Group 4 :

1. Anggreini
2. Alsa Laily Martanisa
3. Amelia Mega Puspita
4. Murya Widianti
5. Falah Tinton Firdaus
6. Dhea Gladys Malinda
7. Monica Octalia AP
8. Anisa Widiastuti
9. Andria Wahyuningsih
10. Tata Iqmalia Firdani
11. Sindy Retno Damayanti
12. Dwi Elita Kartika
The epidermis is a stratified, squamous epitheium layer that is
composed primerily of to types of cellss
1. Keratinocytes
2. Dendritic
epidermis consists of layers :
1. Melanosid
2. Langers hans cell
3. Markel cell
4. Karatinosid consist of layers :
a) stratum korneum
b) Stratum lucidum
c) Stratum granulasum
d) Strasum spinosum
Dermis The boundary of the dermis (skin) is definitely difficult to
determine because it blends with the subcutaneous layer
(hypodermis). Thickness between 0.5-3 mm. Several times thicker
than the epidemic formed from binding tissue components.
Derivatives (derivatives) of the dermis consist of hair, oil glands,
mucous glands, and sweat glands that burrow deep into the
dermis.
• Subcutaneous tissue or hypodermis is the innermost layer of
skin. This layer is mainly in the form of adipose tissue that
provides cushioning between the layers of the skin and internal
structures such as muscles and bones. Many contain blood
vessels, lymph vessels and nerves, there are also sweat gland
rolls and the base of hair follicles. This tissue allows skin
mobility, changes in body contour and body heat insulation.
Physiology of the integument system The skin has many functions,
which are useful in maintaining body homeostasis. These functions
can be divided into functions of protection, absorption, excretion,
perception of body temperature regulation (thermoregulation),
and formation of vitamin D
1. Protection functions The skin provides protection against the body in
various ways as follows:
a. Keratin protects the skin from microbes, abrasion (heat), heat, and
chemicals Keratin is a hard, rigid structure, and is arranged neatly and
tightly like a brick on the surface of the skin
b. Lipids that are released prevent water evaporation from the surface of the
skin and dehydration: besides it also prevents the entry of water from the
environment outside the body through the skin
c. c. Oily sebum from the sebaceous glands prevents skin and hair from
drying out and contains bactericidal substances that function to kill bacteria
on the surface of the skin.
d. d. Melanin pigments protect against the effects of harmful UV rays. This
pigment is in charge of protecting genetic material from the sun, so genetic
material can be stored properly.
e. e. In addition there are cells that act as protective immune cells. The first is
Langerhans cells, which represent antigens against microbes. Then there
are phagocytic cells in charge of phagocytosis of microbes that enter
through keratin and Langerhans cells
2. Absorption function The skin cannot absorb water, but can
absorb lanut-lipid materials such as vitamins A, D, E, and K,
certain drugs, oxygen and carbon dioxide.

3. The function of excretion Kult also functions in excretion by the

mediation of two exocrine glands, namely the sebaceous glands
and sweat glands
4. Perceptual function The skin contains sensory nerve endings in
the dermis and subcutis. Against the heat stimulation played by
Ruffini bodies in demis and subcutis. Against the cold played by
the Krause bodies located in the dermis, the Meissner tactile body
located on the papillae of the dermis plays a role in palpation, as
does the Merkel Ranvier body located in the epidermis.
• 5. Function of regulating body temperature (thermoregulation)
The skin contributes to regulating body temperature
(thermoregulation) in two ways: perspiration and adjusting
blood flow in capillaries. At high temperatures, the body will
sweat in large quantities and widen blood vessels (vasodilation)
so that heat will be carried out of the body. Conversely, at low
temperatures, the body will release less sweat and narrow
blood vessels (vasoconstriction), thereby reducing the body's
heat expenditure.
6. Synthesis of vitamin D is carried out by activating the precursor
of 7 dihydroxy cholesterol with the help of ultraviolet light.
Enzymes in the liver and kidneys then modify the precursors and
produce calcitriol, an active form of vitamin D. Calcitriol is a
hormone that plays a role in absorbing calcium from food from
the gastrointestinal tract into the blood vessels.
a life-threatening condition that affects the skin, where cell death
causes the epidermis to separate from the dermis. This syndrome
is thought to be due to hypersensitivity reactions that affect the
skin and mucous membranes. Although in most cases it is
idiopathic. Stevens Johnson syndrome is a syndrome that affects
the skin, mucus in the orithium and eyes with general conditions
varying from mild to severe, abnormalities in the skin in the form
of erythema, vesicles / bullae may be accompanied by purpura.
• Etiology of Infection (Usually a continuation of infections such as
Herves simplex virus, influenza, histoplasmosis, epstein-virus virus
or the like). Side effects of drugs (alloporinol, diclopenak,
floconazole, valdecoxib, sitagliptin, penicillin, sulpona mide,
phenytoin, azithromycin, modafinil, lamotrigine, neviravin,
ibupropen, etc.) Malignancies (carcinoma and lymphoma).
Idiophatic factor
The pathogenesis is unclear, presumably caused by allergic
reactions type III and IV. Type III reactions (immune complex
reactions) occur due to the formation of antigen-antibody
complexes that form micro-presitipation so that neutrophil
activation occurs which then releases lysozim and causes damage
to target tissues and organs (target organs). Type IV reactions
(slow hypersensitivity reactions) occur as a result of sensitized T
lysozyme re-contracting with the same antigen and then lysozim is
released resulting in an inflammatory reaction.
• This syndrome is rarely found at the age of less than 3 years.
Conditions generally vary from mild to severe. In those with
decreased consciousness, sufferers can respond to coma. The
beginning of acute illness can be accompanied by symptoms of
high-grade prodromal, malaise, headache, cough, runny nose, and
throat pain. In this syndrome seen trias abnormalities in the form
of:
• Skin disorders
• Mucous membrane abnormalities in the orifice
• Eye disorders
Laboratory Supporting Examination: Usually found leukocytosis or
eosinophilia. If the suspected cause of the infection can be done
by blood culture. Histopathology: Abnormalities in the form of
mononuclear cell infiltrates, edema and extravasation of red
blood cells, degeneration of the basal layer. Epidermal cell
necrosis and spongiosis and intracellular edema in the epidermis.
Immunology: IgM and C3 deposes are found in superficial dermal
vessels and there are immune complexes containing IgG, IgM, IgA.
In Stevens Johnson syndrome the handling must be precise and
fast. The use of costostosteroid drugs is a life-saving measure.
Dexamethasone is usually used intravenously, with an initial dose
of 4-6 X 5 mg daily. In general, the critical period can be
overcome in a few days with changes in general condition
improved, no new lesions arise, while the old lesions experience
involution.
the effect of high-dose corticosteroid therapy is reduced immunity,
therefore if necessary antibiotics are given to treat infections. The
choice of antibiotics should rarely cause allergies, be broad-
spectrum and bactericidal. To reduce the side effects of
corticosteroids given a diet that is poor in salt and high in protein.
Another thing to note is to regulate the balance of fluids,
electrolytes and nutrients. If necessary, infusion can be given in the
form of 5% dextrose and Darrow solution. But topical is not as
important as systemic therapy for lesions in the mouth can be
given in database orabase. For lesions on the skin in erosive
places can be given sofratul or betadin.
Complications The most common complications are
bronchopneumonia, loss of fluid / blood, impaired electrolyte
balance and shock. Blindness can occur in the eyes due to lacrimal
disorders
• Disorders of comfort, fever, headache, throat associated with
bullae
• Impairment of nutritional fulfillment: Less than the body's needs
associated with difficulty swallowing
• Impaired skin integrity associated with fragile bullae
• Impaired sensory vision associated with erosion and corneal
perforation
• An increase in body temperature is associated with
inflammation compensation
• Impaired low self-esteem associated with extensive erosion and
purpura
TERIMA KASIH