Oleh:KOMANG AGUS PERMANA JAYADALAM RANGKA KEPANITERAAN KLINIK
SMF PENYAKIT KULIT DAN KELAMINRSUD SANJIWANI
GIANYAR20151DERMATOMIKOSIS2MIKOSISMIKOSISMikoi !"e#$ii%lMikoi
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dermatofitaDe$i(ii 2E'iolo,iDe$i(ii 2E'iolo,iE"i+e#&o"h/'o(
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J%&!#DermatoftosisPenyebaran & Habitat Fungi1. Antropofilik
Menyerang manusia, jarang mengenai hewanTrichophyton spp.: T.
rubrum, T. mentagrophytes (var. interigitale!, T. schoenleinii, T.
tonsurans, T. violaceum. Microsporum auouinii. "piermophyton
floccosum#. $eofilik TanahTrichophyton spp.: T. e%uinum, T.
mentagrophytes (var. mentagrophytes!, T. verrucosum. M. canis.
&. 'oofilik(ewan (anjing, kucing, sapi, kua, ll!, apat juga
menyerang manusia Microsporum spp.: M. gypseum, M. nanum
3Patogenesis 5J%&!# &e(e&"el +ik!li'J%&!#
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ke#%'oli'ikKe#%'i( h%()!# e1%,%i!&1e# &%k%(%(
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&ele1%# +,( ,%&1%#%( central healing10:l%)k +o'
#i(,6o#&T. tonsurans, T. violaceumrambut rapuh, patah tepat di
muara folikel, tampak sbg bintik2 hitamLampu Wood: fluoresensi
(!G#%/ "%')h #i(,6o#& ". audouinii#".ferrugineumpapul eritem
sktr btg rambut , bercak memucat $ bersisik, rambut abu2, tdk
berkilat, mudah patahLampu %ood: fluoresensi (&!(hi'au
kekuningan!()( *(+L,"T*)(11Ke#io( i(%# UA .207300 (&? Mik#oko"i
>KOB 10C* .0C? K!l'!# >A,%# S%1o!#o!+* Mo+i$ik%i A,%#
S%1o!#o!+?.1.2Ti(e% k%"i'i: hi0%! 'e#%(,* 1i#! kehi0%!%(Pi'i#i%i
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%#'#o"o#% +i 1%,i%( l!%# 1%'%(, #%&1!'E(+o'#ik: %#'#o"o#% +i
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&i(,,! e'el%h kli(i e&1!h?A'%!
'e#1i(%$i(>52*57250&,?.31;Malassezia furfur (bersifat
lipoflik) dapat hasilkan asam decarboxylase yang menghambat
tyrosinase hypopigmentasiPredileksi: Punggung, dada, lengan
atas!uga bisa pada tempat lain"linis : Makula hipopigmentasi atau
kecoklatan,multipel dengan s#uama halus$ampu %ood: &uoresensi
kuning keemasanMikroskopis ("'(): meat ball and
spahetti.5TerapiTopikal.ampo selenium sulfid 2,;< tiap hari
selama 2 mgg .emua golongan a=ol (micona=ol, ketokona=ol dll!.ampo
ketokona=ol 2< diulangi selama 1 hari berturutturut .olusio
terbinafin 2< 2># hr selama ? hr.istemikKetokona=ol oral 2@@
mgTiap hr slm ? hr *trakona=ol oral 2@@A@@ mgTiap hr slm1? hr
+lukona=ol A@@ mg dosis tunggal.8kandidiasiskandidiasiskebanyakan
)andida albicanskebanyakan )andida albicans (&ora normal mulut,
traktus digesti*us*agina) ,semi anaerob,mycelium:infeksi kronis
yeast :infeksi akut (&ora normal mulut, traktus
digesti*us*agina) ,semi anaerob,mycelium:infeksi kronis yeast
:infeksi akut+aerah intertrigeneus, basah:+aerah intertrigeneus,
basah:inguinal, infra mamma, perianal, interdigital, axilia,
sekitar mulut mulut, genitalsela kuku-inguinal, infra mamma,
perianal, interdigital, axilia, sekitar mulut mulut, genitalsela
kuku-.aktor /isiko:.aktor /isiko:faktor endogen dan faktor
eksogenfaktor endogen dan faktor eksogen.;'kk *andidiasisPacth
eritem yang ditutupi pseudomembran,bila diangkat nampak dasar yang
erosifK%(+i+i%i O#%lPatch eritem yang melebar, dikelilingi lesi
satelit ditengah lesi nampak erosif, di tepi lesi ter!adi
pengelupasan tanpa peninggian-K%(+i+i%i k!'%(0ampak eritem dan
edema pada kulit sekitar kuku bantal kuku (nail bed) disertai gamb
kelainan !amur kuku menebal, mengeras, berlekuk1lekuk , %arna
kecoklatan, tidak rapuh, tetap mengkilat2,tidak terdapat sisa
!aringan diba%ah kukuK%(+i+i%i k!k!.@Kandidosis se)aput )endir30Ukk
: "e!+o&e&1#%(* "!'ih* )okl%' kel%1!* el%"!' +i%(,k%' +%%#
+%#i "l%k 1%%h* ke&e#%h%( S%ki' +%( "%(% +i&!l!'* &!l!'
1%! %%&P%+% 1%/i +%( BIA AIDSTh#!h %'%! 'o&%'i'iUkk: Lei
1e('!k $i!#% "%+% !+!' &!l!'* &%e#%i* e#oi* 1%%h*+%%#
e#i'e&F%k'o# "#e+i"oii : +e$iie(i #i1o$l%-ii(Pe#le)he31Ukk:
l%1i% +%( -!l-% e#i'e&* e+e& * 'e#+%"%' $l!o# %l1!
&!ko"!#!le( G%'%l +%e#%h -!l-%P%+% DM +%( keh%&il%(A!l-o
-%,i(i'iUkk :P%"!l7"%"!l e#i'e&* "!'!l* -eikel* e#oi "%+% ,l%(
"e(i 2 !lk! ko#o(%#i!* '%&"%k hi"e#e&iEE /%(, 'i+%k +i
i#k!&i +%( &!()!l e'el%h 1e#h!1!(,%(+e(,%( 6%(i'% /%(,
'e#i($eki:%l%(o"o'i'iKandidiasis kutis32Ukk: lei eritematosus +%(
eksudasi basah# lembab* +ikelili(,i lesi satelit papularIok%i :
"%+% li"%' ke'i%k* i(,!i(%l* "%/!+%#%* i('e#,l!'e%l* i('e#+i,i'%l*
,l%( "e(i 2 !&1ilik!=N/e#i* ,%'%l * #%% 'e#1%k%#P%+% e'i%"
lii"%'%( +%( O1ei'% K%(+i+i%i k!'i i('e#'#i,i(o%Ukk: Lei
ek=ematoid, vesikel, pustul, &e(,e(%i +%e#%h /%(, l!%= Me(,e(%i
k!li' ,l%1#o%* 1i% %ki1%' "e#l!%%( k%(+i+i%i i('e#'#i,i(o%*0!,% +i
"%/!+%#%* i('e#,l!'e%l* +%( !&1ilik!= Te#0%+i "%+% 1%/i /%(,
i1!(/% &e(+e#i'% -%,i(i'i %'%! i&!(olo,ikK%(+i+i%i k!'i
,e(e#%li%'% 3.UKK: e#i'e&%* k!%&% 2 "!'!l %'eli' >kh%?*
+%"%' +ie#'%i k!%&% "%+% 'e"i(/%=A"%1il% kel%i(%( 'e#e1!'
&e(e'%"* &e(i&1!lk%( e#oi !"e#$ii%l /%(, (/e#i +ie1!'
e1%,%i er-thema of 8acBuet:oko(, 2 +%e#%h "e#i%(%l "%+% 1%/i*
1e#h!1!(,%( +e(,%( "e&%k%i%( "o"ok* Pe(/%ki' "o"ok>k%(+i+i%i
"o"ok?UKK: "%"!l hi"e#ke#%'o'ik /%(, +i'!'!"i oleh krusta tebal
ber%arna kuning kecoklatan (granuloma!. K%+%(,7k%+%(, lei
'!&1!h &e(o(0ol hi(,,% 2 )& &e(/e#!"%i tanduk. EE
"+ %(%k7%(%k= Lei !&!&(/% &e(,e(%i 6%0%h* (%&!(
+%"%' 0!,% 'i&1!l "%+% k!li' ke"%l% 1e#%&1!' >)%l"?*
0%#i '%(,%(* 1%+%(* k%ki 2 $%#i(,= G#%(!lo&%
k%(+i+%oniko"ikosis33I(-%i "%+% k!k! /%(, 'el%h o(ikolii=
:iperkeratosis subungual +,( massa abuabu kekuningan +i
1%6%h(/%k!k! menebal, mengeras, berlekuklekuk , %arna kecoklatan,
tidak rapuh* 'e'%" &e(,kil%'2*'i+%k 'e#+%"%' i% 0%#i(,%(
+i1%6%h k!k!Pe"eriksaan penun!ang Ke#ok%( k!li' %'%! !%"%(
&!kok!'%( +i"e#ik% +e(,%( l%#!'%( KOB 10C %'%! +e(,%( "e6%#(%%(
,#%&'e#lih%' el #%,i* 1l%'o"o#%* %'%! hi$% e&!=
Pe&e#ik%%( l%(,!(,Pe&e#ik%%( l%(,!(,:%h%( /%(, %k%(
+i"e#ik%k%( +i'%(%& +%l%& %,%# +ek'#o% ,l!ko% S%1o!#%!+=
Pe#1e(ih%( +ii&"%( +%l%& !h! k%&%# %'%! le&%#i !h!
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