#lalui
mani"#stasi $linis *an anamn#sa pasi#n.
RAS %an t#rja*i pa*a pasi#n 0#rumur 24 ta/un ini 0#rupa uls#r *asar
0#rarna $#$uninan 6#$un *an$al t#rtutup ps#u*om#m0ran 0#r0#ntu$
0ulat marin 0#raturan *#nan /alo #rit#m *an *iam#t#r $uran l#0i/ 3 mm pa*a
*a#ra/ mu$osa la0ial /al ini s#suai *#nan p#rn%ataan S6ull% an* #li8 (2,,')
0a/a uls#r a"tosa minor m#mpun%ai mani"#stasi $linis %an t#rja*i t#rutama
pa*a $#lompo$ usia 1,:4, ta/un 0#r0#ntu$ uls#r 0ulat atau oal *an$al
0#rarna $unin:$#la0u *#nan *iam#t#r s#$itar 2:4 mm marin /alo #rit#m *an
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*is#rtai o*#ma *an *it#mu$an t#rutama pa*a mu$osa non:$#ratin s#p#rti pa*a
mu$osa la0ial. asi#n m#na$u #mpat /ari s#0#lumn%a pasi#n m#njalan$an
i0a*a/ puasa namun ti*a$ ma$an sa/ur *an saat 0#r0u$a puasa ma$an ma$anan
p#*as. K#mu*ian pasi#n *itan%a m#n#nai pola ma$an untu$ m#nali
$#mun$inan a*an%a *#"isi#nsi nutrisi. asi#n s#rin ma$an 2 $ali s#/ari jaran
ma$an sa%ur s#rin m#nanti ma$anan *#nan or#nan *an sanat s#*i$it
minum air puti/. K#a*aan ini m#nunju$$an pasi#n m#mpun%ai asupan ii %an
$uran 0ai$ *an s#suai *#nan p#rn%ataan Sain et al (2,12) 0a/a "a$tor nutrisi
*apat m#mi6u t#rja*in%a RAS t#rutama *#"isi#nsi at 0#si "olat *an itamin 12.
RAS *apat *ipi6u pula ol#/ str#ss (Sain et al 2,12) *apat *itunju$$an m#lalui
p#na$uan pasi#n s#*an m#mili$i 0an%a$ p#$#rjaan s#/ina $uran ti*ur.
asi#n jua p#rna/ m#nalami sariaan s#0#lumn%a $uran l#0i/ - 0ulan %an
lalu *an *ii$uti *#mam m#nunju$$an a*an%a $#6#n*#runan uls#r %an 0#rulan.
&al ini s#suai p#rn%ataan Ko%0asi et al (2,,-) 0a/a RAS m#rupa$an p#n%a$it
uls#r 0#rulan tanpa a*a tan*a *ari p#n%a$it lain *an *apat s#m0u/ *#nan
s#n*irin%a.
RAS pa*a pasi#n ini /arus *i*ianosa 0an*in *#nan in"#$si /#rp#s simpl#$s.
&al ini *i$ar#na$an a*an%a ria%at uls#r pasi#n s#0#lumn%a *an p#r0#*aan
$on*isi uls#r p#rtama $ali *an saat p#n%#m0u/an s#/ina m#m0uatn%a p#rlu
*i*ianosa 0an*in *#nan p#n%a$it ini.
!ani"#stasi $linis in"#$si /#rp#s simpl#$s %aitu a*an%a ria%at #jala
pro*ormal %an m#n*a/ului l#si lo$al s#lama 1 atau 2 /ari 0#rupa mual munta/
sa$it $#pala *an malais# (r##n0#r an* li6$ 2,,3). asi#n s#0#lumn%a p#rna/
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m#mili$i ria%at uls#r *an *ii$uti *#mam namun in"ormasi m#n#nai ria%at
#jala pro*ormal %an m#n*a/ului l#si uls#r saat ini ti*a$ *i$#ta/ui *ari pasi#n
s#/ina in"ormasi ti*a$ m#n6u$upi untu$ m#n*ianosa 0an*in uls#r t#rs#0ut
*#nan in"#$si /#rp#s simpl#$s. A*an%a ria%at /#rp#s la0ialis r#$ur#n %an
n#ati" *an ria%at $onta$ lansun *#nan pasi#n /#rp#s prim#r atau r#$ur#n
%an positi" jua *apat m#m0antu untu$ m#m0#*a$ann%a *#nan RAS
(r##n0#r an* li6$ 2,,3).
#m#ri$saan uls#r l#0i/ lanjut 0#r*asar$an /asil "otora"i *i*ua t#r*apat
#si$#l $#6il %an mun6ul 0#rs#0#la/an *#nan uls#r pa*a $unjunan p#rtama.
S#lanjutn%a u$uran uls#r m#nalami p#r0#saran pa*a $unjunan $#*ua
*i0an*in$an $unjunan p#rtama $#mun$inan *is#0a0$an a*an%a #si$#l %an
ruptur *an 0#ra0un m#m0#ntu$ uls#r %an l#0i/ 0#sar s#/ina pros#s
p#n%#m0u/an m#nja*i l#0i/ lama. Anamn#sa m#n#nai ria%at l#si uls#r
s#0#lumn%a *an p#m#ri$saan $linis s#0ai$n%a *ila$u$an *#nan 6#rmat pa*a
pasi#n untu$ m#n*ianosa 0an*in *#nan p#n%a$it ini.
Eliminasi "a$tor:"a$tor p#mi6u %an *ila$u$an a*ala/ m#m0#ri$an instru$si
ma$an ma$anan %an 0#rii t#rutama m#nan*un itamin 12 # *an asam
"olat *an minum air puti/ s#p#rti sa%ur 0a%am $an$un $unin t#lur ati a%am
*an $a6an /ijau *an instru$si untu$ m#mp#r0ai$i pola ti*ur. S#lain p#ru0a/an
pola ma$an asupan ii *apat *itin$at$an m#lalui p#m0#rian multiitamin. &al
ini s#suai p#rn%ataan ?ulan*ari *an S#t%aati (2,,>) 0a/a $or#$si *#"isi#nsi
/#matini$ *apat *ila$u$an *#nan p#ru0a/an pola ma$an aar asupan ii
t#r6u$upi *an p#m0#rian supl#m#n multiitamin. #nunaan 0#ta*in# solution
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1,D s#0aai antis#pti$ *alam rona mulut s#/arusn%a ti*a$ *iuna$an s#0aai
pili/an p#raatan $ar#na p#nunaann%a s#0aai o0at luar. <i$a RAS pili/an
p#raatan a*ala/ p#m0#rian $orti$ost#roi* topi$al *alam 0#ntu$ pasta a*/#si#
%aitu triam6inolon# a6#toni*# ,1 D *iapli$asi$an 3:1, $ali s#/ari s#lama 3:'
m#nit (uallar et al 2,14) ji$a l#si uls#r t#rolon minor *an tunal.
5amun $ar#na uls#r ini *i*ua m#rupa$an in"#$si /#rp#s simpl#$s pili/an
p#raatann%a 0#r0#*a *#nan RAS. ili/an p#raatann%a %aitu $rim 'D
acyclo%ir ' $ali s#/ari s#lama ' /ari m#nin$at$an a$tu p#n%#m0u/an *an
*urasi n%#ri (Tu0ri*% et al 2,14). Acyclo%ir ti*a$ m#m0#ri$an #"#$ pa*a s#l
normal t#tapi m#n/am0at r#pli$asi 5A pa*a s#l %an t#rin"#$si &SC. Acyclo%ir
jua m#nurani lama *ari *#mam sa$it l#si *an %iral-shedding (r##n0#r an*
li6$ 2,,3).
S#lain itu pasi#n jua *iinstru$si$an untu$ m#natur *an m#noptimal$an
a$tu $#rja l#0i/ 0ai$ s#/ina *apat istira/at 6u$up *an m#nurani tin$at
str#s. T#rapi RAS ini *ila$u$an 0#rtujuan untu$ m#n/ilan$an rasa sa$it
m#nurani in"#$si s#$un*#r m#mp#r6#pat p#n%#m0u/an uls#r s#/ina
m#nurani *urasi *an m#n6#a/ r#$ur#nsi (?ulan*ari *an S#t%aati 2,,>).
S#lanjutn%a pasi#n *iminta untu$ *atan #mpat /ari $#mu*ian untu$ m#li/at
$on*isi uls#rn%a.
Kon*isi uls#r pa*a #mpat /ari s#t#la/ $unjunan p#rtama m#nunju$$an
p#r0ai$an %aitu rasa sa$it su*a/ /ilan *an /alo #rit#m su*a/ 0#r$uran namun
uls#r masi/ t#rtutupi ps#u*om#m0ran. &al ini m#nunju$$an pasi#n t#la/
m#la$u$an instru$si s#suai anjuran %an *i0#ri$an. asi#n t#la/ m#natur pola
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ma$an pola ti*ur *an m#minum multiitamin %an *i0#ri$an. ?alaupun
*#mi$ian pasi#n *iminta untu$ *atan $#m0ali pa*a /ari $#tuju/ *ari $unjunan
p#rtama $ar#na uls#r 0#lum s#m0u/ s#luru/n%a.
asi#n *atan $#m0ali pa*a /ari $#tuju/ *ari $unjunan p#rtama. Uls#r t#rli/at
m#nalami p#r0ai$an *i0an*in$an /ari $##mpat. s#u*om#m0ran su*a/ /ilan
namun pas6a p#n%#m0u/an masi/ t#rli/at ma$ula $#m#ra/an. asi#n m#rasa$an
$#para/ann%a t#la/ 0#r$uran %aitu ti*a$ t#ranun%a p#nun%a/an *an 0i6ara
pasi#n a$i0at a*an%a uls#r t#rs#0ut. 5amun *#mi$ian pasi#n *iminta untu$ *atan
$#m0ali pa*a /ari $#:14.
Uls#r m#nalami p#r0ai$an l#0i/ lama $ar#na pasi#n 0#lum m#la$sana$an
instru$si s#luru/n%a. asi#n $uran m#nonsumsi sa%ur *an 0ua/ air puti/ *an
t#tap m#nonsumsi ma$anan %an p#*as *an panas. #0an $#rja %an *imili$i
pasi#n masi/ 0an%a$ s#/ina pasi#n masi/ ti*ur larut malam *an $uran istira/at
%an 6u$up. ?alaupun *#mi$ian pasi#n t#tap m#njaa p#m#li/araan $#0#rsi/an
rona mulutn%a *#nan si$at ii s#6ara t#ratur.
&ari $#:14 pasi#n ti*a$ *apat *atan *i$ar#na$an $#si0u$an p#$#rjaan namun
pasi#n *iminta untu$ m#nunju$$an $#a*aan sariaann%a. Kon*isi uls#r pa*a /ari
$#:14 t#rli/at su*a/ /ilan alaupun mu$osa la0ial masi/ s#*i$it $#m#ra/an.
asi#n t#tap *imonitor sampai uls#rn%a s#m0u/. Uls#r m#nalami p#r0ai$an %an
sini"i$an pa*a /ari $#:21 *an t#rli/at $#m#ra/an pa*a mu$osa la0ial 0#r$uran
*i0an*in$an s#0#lumn%a.
.A. +
KESIMPULAN
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ianosis RAS ( Recurrent Apthous Stomatitis ) *apat *it#a$$an
m#lalui anamn#sa *an am0aran $linis l#sin%a. Eliminasi atau p#r0ai$an "a$tor
pr#*isposisi *apat m#nurun$an "r#$u#nsi *an $#para/an l#si RAS ini.
DA,TAR PUSTAKA
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