TINEA CORPORISNurotus Saniyah G9911112115
Pembimbing: Dr. Nugrohoaji Dharmawan, SpKK, M.Kes
SYNONIMS
Tinea circinata Tinea glabrosa Schrende Fletche Herpes circine trichophytique Ringworm of the body Kurap
DEFINITIONTinea corporis All dermatophytosis of glaborous skin (facial, body, upper and lower extremity)
Dermatophytosis
disease caused by dermatophyte
A group of taxonomically related fungi that has ability to form molecular attachments to keratin and use it as a source of nutrients allow s them to colonize keratinized tissues, including the stratum corneum of epidermis, hair, and nails.
EPIDEMIOLOGY All age Man:Woman = 1:1 Usually occurred in areas with high humidity Depends on body and environment hygiene
ETIOLOGYMycrosporum
Dermatophytes
Epidermophyton
Tricophyton
Tinea Corporis
T. rubrum, T. mentagrophytes, M. canis, T. tonsurans
PATHOGENESISadherence
3 main steps
penetration
Development of a host respons
Adherence
Dermatophytes must overcome several obstacles (UV light, variation of temperature and moisture, and competition from normal flora) in order to adhere to keratinized tissue
Penetration
Secretion of keratinase enzyme by dermatophytes that will invate stratum korneum and keratin to provides a source of nutrition for the dermatophytes
Development of host response
To create clinical symptoms, the dermatophytes must overcome non spesifik and spesifik immune of the host
SIGN AND SYMPTOMSMany variants The classic presentation : annular lesion with scale across the entire erythematous border, some lesions are often confluented. Lesion: Erythematous with skuama, centra healing Erosion and crusta sometimes appear caused by scratching of the skin Itchy, especially when the patient is sweating
LABORATORY STUDIES
Skin scraping with KOH 10-20% hyphae or fungis spore
DIAGNOSISFrom the clinical manifestation Add the laboratories finding
DIFFERENTIAL DIAGNOSISDermatitis seborroik Psoriasis Morbus Hansen Pitiriasis Rosea Dermatitis Numularis Candidiasis Neurodermatitis Circumscripta
TREATMENT : NON MEDIKAMENTOSAEducation for increase body and environment hygiene Recommend for avoiding tight and non sweat absorbable clothing
TREATMENT : MEDIKAMENTOSATopical Systemic
Derivat imidazole (mikonazole, klotrimazole, tiokonazole, ketokonazole) Derivat alilamin (terbinafin, naftitin HCl)
Griseofulvin1st line Itrakonazol
Broad Fungisid Fungistatic Non hepatotoxic
Ketokonazole
Flukonazole
PROGNOSISWith proper treatment Commonly are good Important to prevent re-infection
CASE REPORTName Age Sex Address
: Mrs. M : 56 years old : woman : Griyan RT 2/1 baturan Colomadu, Karanganyar Date of inspection : 29 May 2012 Number of MR : 01121232
CHIEF OF COMPLAIN
Feeling itch in the upper arm and back
HISTORY OF DISEASE
Approximately 1 year before goes to hospital, the patient complain some lesions at upper arm, then she lubricates some aloe vera to the lesions. After that the lesion become itchy and spread to the back. Previously, patient checked up at the puskesmas for 6 times. She got mikonazole zalf, after that the complain reduced but not totally healed.
HISTORY OF PREVIOUS DISEASEHistory of similar disease History of food allergy History of drug allergy History of hypertension History of DM History of atopic : (-) : (-) : (-) : (-) : (-) : (+)
HISTORY OF FAMILY DISEASEHistory of similar disease History of food allergy History of drug allergy : (-) : (-) : (-)
HISTORY OF HABITThe patient usually take a bath 2 times for a day with the soap and using different towel with other family. The patient often scratch her skin when she feels itch.
PHYSICAL EXAMINATIONA. Generalis status Generally
Head Face Neck Back Axilla Thorax Abdomen Gluteus Upper extremity Lower extremity
: good, compos mentis, sufficient nutrient impressive : normally : normally : normally : look at dermatology status : look at dermatology status : normally : normally : normally : look at dermatology status : normally
DERMATOLOGY STATUSRegio upper extremity, axilla, and thorax posterior (back): some macula erythematous lesions with skuama and centra healing.
SKIN SCRAPING WITH KOH LONG HYPHAE
DIFFERENTIALDIAGNOSIS Tinea corporis Psoriasis vulgaris Pitiriasis rosea
DIAGNOSIS
Tinea corporis
TREATMENT Non medikamentosa o keep the hygiene of body, clothes, and environment o Keep the lesion area away from sweat and high humidity condition o Use different towel with other families o Not scratch the skin Medikamentosa o Ketokonazole 2x200 mg (for 14 days) o Cetirizin 1x10 mg (for 7 days, if the patient feels itch) o Miconazole cream gr 50
PROGNOSE Ad vitam ad sanam Ad functional Ad cosmeticum
: good : good : good : good
