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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
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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?

A B C
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

Itchy

macules and
papules

verucous flat top papules/ Dome shaped miliar papules in


papules plaque papules specific area

Veruccae Moluscum
Tinea korporis Scabies
vulgaris contagiosum

Tinea kapitis
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Itchy, macules and papules

VERUCCA VULGARIS
Etiology
• HPV

History
https://www.childrens.com
• Can persist several years if not
treated
Morfology
• Common in children
• Extensor extremities • Verucous firm papules, cleft surface
with vegetations
Transmission • Patognomonic: red or brown dots
• Isolated lession, scattered discrete
• Fomites, skin to skin contact lesion. 11
Verucca vulgaris

• Phototherapies
Treatment:
• Laser (CO2 and pulsed dyle
lasers)
• Therapies for children must be • Photodynamic Therapy
safe and preferably painless • Immunotherapies
• Cimetidine 25-40 mg/kg/day
• Destructive Methods • Zinc 10 mg/kg
• Injected Immunotherapies
• Salicylic acid 30-40% • Interferon
• Imiquimod
• Cantharidin 0,7%
• Antimitotic Therapies
• Cryotherapy • Bleomycin
• Podofilin
• Retinoids
Pediatric Dermatology Vol. 28 No. 3 May ⁄ June 2011 12
Itchy, macules and papules

MOLUSCUM CONTAGIOSUM
• Etiology
• Molluscipox virus
• Transmission
• Skin to skin contact
• Children: common
on exposed skin
sites https://wikem.org/wiki/Molluscum_contagiosum
• Resolved
spontaneously • Physical examination
within 6 moth • Papules, nodules, pearly white
or skin-colored. Round, oval,
hemisphrical, umbilicated
• Distribution
• anysite 13
Molluscum contagiosum

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Itchy, macules and papules

TINEA
• Definition: group of
fungi capable of
infecting nonviable
keratinized cutaneous
structures
• Chidren common:
• Tinea capitis
• Tinea corporis

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Tinea capitis

• 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

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Tinea Capitis

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

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Itchy, macules and papules

SCABIES

Etiology:
S. Scabiei var. hominis.

Transmission: skin to skin contact

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Clinical manifestation

http://wordinfo.info/results/scabies

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

www.drscabies.com 20
Dermatologic Algorithme

Pain and/or
fever

macules and vesicles and


papules bullae

patch erythema
papul erythema teardrop "football-
with satelit hipopion bullae
with pus inside vesicles shaped" vesicles
lesion

Candidiasis
Follicullitis Varicella Impetigo bullosa HFMD
cutaneous

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Pain and/or fever,
papules and macules
MUCOCUTANEOUS CANDIDIASIS
Etiology:
most frequently Candida albicans
Age of onset: children, geriatric
Diaper dermatitis can cause
secondary by candida

Courtesy: IK.KK FK UNS

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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
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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Pain and/or fever,
papules and macules
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)

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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.

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Treatment
When the lesions are large, painful, and A systemic antibiotic (as for MRSA
fluctuant, then incision and drainage are impetigo). For severe infections or
the most important actions that one infections in a dangerous area, maximal
should take in a timely manner. If the antibiotic dosage should be employed by
infection is recurrent or complicated by the parenteral route. Vancomycin (1.0–2.0
comorbidities, a culture can be sent. g intravenously daily in divided doses) or
Draining lesions should be covered to other systemic parenteral agents that
prevent autoinoculation and diligent hand have anti-CA-MRSA activity are indicated
washing performed for these patients for at least 1 week

Simple furunculosis may be aided by local


application of moist heat

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Pain and/or fever,
papules and macules

IMPETIGO

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Pain and/or fever,
papules and macules

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Pain and/or fever,
papules and macules
VARICELLA

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Hand, foot and mouth
disease

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