bed side teaching 2
TRANSCRIPT
BED SIDE TEACHING 2
SEBORREICH DERMATITIS
1. Benhardy Rambu T2. Nurul Bariah3. Sri Jayanti4. Wahyuni Surya
Wulandari5. Desti Priani6. Hj. Harfana Alwi7. Lisna Rosalia Agaus8. Isnaeni Salamiya9. Surahmayanti Tahir10. Tajul Arifin
11. Marisa Trirahayu12. Steven S. Katuk13. Nahdiah Zainuddin14. Andi Fatmawati
Mahir15. Ali Khomeini16. Andi Amalia Ayu17. Arisal18. Indra Pahri Putra
GROUP MEMBERS
Name : Mr. Ridwan Ais Iwan Gender : Male Age : 33 y.o Marital Status : Single Religion : Moslem Address : Lapas Kelas II Maros Occupation : - Registered : 10 March 2013
PATIENT’S IDENTITY
Anamnesis :(Alloanamnesis from patient’s family)
Chief complaint : Pruritus
Further Anamnesis:Since four days ago. Face’s skin is abraded. It happened when his still in the jail. History of medication (-).
HISTORY TAKING
Systematical Anamnesis : Fever (+), Cough (+), chest pain (-), nausea (-), vomit (-) Defecation : normal Urination : normal
History of similar disease : (-)History of another disease: KP Patient had the same complaint : ( - ) Family History with the same complaint : ( - ) Treatment history : (-) Lifestyle : smoking (+)
alcohol (+) narcotic (+) exercise (-)
Allergic : (-) Systemic disease : (-)
General condition : Severe Consciousness : Compos mentis Vital sign:
BP : 100/70 mmHgPulse : 88x/minute,regulerBreathing : 20x/minuteTemperature : 38,50 C
Head Examination : Icteric (-) Anemic (+) Cyanosis (-)
Cor / Pulmo : BJ I/II, Pure, Reguler Thorax : Vesikuler, Rh (+)/Wh(-) Abdomen: Normal, Peristaltic (+) Extremities : Normal
PRESENT STATUS
Dermatology Status- Location : Regio Scalp, and
Facialis- Efflorescence : Makula hipopigmentasi, skuama
Venerology Status (-)
Additional Examination- Laboratory : (-)
DIAGNOSIS- Seborrheich Dermatitis
DIFFERENTIAL DIAGNOSIS - Psoriasis , Pityriasis rosea, Contact dermatitis, SLE ,
Atopic dermatitis
MANAGEMENT- Topical: Miconazole Cream (Morning, Afternoon)- Systemic : Ketokonazole 200 mg 1x1 tab
Cetimizin 1 x 1 tabKetomed shampo
PROGNOSIS- Dubia
Chronic papulosquamous condition Occur on sebum-rich area of scalp, face and trunk Occur as an isolated condition or in conjunction with
other disorder such as blepharitis, acne vulgaris, ocular rosacea
Varies from mild dandruff to exfoliative erythroderma Aggravated by change in humidity, change in season,
trauma (e.g. scratching) or emotional stress Associated with several systemic disease include
AIDS, zinc deficiency, Parkinson disease Frequently seen in patient who received psoralen
with UVA therapy
Seborrheic dermatitisDiscussion
Malassezia globosa- Lipophilic yeast
-Found in normal skin -Research document supported relation
between Malassezia and seborrheic dermatitis :clinical response to antifungal drug :increase in number of Malassezia in recurrence disease
Sebum production Genetic susceptibility for inflammatory response
Causative factor
Malassezia are not the cause but are a cofactor link to T-cell depression, increase sebum level and activation of the alternative complement pathway
Skin barrier dysfunction prone to disease Medication that induced flare up : auranofin,
aurothioglucose, buspirone, chlorpromazine, cimetidine, ethionamide, gold, griseofulvin, haloperidol, interferon Alfa, lithium, methoxsalen, methyldopa, phenothiazines, psoralens, stanozolol, thiothixene and trioxsalen
Causes
Depend on age, skin type, presence or absence of concurrent systemic illness
Dry and flaky with white scale or greasy with crusting
Skin type 4-6 :reduce visible erythema:hypo or hyperpigmented
Increase in winter and early spring Remission commonly in summer
Clinical
Differential diagnosis in adult Psoriasis Pityriasis rosea Contact dermatitis SLE Atopic dermatitis
Candidiasis Rosacea Impetigo Tinea versicolor Sarcoidosis
Early treatment Behavior modification to reduce excoriation Avoid shampoo and topical product that dry the hair and skin Steroid
:low and middle potency:may increase recurrence rate:rebound effect :discourage except for short term use
Antifungal drug:ketoconazole:ciclopiroxolamine:selenium sulfide
Treatment
Thank You