Keloid Ricki

7/23/2019 Keloid Ricki

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AMANDA RICKI(110 2011023)

P EM B IM B IN G : DR . HEN RY M O ES FA IR I LSP.B

KELOID

CASE REPORT



IDENTITAS PASIEN

Nama : Ny. YSM

Umur : 36 tahun

Jen! "e#amn : Perem$uan

A%ama : I!#am

Statu! $er"a&nan : Men"ah

Pen''"an Tera"hr : SMP

Pe"er(aan : I)u Rumah Tan%%a

N*. RM : +3,-3

A#amat : Cn%/n Permata In'ah 0#*" 1 26 Rt+6

Ke/S*rean% Ka). 0an'un%

Tan%%a# $emer"!aan : 43 N*5em)er 4,+



Keluh! "#$

• Be!%&l! ' &*&!+ *!!

R,-# Pe!*,# Se*/!+

• P,e! #!+ *e '&l,*l,!,* eh RS"D S&/e!+e!+! *eluh! e!%&l! &*&!+. P,e!$e!+#*! e!%&l! uh #e/l,h# e%* 1#hu! !+ llu. A-l! e!%&l! #e/eu#e/u*u/! *e,l !$u! l$ *el$! u*u/!e!%&l! $*,! $e$e/. Seelu$! 'e/!h u*u/! *e,l !$u! h,l!+ e!+!

e!,/,!. Ne/, #e*! +#l ,!+*l &leh',e!. Seelu$! e/&# *e Pu*e$!$u! /, &*#e/ Pu*e$ $e!%el*!h- e!%&l! ',e! 'e/lu 'e!!+!! le,hl!%u# eh,!++ ',e! , /u%u* *e RS"D

S&/e!+. Keluh! #,* ,e/#, '! !



R,-# Pe!*,# 4e/hulu• P,e! 'e/!h 'u! /,-# e!%&l! !+

$ e!+! u*u/! *e,l !$u! h,l!+e!+! e!,/,!. 4,* /,-# DM

h,'e/#e!, le/+, $u'u! $.

R,-# Kelu/+

•R,-# 'e!*,# e/u' ' *elu/+ #,*



S 4 A 4 " S

G E

N E R A L I S

• Ke/!: C&$'&$e!#,

• 4! 5,#l :

• 4D 6 110780 $$H+• RR 6 20 97$e!,#• N 6 ; 97$e!,#• S 6 3;3 0C• BB 6 2< *+

• Mata : K&!%u!+#,5!e$, (=) *le/ ,*#e/,*(=)

• Leher : Kele!%/ Ge#hBe!,!+ #,* #e/$

• Th*ra7: >BS *6*, Rh=7= ?h =7=

• A)'*men: e$u!+&e'el B" (@) H7L #,*#e/ $

• E"!tremta!: A*/lh!+# ',ll/ /ell

S 4 A 4 " S

L O K A

L I S

• In!$e"!:•

4$'* e!%&l!' &*&!+ *!!.?/! le,h $e/h*eh,#$! /,'*ul,# e*,#/!

u*u/! <91 !391$.• Pa#$a!:• 4e/ e!%&l!

e!+! *&!,#e!,

lu!* # #e+.!e/, (@).



A7R GL"4EALIS DE4RA



RESUME

Pa!en 'atan% "e RS 'en%an "e#uhan )en(*#an yan% ma"nmem)e!ar )*"*n% "anan. Pa!en men%a"u )en(*#an ter!e)ut!u'ah ter'a$at !e(a" , tahun yan% #a#u. 0en(*#an t'a" tera!anyer 'an )er&arna )ru. Pernah $unya )en(*#an "e/# namunh#an% 'en%an !en'rnya. Pa'a $emer"!aan ter#hat a'anya)en(*#an )er&arna )ru tua 'an tera)a )eru"uran +7, 'an 37,m*)#e "*n!!ten! #una" $ermu"aan rata 'an nyer te"an $a'a

'aerah )en(*#an 89



DIA1NOSIS 0ANDIN1

Ke#*'

Jarn%an $arut h$ertr*;

Dermat*;)r*ma



DIA1NOSIS KERJA

Ke#*' ar 1#utea#! De7tra



PENATALAKSANAAN

0*$! e"!!



PRO1NOSA

<u* a' 5tam : a' )*nam

<u* a' =un/t*nam : a' )*nam

<u* a' !anat*nam : a' )*nam



NJAUAN PUSTAK



ANATOMI DAN >ISIOLO1I KULIT





,. Stratum "*rneum 8#a$!an tan'u"

La$!an $a#n% #uar

Se# %e$en%? t'a" )ernt

Pr*t*$#a!ma )eru)ah men(a' @at "eratn8@at tan'u"

. Stratum #u!'um

Ter#eta" ')a&ah !tratum "*rneum

Se# %e$en%? t'a" )ernt

Pr*t*$#a!ma )eru)ah men(a' $r*ten

8e#e'n3. Stratum %ranu#*!um 8#a$!an "erat*ha#n

atau 3 #a$! !e# %e$en% 'en%an !t*$#a!ma)er)utr "a!ar nt 'antaranya

0utr "a!ar ter'r 'ar "erat*ha#n



2. Stratum !$n*!um 8!tratum ma#$h%atau $r/"#e /e## #ayer 8#a$!an a"anta

Se# )er)entu" $*#%*na#

Pr*t*$#a!ma (ernh 8men%an'un%)anya" %#"*%en

Se# !ema"n %e$en% )#a 'e"at$ermu"aan

ter'a$at nter/e##u##ar )r'%e? n*'u#u!)@@*@er*? !e# #an%erhan!

+. Stratum )a!a#!Se# "*#umnar 8"u)*' 'an !e#

me#an*!t

Se# )a!a# )ermt*!! 'an )er=un%!

re$r*'u"t=



KELOID

/,!+! '/u# *,# lu* #u #/u$ !+

e/*e$!+ e/le,h! $e!,$ul ! $ele,h,u*u/! lu* #u #/u$ !+ #e/%,.



EPIDEMIOLOGI

Le)h !ern% ter(a' $a'a "u#t htam

An%"a "e(a'an "e#*' $a'a &anta 'an $raa'a#ah !ama

Sern% tm)u# $a'a $en'erta yan%men%a#am #u"a )a"ar $arah 'an ' #*"a!5a"!na!.



E # , & l & +

, Ge!e#,*

4/u$ *ul,#



PA4OGENESIS

Pr*!e! ter)entu"nya "e#*' )erhu)un%an 'en%an $r*!e!$enyem)uhan #u"a

Ke#*' 'a$at ter(a' 'a#am (an%"a &a"tu !atu )u#an !am$a!atu tahun !ete#ah trauma atau nBama!

Trauma "u#t $a'a 'erm! ret"u#er atau #a$!an "u#t #e)h'a#am #a% /en'erun% )er$*ten! men(a' !"ar h$ertr*;"'an "e#*'



PROSES PENYEMB"HAN L"KA

Sete#ah ter(a' trauma#u"a? $a'a #*"a! #u"a ter(a' 'e%ranu#a!$#ate#et? a"t=a! =a"t*r $em)e"uan 'an "*m$#emen?men%a")at"an $em)entu"an )e"uan ;)rn untu" hem*!ta!!.

0e"uan n !e#an(utnya )er$eran !e)a%a ran%"a untu"

$enyem)uhan #u"a.

De%ranu#a! $#ate#et menye)a)"an $e#e$a!an 'an a"t=a! !t*"n$*ten terma!u" transforming growth factor 9 8T1>9? epidermalgrowth factor 8E1>? insulin like growth factor-1 8I1>9, 'an platelet-derived growth factor 8PD1>. Growth factor )er=un%!

mere"rut 'an men%a"t="an !e# netr*;#? e$te#? en'*te# ma"r*=a%?!e# ma!t 'an ;)r*)#a!.



>)r*)#a! yan% ter'a$at $a'a "e#*' mem$r*'u"! type I procollagen !e/ara )er#e)han

ter'a$at "*#a%en 'a#am (um#ah )anya".

Se#an tu >)r*)#a! Ke#*' 8>K (u%a men%ha!#"an e#a!tn?;)r*ne"tn? 'an $r*te*%#"an !erta /h*n'r*tn 2 !u#=at 8C2S#e)h )anya" ')an'n% ;)r*)#a! n*rma#. >)r*)#a! "e#*'men%ha!#"an "*#a%en t$e I 'an mem#" "a$a!ta! untu")er$r*#=era! 4 "a# #e)h )e!ar ')an'n%"an 'en%an;)r*)#a! n*rma#



MANIFES4ASI KLINIS

n*'u# ;)r*!a? $a$u# atau $#a"? "era!? e#a!t!? )er"#at? t'a"teratur? )er)ata! te%a!? ter'a$at te#an%e"ta!! 'an)er&arna merah mu'a? merah !am$a /*"#at %e#a$.

!ern% ter'a$at ra!a %ata# 'an nyer.

Pemer"!aan h!t*$at*#*%! menun(u""an a'anya ha#n!a!!era)ut "*#a%en yan% ter!u!un me#n%"ar











DIAGNOSIS

0er'a!ar"an %am)aran "#n! :

K*n!!ten! "e#*' yan% )er5ara! 'ar #una"? !e$ert"aret !am$a "era!.

Le! a&a# )a!anya "emerahan.

Le! men(a' merah "e/*"#atan atau !e$ert &arna'a%n%.

Le! )a!anya t'a" men%an'un% =*#"e# ram)ut atau$un"e#en(ar a'ne"!a #annya



DD

S/ar hy$ertr*$hy Dermat*;)r*ma Ke#*'

e/ '/u# eu,

e!+! lu*!

N&ul *e,l e!+!

u*u/! 3=10 $$

4,* '# $e!+e,l

'e/#u$uh! *e#($e!&!%&l) %/,!+!'/u# ,!, #,*$ele-#, # #e',lu*

Be!#u*! '#e/u' ''ul 'l*#u !&ul ##e+ $e!e#'l$ *ul,# !'# ,#e*! *e-h #u e,*,#$e!,!++,

Be/*e$!+$ele-#, # -l/, lu*

#,$ul e+e/ e#elhlu* ,! $,!++u ! *!$e!+l$, /e+/e,

Su#u #! *l,!,*h ,#u ,$'le,+! #uF,#'#/,* ,+!*!, %,* ,, l#e/l,#e*! $* *!$e$e!#u*

, e/h #e/!u$hu u',!+ #el,!+',!++!+ ! -%h



SCAR HYPER4ROPHY



DERMA4OFIBROMA



PENA4ALAKSANAAN

In(e"! "*rt"*!ter*' ntra#e!

)e'ah e"!!+9Bu*ru*ra!#

Cryotherapy

La!er

Ra'a!

Silicone gel sheeting



KOR4IKOS4EROID IN4RALESI

Mu'ah '"er(a"an

Men%nh)! $ertum)uhan ;)r*)#a! 'an $r*'u"! me'at*rnBama!? men%uran% !nte!! "*#a%en 'an men%u)ah!nte!! %#y"*!amn*%#"an !ehn%%a men%uran% (um#ah

"*#a%en $a'a "e#*'.

Se/ara "#n! men%uran% ra!a %ata#? me#em)ut"an 'anmerata"an #e!.

Tram!n*#*n a!et*n' ntra#e! meru$a"an (en! !ter*' yan%!ern% '%una"an. Da$at '"*m)na! 'en%an tera$ #anuntu" menn%"at"an re!$*n 'an e;"a! tera$



D*!! yan% '%una"an untu" "*t"*!ter*' ntra#e! ,4924 m%mL'en%an nter5a# 296 mn%%u 'an )ata! '*!! $er)u#an 'artram!n*#*n a!et*n' a'a#ah 4 m%

E=e" !am$n% "*rt"*!ter*' ntra#e! yan% )!a mun/u#terma!u" h$er9h$*$%menta!? atr*$? 'an te#an%e"ta!





BEDAH EKSISI

Pem)e'ahan '$er#u"an !e)a%a tera$ #n "e'ua untu" #e!yan% t'a" )ere!$*n terha'a$ tera$ #an.

0e'ah e"!! (u%a '#a"u"an $a'a #e! "e#*' yan% #ua!!ehn%%a mem)utuh"an debulking #e)h 'ahu#u !e)e#umtera$ #an '#a"u"an.

KIL untu" menurun"an re"uren! 'a$at '#a"u"an $a'a mn%%u $*!t e"!!

A#ternat= m*n*tera$ : mum*' t*$"a# 'an ra'a!



< FL"ORO"RACIL (<=F")

meru$a"an ana#*% $rm'n yan% )anya" '%una"an 'a#am$en%*)atan "an"er 'an %#au"*ma.

Da#am !e# +9>U '"*n5er!"an men(a' !u)!trat a"t= yan%men%ham)at !nte!! DNA 'en%an /ara "*m$ett= terha'a$$en%%a)un%an ura!#. Pene#tan ter)aru men'a$at"an)ah&a +9>U mem#" e;"a! yan% )a" untu" menan%an

"e#*'. Kemam$uan +9>U untu" untu" men%%an%%u TG-bsignaling meru$a"an 'a!ar $en%%unaan +9>U untu"men%ham)at $em)entu"an "e#*'



E=e" !am$n% yan% !ern% ter(a' a'a#ah nyer ' #*"a! n(e"!?u#!era! 'an ra!a ter)a"ar

Karena tera$ +9>U !!tem" 'hu)un%"an 'en%an anema?#eu"*$ena 'an tr*m)*!t*$ena? ma"a $a!en haru!'m*nt*r %am)aran 'arah te$nya !e/ara "etat. Tera$men%%una"an +9>U (u"a t'a" 'an(ur"an untu" &anta ham#atau menyu!u 'an $a'a $a!en 'en%an bone marrowsuppression



KOMPLIKASI

Trauma $a'a "e#*' 'a$at menye)a)"an er*! #e! 'an men(a'!aran% n=e"! )a"ter.

Re"uren!

Stre!! $!"*#*%" ("a "e#*' !an%at #ua! 'an menm)u#"an/a/at.



PENCE1AFAN

,. Fn'ar %era"an )er#e)han yan% 'a$at mere%an%"an #u"a

. 1una"an $er)an 'an "an $em)a#ut #u"a 'en%an te$at.3. Fn'ar"an #u"a 'ar 'aya me"an! #an%!un% 8m!a#nya

%e!e"an 'an %aru"an

2. 1una"an gel sheeting 'an $#e!ter $ere"at.

+. Untu" $a!en 'en%an #u"a ' te#n%a? "uran% "*nta"

'en%an )anta# "et"a t'ur?untu" men/e%ah %e!e"an.6. Untu" $a!en &anta 'en%an #u"a ' 'a'a? %una"an )ra 'an

$a"aan 'a#am "etat untu" men/e%ah re%an%an "u#t yan%'!e)a)"an *#eh )erat $ayu'ara.

-. Untu" $a!en 'en%an #u"a ' !u$ra $u)"? 'an(ur"an untu"mema"a "*r!et.

. Sete#ah $em)e'ahan 'an trauma? #u"a yan% ter(a' haru!'(a%a teta$ )er!h 'en%an/ara me#a"u"an rr%a! 'anmen%*#e!"an *)at ant)a"ter atau ant (amur.

G. Sete#ah $em)e'ahan 'an trauma? hn'ar "*nta" antara'erm! 'aerah #u"a 8terma!u" #u)an% tn'" te#n%a'en%an )en'a a!n%.

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Keloid Ricki