Dermatitis Perioral
February 26, 2019 | Author: Nurulmukhlisahismail Manyumnyatiganoldua Siikeonknyonya | Category: N/A
Short Description
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Description
LAPORAN TUTORIAL
DERMATITIS DERMATITIS PERIORAL BLOK INDRA KHUSUS
DISUSUN OLEH : Nama
: Nurul Mukhlisah Ismail Ismail
No. Registrasi
: 13 – 777 !"#
FAKULTAS KEDOKTERAN UNIVERSITAS ALKHAIRAAT PALU 2015
DAFTAR ISI
1.
De$i%isi
&.
E'i(emiologi
3.
)lasi$ikasi
#.
Etio'atoge%esis
*.
+am,ara% )li%is
-.
Deraat (ermatitis 'erioral
7.
Diag%osis /a%(i%g
0.
atalaksa%a
".
)om'likasi
1!.
2rog%osis
D4R 2US)
DAFTAR GAMBAR
+am,ar 1. Lokasi (ermatitis 'erioral +am,ar &. 5IRD (a% (ermatitis 'erioral i(io'atik +am,ar 3. Granulomatous periorificial dermatitis +am,ar #. Dermatitis 'erioral +am,ar *. Dermatitis 'erioral 'a(a a%ak +am,ar -. Granulomatous periorificial dermatitis +am,ar 7. 5o%toh Skori%g 2ODSI +am,ar 0. lgoritma tera'i
DAFTAR TABEL
a,el 1. Distri,usi lokasi lesi (ermatitis 'erioral a,el &. Perioral dermatitis severity index a,el 3. Diag%osis ,a%(i%g (ermatitis 'erioral a,el #. era'i $armakologis (ermatitis 'erioral
PENDAHULUAN
2erioral (ermatitis a(alah ,e%tuk lesi kulit 6a%g tam'ak se,agai 'a'uloeritema (a% 'ustule 6a%g tim,ul (isekitar mulut. 2erioral (ermatitis seri%g tam'ak se'erti ak%e ulgaris8 rosa9ea (a% (ermatitis se,oroik. 2e%6e,a, 'erioral (ermatitis hi%gga ki%i masih ,elum (iketahui (e%ga% elas8 %amu% ter(a'at ,e,era'a $aktor 'e%ti%g 6a%g telah (iketahui ,erhu,u%ga% erat (e%ga% tim,ul%6a 'erioral (ermatitis a%tara lai% orga%isme 'atoge%ik i%$eksius8 $aktor hormo%al8 'e%ggu%aa% o,ato,ata% steroi( to'ikal (a% 'a'ara% at kimia se'erti 'asta gigi 6a%g me%ga%(u%g $luor. 2erioral (ermatitis 'ertama kali (i(e$i%isika% 'a(a sekitar akhir 1"*! 1"-!. 2a(a era terse,ut 'e%ggu%aa% 'asta gigi ,er$luori(e (a% kortikosteroi( to'i9al mulai terse(ia (a% (igu%aka% se9ara luas. 2a(a saat itu ,a%6ak (okter merese'ka% o,at kortikosteroi( to'i9al kuat 6a%g (igu%aka% 'a(a kulit ;aah se(a%gka% e$ek sam'i%g (ari o,at terse,ut ,elum (iketahui. 2erioral (ermatitis seri%g tera(i 'a(a (ua kelom'ok usia a%tara lai% a%aka%ak ,erusia - ,ula% sam'ai 1- tahu% ,aik lakilaki mau'u% 'erem'ua% (a% ;a%ita ,erusia 17 tahu% sam'ai #* tahu%. Dalam se,uah stu(i (i(a'atka% ,ah;a 71 (ari 73 'asie% telah me%ggu%aka% kortikosteroi( (e%ga% $luori% se,elum tim,ul%6a o%set 'erioral (ermatitis. Dalam stu(i lai%%6a 'a(a a%aka%ak mau'u% (e;asa uga (i(a'atka% a(a%6a ri;a6at 'e%ggu%aa% kortikosteroi( to'i9al se,a%6ak 7&< (ari total kasus 'erioral (ermatitis. (a%6a ka%(u%ga% $luori(e uga (iketahui mem'u%6ai keterli,ata% (alam tim,ul%6a 'erioral (ermatitis. Dalam suatu 'e%elitia% 6a%g meli,atka% -* 'asie% 'e%(erita 'erioral (ermatitis
(ima%a kesemua%6a
meru'aka% 'e%ggu%a 'asta gigi ,er$luori(e (ilakuka% 'e%gga%tia% (e%ga% 'asta gigi ta%'a $luori(e (a% hasil%6a sete%gah (ari umlah 'asie% terse,ut me%galami 'er,aika%. De$i%isi 'erioral (ermatitis ki%i (i'erluas me%a(i 'erio$i9ial (ermatitis seiri%g ,a%6ak%6a uga lesi kulit 'a(a area 'eri%asal (a% 'erior,ital.
1. Definisi
Dermatitis 'erioral meru'aka% ,e%tuk i%$lamasi kulit 6a%g terlihat se,agai 'a'uloeritema8 esikel (a% 'ustula 6a%g tim,ul terlokalisasi (isekitar mulut8 hi(u%g atau'u% mata. Dermatitis 'erioral meru'aka% si%o%im (ari rosacea – like dermatitis.
2. Epie!i"#"$i
I%si(e%si (ermatitis 'erioral terhitu%g me%9a'ai !8* – 1< (i %egara i%(ustri8 terga%tu%g (ari $aktor geogra$is 6a%g a(a. Di =erma% (i(a'atka% -< ;a%ita 6a%g ,erku%u%g u%tuk melakuka% 'emeriksaa% kesehata% kulit me%galami (ermatitis 'erioral8 se(a%gka% ha%6a !83< lakilaki saa 6a%g me%galami (ermatitis 'erioral. /er(asarka% hasil 'e%elitia% se,elum%6a8 'a(a a%aka%ak 6a%g me%(erita asma a%gka kea(ia% (ari (ermatitis 'erioral i%i ter9atat se,a%6ak 3< ,erasal (ari kelom'ok umur - ,ula% – 10 tahu%. Selai% itu8 me%urut hasil 'e%elitia% terha(a' lokasi lesi (ermatitis 'erioral (i(a'atka% sekitar &!< (ari kasus tiak tera(i 'a(a 'erioral >ta,el 1?.
+am,ar 1. Lokasi (ermatitis 'a(a 'eri%asal (a% 'erior,ital
a,el 1. Distri,usi lokasi lesi (ermatitis 'erioral 2erioral 3"< 2eri%asal
13<
2eriokular
1<
2erioral (a% 'eri%asal
1#<
2erioral (a% 'eriokular
-<
2eri%asal (a% 'eriokular
-<
2erioral8 'eri%asal8 (a% 'eriokkular
1!<
%. K#&sifi'&si
/er(asarka% 'e%6e,a,%6a (ermatitis 'erioral se9ara garis ,esar (a'at (i,e(aka% me%a(i (ermatitis 'erioral 6a%g ,erhu,u%ga% (e%ga% 'e%ggu%aa% kortikosteroi( to'ikal 6a%g meru'aka% su,ti'e (ari 5IRD >corticosteroid-induced rosacea-like dermatitis? mau'u% 6a%g ti(ak ,erhu,u%ga% (e%ga% 'e%ggu%aa% kortikosteroi( to'ikal > Idiopathic dermatitis perioral ? . 5IRD mem'u%6a tiga su,ti'e 6a%g (i,agi ,er(asarka% lokasi a%atomi a%tara lai% 'erioral8 9e%tro$a9ial8 (a% diffuse. Dermatitis 'erioral 6a%g meru'aka% su,ti'e (ari 5IRD meru'aka% su,ti'e 'ali%g seri%g tera(i 'a(a (e;asa (a% a%aka%ak. 2a(a ,e,era'a kasus uga tera(i 'a(a 'eri%asal (a% 'eriokular. 2a(a su,ti'e 9e%tro$a9ial tera(i 'a(a 'i'i ,agia% (alam8 kelo'ak mata ,agia% (alam8 hi(u%g (a% (ahi. 2a(a su,ti'e diffuse tera(i 'a(a seluruh ;aah (a% seri%gkali meluas sam'ai ke leher. a.
,.
+am,ar &. a.Cortikosteroid induced perioral dermatitis@ ,. (ermatitis 'erioral i(io'atik
Dermatitis 'erioral i(io'atik ,iasa%6a le,ih seri%g tera(i 'a(a 'asie% ;a%ita ,erusia &! – #* tahu% meski'u% (a'at uga tera(i 'a(a 'ria. Dermatitis 'erioral i(io'atik uga tera(i 'a(a a%aka%ak ta%'a a(a%6a (omi%asi ge%(er. er(a'at aria% lai%%6a (ari (ermatitis 'erioral i(io'atik 6aitu granulomatous periorificial dermatitis
atau
Facial
Afro-Caribbean
Childhood
ruption
>45E?.
Granulomatous periorificial dermatitis 'ali%g seri%g tera(i 'a(a a%aka%ak ras $rikamerika
(a%
mu%gki%
uga
,erhu,u%ga%
(e%ga%
'e%ggu%aa%
kortikosteroi( to'ikal. Dermatitis 'erioral i(io'atik ti(ak (i'e%garuhi oleh 'e%ggu%aa% 'asta gigi ,er$luori(e8 'emakaia% kosmetik (a% 'elem,a,8 stress emosio%al8 (a% age% mikro,iologi. Granulomatous periorificial dermatitis le,ih seri%g tera(i 'a(a a%aka%ak 're'u,ertas. 2a(a 'asie% (e%ga% granulomatous periorificial dermatitis ter(a'at lesi eru'si 'a'ular 6a%g ,iasa%6a ,erukura% 1 – 3 mm ter(a'at (i sekitar mulut8 hi(u%g (a% mata. 2a(a 'emeriksaa% histo'atologi me%u%ukka% 'ola gra%ulomatus8 ter(a'at i%$iltrat gra%ulomatosa 'eri$olikular 6a%g ter(iri (ari sel makro$ag e'itel8 lim$osit (a% giant sel. Granulomatous periorificial dermatitis meru'aka% kea(aa% self-limited (a% ti(ak terlalu mem,utuhka% tera'i khusus.
+am,ar 3 Granulomatous periorificial dermatisis
(. E)i"#"$i &n P&)"fisi"#"$i
2e%6e,a, 'asti (ermatitis 'erioral ,elum (iketahui (e%ga% elas. 2e%6e,a, terseri%g 6a%g seri%g teri(e%ti$ikasi a(alah 'e%ggu%aa% kortikosteroi( to'ikal 'a(a
;aah. Dermatitis 'erioral uga ,isa (ise,a,ka% kare%a 'e%ggu%aa% o,at kortikosteroi( i%halasi (a% kortikosteroi( sistemik.
2e%6e,a, lai% 6a%g
memu%gki%ka% (a'at me%6e,a,ka% (ermatitis 'erioral a(alah kulit keri%g. 2e%ggu%aa% kosmetik8 moisturi!ing cream8 (a% 'asta gigi 6a%g me%ga%(u%g $luori(e. Dermatitis 'erioral tim,ul aki,at reaksi 'e%olaka% (ari kulit ;aah terha(a' iritasi. )elai%a% 6a%g sama uga (a'at tim,ul 'a(a (aerah lai%8 terutama 'eriokular > periocular dermatitis?. 2e%ggu%aa% kosmetik ;aah se'erti 'em,ersih atau'u% krim kulit ;aah (a'at me%6e,a,ka% iritasi kulit ;aah. /ersamaa% (e%ga% itu8 ke,a%6aka% (ari 'asie% memiliki kelai%a% ato'i. 2a(a $ase a;al8 aki,at 'e%ggu%aa% o,at to'ikal 'a(a ;aah aka% me%gi%(uksi ga%ggua% $u%gsi la'isa% e'i(ermis. Hal i%i aka% me%6e,a,ka% 'em,e%gkaka% stratum kor%eum 6a%g (isertai ga%ggua% mi%imal 'a(a $u%gsi la'isa% kulit (a% me%i%gkat%6a kehila%ga% 9aira% tra%se'i(ermal >transepidermal "ater loss?. )emu(ia% (a'at me%6e,a,ka% la'isa% kulit me%a(i le,ih tega%g (a% keri%g 6a%g me%(esak ari%ga% sekitar%6a aki,at kom'e%sasi 'e%ggu%aa% o,at to'ikal. 2e%ggu%aa% kortikosteroi(8 terutama to'ikal kortikosteroi(8 sa%gat ,erkaita% erat (e%ga% 'eru,aha% 'a(a struktur e'i(ermis (a% 'ermea,ilitas mem,ra% e'i(ermis8 termasuk uga ,ere$ek 'a(a 'e%uru%a% (e%sitas (a% maturasi 'em,e%tuka% ,a(a% lamellar8 e$ek lai% 6a%g tera(i a(alah 'e%uru%a% si%tesis e%im oleh la'isa% e'i(ermal8 'e%uru%a% kerati%osit (a% 'e%i'isa% la'isa% e'i(ermal. 2eru,aha% 'a(a e'i(ermal (a% (ermal termasuk 'e%i'isa% stratum kor%eum (ita%(ai (e%ga% hila%g%6a matriks 'a(a la'isa% e'i(ermal8 'e%ge9ila% gra%ular8 'e%i%gkata% EAL8 'e%uru%a% kolage% (ermal8 'e%i'isa% ,agia% atas serat elasti% (ermal8 'e%guraia% lemak e'i(ermal termasuk 9erami( (a% a(a%6a res'o% hi'erse%sitiitas ti'e IB. 2a(a 'asie% (e%ga% kasus (ermatitis 'erioral (a% ri;a6at (ermatitis ato'ik8 memiliki ta%(a a,%ormalitas 'a(a stratum kor%eum 6a%g ,erhu,u%ga% (e%ga% (ermatitis ato'ik (a% kulit ato'ik 6a%g ,ere$ek tera(i%6a 'e%uru%a% su,$raksi ceramid s'esi$ik (a% lemak lai%%6a (a% (alam ,e,era'a kasus8 tera(i mutasi 'a(a ge% $illagri% me%6e,a,ka% tera(i%6a 'e%uru%a% $aktor 'elem,a, alami8
'e%i%gkata% EAL ;aah 6a%g meru'aka% karaktristik utama (ari (ermatitis 'erioral (e%ga% ato'ik (iatesis 6a%g (i6aki%i se,agai $aktor resiko 6a%g mu%gki% 'a(a 'erkem,a%ga% (ermatitis 'erioral. ta%(a (a% geala (ari aki,at se%sititiitas (ari kulit ;aah 6a%g a(a termasuk kulit keri%g8 skuama8 e(ema8 'riritus8 se%sasi 'a%as8 rasa ter,akar (a% %6eri. 2e%ggu%aa% to'ikal kortikosteroi( ,erke'a%a%ga% me%6e,a,ka% ,e,era'a 'eru,aha% $u%gsio%al (a% ,iologi 'a(a kulit8 hal i%i (a'at me%6e,a,ka% res'o% 'a(a kulit sehi%gga me%im,ulka% 'e%uru%a% si%tesis kolage% (a% elasti% serta me%6e,a,ka% (egra(asi matriks (ermal (e%ga% 'e%uru%a% struktur 'e%(uku%g 'em,uluh (arah su'er$isial 6a%g me%6e,a,ka% aso(ilatasi 'a(a kulit8 gam,ara% i%i (a'at (ilihat se9ara kli%is se,agai tela%gietaksis (a% eritema (i$$usa. 2e%ggu%aa% to'ikal kortikosteroi( uga (a'at me%gga%ggu keseim,a%ga% homeostasis (ari me(iator kimia;i 6a%g meru,ah alira% (arah kuta%eus 6a%g meru'aka% $aktor 'atoge%esis utama (ari (ermatitis 'erioral. Hal utama 6a%g me%6e,a,ka% eksaser,asi (ermatitis 'erioral 6a%g (iikuti (isko%ti%uitas (ari 'emakaia% to'ikal kortikosteroi( se9ara ti(ak teratur 6a%g tam'ak terlihat 'a(a akumulasi oksi(a %itrat e%(otel >eNO? kulit 6a%g me%gaki,atka% (ilatasi ,erle,iha% (ari 'em,uluh (arah kulit selai% itu eNO uga (ise,ut se,agai $aktor relaksasi e%(otel ,a;aa% 6a%g meru'aka% aso(ilator e%(oge% 6a%g (iham,at oleh glukokortikosteroi( termasuk uga 'e%ggu%aa% to'ikal
kortikosteroi(.
Selama
'e%ggu%aa% to'ikal
kortikosteroi(8
tim,ul
asoko%triksi (a% me%gham,at 'ele'asa% eNO 6a%g me%6e,a,ka% (ilatasi ,erle,ih 'a(a askular8 se,agai hasil%6a tim,ulah geala kli%is se'erti eritem8 e(ema8 (a% geala lai%6a. Hal itu %a%ti%6a (a'at me%6e,a,ka% aso(iltasi 6a%g me%eta' sehi%gga tim,ul C#rampoline ffect$ atau C %eon signC. Etiologi 6a%g 'ali%g mu%gki% me%6e,a,ka% (ermatitis 'erioral i(io'atik termasuk 'asta gigi ,er$luori(e8 'e%ggu%aa% krim 'elem,a, (a% kosmetik ,erle,ih8 stress emosio%al (a% $aktor mikro,iologi. /agaima%a'u% etiologi 6a%g (ise,utka% (iatas masih se,agai s'ekulasi8 (a% ti(ak a(a $aktor (iatas 6a%g 'er%ah ter,ukti ,erhu,u%ga%. 2a(a akhir%6a me%a(i li%gkara% seta%8 me%6e,a,ka% iritasi (a% kulit semaki% keri%g ,ila (e%ga% 'e%ggu%aa% o,at to'ikal le,ih la %ut. Reaksi i%$lamasi
6a%g (itim,ulka% 'a(a akhir%6a (a'at me%garah ke $ase kli%is (ermatitis 'erioral. Oleh kare%a itu 'e%ggu%aa% kortikosteroi( to'ikal me%a(i ko%trai%(ikasi 'a(a (ermatitis 'erioral kare%a (a'at me%i%gkatka% ga%ggua% 'a(a la'isa% e'itel.
5. G&!*&+&n '#inis
)arakteristik%6a a(alah keterli,ata% (aerah sekitar mulut (e%ga% lesi ke9il. Seri%g uga meli,atka% li'ata% %asola,ial8 'i'i serta ke(ua kelo'ak mata 6a%g terlihat simetris. erga%tu%g 'a(a (eraat kli%is8 (ermatitis 'erioral (a'at meluas hi%gga ke (agu8 gla,ela8 ,agia% lateral kelo'ak mata ,a;ah8 kelo'ak mata atas8 'i'i (a% (ahi. Diag%osis (i,uat se9ara kli%is8 aka% terlihat eritema (e%ga% te'i ti(ak rata (isertai 'a'ula esikel 6a%g ,er,e%tuk se'erti keru9ut8 ka(a%g (isertai 'ustula (e%ga% (iameter 1 – & mm serta 'a(a (aerah kulit 6a%g ti(ak terke%a (a'at terlihat keri%g.
+am,ar # Dermatitis 'erioral +eala khas 6a%g seri%g terlihat a(alah se%sasi %6eri atau ter,akar. )a(a%g 'asie% uga merasaka% se%sasi tega%g 'a(a kulit. 2a(a (ermatitis 'erioral 6a%g lama (a'at tera(i kolo%isasi ,akteri 6a%g (ita%(ai a(a%6a 'a'ulo'ustul.
4aktor 6a%g (a'at mem'er,erat (ermatitis 'erioral a(alah 'a'ara% si%a matahari8 seri%g me%9u9i ;aah (e%ga% sa,u% 'em,ersih atau 'e%ggu%aa% kosmetika se9ara ,erle,iha% serta 'emakaia% kortikosteroi( (e%ga% 'ote%si me%e%gah (a% ti%ggi. Suatu ,e%tuk khusus (ari (ermatitis 'erioral a(alah lu'oi( (ermatitis 'erioral (ima%a 'a'ul terlihat le,ih 'a(at (a% ,esar ,er;ar%a merah ke9oklata% (isertai (e%ga% skuama (a% i%$iltrat. /e%tuk gra%uloma (ari lu'oi( (ermatitis 'erioral 'a(a a%aka%ak (i%amaka% se,agai Facial Afro-Caribbean Childhood ruption >45E?. /ila kea(aa% i%i sem,uh ti(ak aka% me%6isaka% ,ekas aki,at lesi terse,ut.
+am,ar * Dermatitis 'erioral 'a(a a%ak
+am,ar - Granulomatous periorificial dermatitis
,. De+&-&) e+!&)i)is pe+i"+&#
U%tuk me%gklasi$ikasika% (eraat (ermatitis 'erioral (igu%aka% skor ealuasi kli%is 6aitu 2ODSI > Perioral dermatitis severity index? 'a(a tahu% &!!*. Nilai (iam,il ,er(asarka% lesi 'a(a kulit se'erti eritema8 'a'ula8 (a% skuama kemu(ia% (ihitu%g (e%ga% skala 'erhitu%ga% >! – 3?8 (e%ga% su,gra(asi >!8*@ 18*@ (a% &8*? (e%ga% %ilai maksimal a(alah ".
Dermatitis 'erioral (eraat ri%ga% terhitu%g (e%ga% skor !8* – &8*@ (eraat se(a%g 38! – *8*@ (a% (eraat ,erat -8! – "8!. 2ODSI ,iasa%6a (igu%aka% u%tuk ealuasi o,ekti$ (ari hasil 'e%go,ata% atau'u% me%e%tuka% tera'i8 ta'i (a'at uga (igu%aka% u%tuk 'emeriksaa% ruti%. 2e%ilaia% (eraat (ermatitis 'erioral (e%ga% menggunakan perioral dermatitis severity index >2ODSI? serta 9o%toh 'erhitu%ga%%6a (a'at (ilihat 'a(a ta,el (a% gam,ar. a,el & Perioral dermatitis severity index Deraat 1 Deraat & Deraat 3 )emeraha%
Ri%ga%8 merah am,u8 Se(a%g8 merah elas8 /erat8 merah gela'8 'u9ar8 (iskret ,ela%g terse,ar8 ko%$lue%
2a'ula
se(ikit8 ke9il sekali8 ,er;ar%a se'erti
Se(a%g8 ,e,era'a8 (isemi%ata
/erat8 sa%gat ,a%6ak8 kemeraha%8 ,erkum'ul
Se(a%g8 elas
/erat8 ,esar8 luas
(agi%g Skuama
Ri%ga%8 halus8 sulit (ilihat
a.
Eritema !8*@ 'a'ul 18!@ skuama !@ 2ODSI 18* >2ODSI ri%ga%?
,.
Eritema 18*@ 'a'ul 18*@ skuama !@ 2ODSI 38! > 2ODSI se(a%g?
9.
Eritema 18*@ 'a'ul &8!@ skuama !8*@ 2ODSI #8! > 2ODSI se(a%g?
(.
Eritema &8!@ 'a'ul 18*@ skuama &8!@ 2ODSI *8* > 2ODSI se(a%g?
e.
Eritema &8*@ 'a'ul 38!@ skuama 18*@ 2ODSI 78! > 2ODSI ,erat?
$.
Eritema 38!@ 'a'ul 38!@ skuama 38!@ 2ODSI "8! >2ODSI ,erat?
+am,ar 7 9o%toh skori%g 2ODSI
. Di&$n"sis *&nin$
Se9ara kli%is8 (ermatitis 'erioral harus (i'isahka% (ari ,er,agai kemu%gki%a% (iag%osis 6a%g a(a. ermasuk rosa9ea8 a9%e8 (ermatitis se,oroik (a% (ermatitis
ko%tak. +am,ara% khas (ermatitiss 'erioral ,iasa%6a (a'at (i,e(aka% (e%ga% lesi i%$lamasi 'a(a ;aah lai%%6a. 2asie% (e%ga% rosa9ea ,iasa%6a memiliki gam,ara% tela%giektasis (a% kemerahmeraha% 'a(a muka (e%ga% 'e%6e,ara% 6a%g le,ih luas me%ge%ai ke(ua 'i'i8 hi(u%g (a% (ahi. Dermatitis ko%tak tam'ak se,agai lesi kemeraha%8 ,erskuama (a% krusta 6a%g tim,ul (i sekitar mulut aki,at alergi terha(a' kosmetik li'stik8 maka%a%8 ka;at gigi (a% alat kosmetik lai%%6a. Lesi terlihat se'erti 'a'ula (e%ga% ,atas 6a%g ti(ak tegas. Ermatitis ko%tak uga seri%gkali me%ge%ai area kulit lai%%6a (a% (a'at (i(iag%osis (e%ga% 'at9h test. k%e ulgaris (a% (ermatitis se,oroik ti(ak mem'u%6ai lokasi (a% 'ola 6a%g sama (e%ga% (ermatitis 'erioral. )e(ua%6a terse,ar le,ih luas (a% (a'at me%ge%ai ,a(a% termasuk muka. k%e ulgaris tam'ak se,agai kome(o (a% (ermatitis se,oroik tam'ak skuama. /er(asarka% ke'ustakaa% lai%8 (iag%osis ,a%(i%g (ari (ermatitis 'erioral (i,agi me%a(i %o%gra%uloma (ermatitis 'erioral (a% gra%uloma (ermatitis 'erioral se'erti 'a(a ta,el.
+a%ggua%
a,el 3 Diag%osis ,a%(i%g (ermatitis 'erioral +am,ara% kli%is
Dermatitis 'erioral %o%gra%uloma erseri%g Rosa9ea er(a'at 'a(a hi(u%g8 ;aah@ 'ersiste% eritema (a% tela%giektasis Dermatitis se,oroik
Seri%g 'a(a li'ata% %asola,ial@ skuama
Dermatitis ko%tak alergi
i%strume% musik8 'asta gigi me%ga%(u%g tar8 late8 ka;at gigi8 li'stik
Dermatitis ko%tak irita%
Seri%g 'a(a a%aka%ak
Li'li9ki%g 9heilitis
Seri%g 'a(a a%aka%ak@ skuama@ ,atas tegas
Diag%osis ,a%(i%g lai% k%e ulgaris
/isa 'a(a tu,uh@ kome(o
+ram%egati$ $olikulitis
Le,ih ,a%6ak 'ustula
Demo(e $oli9ulorum i%$estatio%
2ustula ti(ak khas@ 'ruritus@ immu%o9om'romise(
9ro(ermatitis e%terohe'ati9a
I%$a%t (e%ga% akral (a%Fatau (ermatitis 'o'ok
+ra%uloma (ermatitis 'erioral erseri%g +ra%ulomatous rosa9ea
Diag%osis ,a%(i%g lai% /lau s6%(rome /e%ig% 9e'hali9 histio96tosis
4lushi%g tela%giektasis8 'ustula (a% e(ema@ elas 'a(a 'emeriksaa% histo'atologi )ista si%oial8 ueitis8 arthritis gra%uloma8 9am'to(a9t6l8 'a'ula Distri,usi (i$$us 'a(a ;aah
/. T&)&#&'s&n&
=ika 'asie% me%ggu%aka% steroi(m maka la%gkah 'ertama 'e%go,ata% a(alah segera he%tika% 'emakaia% steroi(. 2asie% harus (i'eri%gatka% u%tuk ti(ak me%ggu%aka% steroi( kare%a aka% me%6e,a,ka% (ermatitis 'erioral. E(ukasi 'asie% u%tuk me%ghe%tika% 'emakaia% krim 'elem,a,8 krim malam8 makeu' serta 'asta gigi ,er$luori(e. /er(asarka% gui(eli%e3 me%ge%ai (ermatitis 'erioral8 tera'i 6a%g (i,erika% me%urut 'erhitu%ga% 2ODSI8 6a%g ,isa (ilihat 'a(a algoritma tera'i (ermatitis 'erioral.
lgoritma era'i Ri%ga%
Se(a%g
era'i Gero
era'i a%tii%$lamasi to'ikal
5ream I%(i$$
i(ak res'o% (alam 3 mi%ggu
i(ak res'o% (alam 3 mi%ggu
/erat
era'i a%tii%$lamasi to'ikal %ti,iotik sistemik era'i sistemik maksimal 0 mi%ggu
%ti,iotik sistemik
Sem,uh =ika (i'erluka%8 la%gkah (emila%gkah ,isa (iula%g kem,ali
+am,ar 0 lgoritma tera'i (ermatitis 'erioral 1. era'i !ero era'i ero a(alah (e%ga% me%ghe%tika% semua 'e%ggu%aa% o,at to'ikal8 terutama kortikosteroi( to'ikal (a% kosmetik 6a%g me%a(i $aktor 'e%6e,a, utama. Dalam ,e,era'a stu(i 'a(a 'asie% (e%ga% ermatitis 'erioral (ihe%tike% 'e%gggu%aa% o,at to'ikal (isertai 'em,eria% a%ti,iotik sistemik (e%ga% 'em,eria% 'lase,o memiliki ti%gkat kesem,uha% 6a%g sama 'a(a ke(ua 'asie% terse,ut. &. era'i to'ikal /er,e(a (e%ga% rosa9ea8 ti(ak a(a gol( sta%(ar( (alam 'em,eria% tera'i to'ikal8 %amu% ,er(asarka% ,e,era'a hasil 'e%elitia% a(a tera'i to'ikal 6a%g a'at mem,erika% 'er,aika% kli%is selai% (e%ga% 'em,eria% ero tera'i 6aitu8 a(a'ale%e8 asam aelai98 eritromisi% to'ikal8 i9hth6ol8 metro%i(aole8 'ime9rolimus8 takrolimus8 tera'i $oto(i%amik.
3. era'i sistemik
Dermatitis 'erioral ara%g mem,utuhka% tera'i sistemik. etrasikli% (a% makroli(a telah (igu%aka% u%tuk tera'i seme%tara (ari (ermatitis 'erioral. era'i sistemik 'a(a (ermatitis 'erioral 6a%g (irekome%(asika% a(alah tetrasikli%8 makroli(a8 (a% isotreti%oi%.
2a(a ke'ustakaa% lai% (i%6ataka% tera'i 'a(a (ermatitis 'erioral (a'at (i,erika% tetrasikli%8 (o6sikli%8 (a% mi%osikli% oral (alam 0 hi%gga 1! mi%ggu kemu(ia% ta''eri%g o$$ 'a(a & hi%gga # mi%ggu setelah%6a. 2a(a kasus ,erat le,ih ,aik (i,erika% mi%osikli% atau (oksisikli% atau tetrasikli% (osis ti%ggi. 2a(a a%ak (i,a;ah 0 tahu% eritromisi% oral (irekome%(asika%. era'i a%ti,iotik to'ikal 6a%g 'ali%g seri%g (i,erika% a(alah metro%i(aole. 2iliha% lai% termasuk kli%(amisi% atau eritromisi%8 sul$ur to'ikal8 (a% asam aelaik serta $oto tera'i (e%ga% asam *ami%oleuli%i9. 2em,eria% (a% (osis (a'at (ilihat 'a(a ta,el.
a,el # era'i $armakologis (ermatitis 'erioral )"pi'&# "sis Sis)e!i' Fi+s) #ine
Se"n #ine
metro%i(aole
erithrom69i%
&1
&1
D"sis e&s&
etra969li%e
&*!*!! mg &1 Fhr
(o69i9li%e
*!1!! mg &1Fhari
mi%o969li%e Erithrom69i%e
*!1!! mg &1 Fhari #!! mg 31Fhari atau
atau
3!*! mgFkgFhari
9li%(am69i%
&1
sul$ur
&1
aelai9 a9i( &1 (Sumber: Fit!patrick&s 'ermatology in General (edicine)
. K"!p#i'&si
)e,a%6aka%
(ari
kasus
(ermatitis
'erioral8
%o%gra%uloma
atau'u%
gra%uloma8 (a'at sem,uh ta%'a a(a geala sisa atau'u% kam,uh. Meski'u%8 a(a uga la'ora% me%ge%ai kom'likasi luka aki,at garuka% 6a%g ara%g (ila'orka%.
10. P+"$n"sis
a%'a 'e%go,ata%8 (ermatitis 'erioral (a'at ,erla%gsu%g lama hi%gga me%ahu%. 2e%go,ata% (e%ga% a%ti,iotik to'ikal mau'u% oral 6a%g te'at (a'at mem,erika% hasil (alam - sam'ai 1! mi%ggu. Dermatitis 'erioral (a'at sem,uh ta%'a 'e%go,ata% (e%ga% me%ghi%(ari 'e%ggu%aa% kortikosteroi(8 'elem,a,8 makeu' (a% 'asta gigi ,er$luori(e.
KESIMPULAN 2erioral (ermatitis a(alah ,e%tuk i%$lamasi kulit 6a%g tam'ak se,agai 'a'uloeritema8 esikel (a% 'ustule 6a%g tim,ul terlokalisasi (isekitar mulut8 hi(u%g atau'u% mata. Diag%osis 'erioral (ermatitis (a'at (i'ertim,a%gka% 'a(a 'asie% se'erti ;a%ita mu(a (a% a%aka%ak 6a%g ti(ak ,eres'o% terha(a' tera'i u%tuk rosa9ea8 (ermatitis se,oroik atau'u% ak%e ulgaris 6a%g telah (i(uga se,elum%6a. 2e%6e,a, 'erioral (ermatitis hi%gga ki%i masih ,elum (iketahui (e%ga% elas8 %amu% ter(a'at ,e,era'a $aktor 'e%ti%g 6a%g telah (iketahui ,erhu,u%ga% erat (e%ga% tim,ul%6a 'erioral (ermatitis a%tara lai% orga%isme 'atoge%ik i%$eksius8 $aktor hormo%al8 'e%ggu%aa% o,ato,ata% steroi( to'ikal (a% 'a'ara% at kimia se'erti 'asta gigi 6a%g me%ga%(u%g $luor. Oleh kare%a itu 'e%ti%g sekali ,agi 'asie% u%tuk me%ghe%tika% 'e%ggu%aa% kortikosteroi( to'i9al8 kosmetika ;aah mau'u% 'asta gigi ,er$luori(e. etra969li% oral (a% eritromisi% meru'aka% tera'i 6a%g 'ali%g e$ekti$ u%tuk 'erioral (ermatitis.
DAFTAR PUSTAKA
1.
+OLDSMIH ag8 Ste'he% I)8 /ar,ara +8 mi S28 Dai( =L. 4it'atri9ks Dermatolog6 i% +e%eral Me(i9i%e. M9+ra; Hill. Ne; Jork@ &!!0. 2. 7!" – 1&
&.
=ames A+8 /erger +8 Elsto% DM. %(re;s Diseases o$ he Ski% 5li%i9al Dermatolog6 11th E(itio%. Elseier. Ne; Jork@ &!1&. 2. &#* – -
3.
Aolle% 8 /i,ier 8 Dirs9hka 8 et al. Guideline of Perioral 'ermatitis. =our%al o$ the +erma% So9iet6 o$ Dermatolog6 &!11@ *: #&& – "
#.
Rosso =D. (anagement of papulopustular rosacea and perioral dermatitis "ith emphasis on iatrogenic causation or exacerbation of inflammatory facial dermatoses. =our%al o$ 5li%i9al estheti9 a%( Dermatolog6 &!11@ #: &! – 3!.
*.
Leu%g a%( /ara%ki% /. *hat&s your diagnosis+ (ultiple erythematous papules on a , – year – old&s face. 5o%sulta%t $or 'e(iatri9ia% &!13
-.
)ihi9ak +8 5ru M8 S9h;arts R. Case report : periorificial dermatitis in children: an update and description of a child "ith striking features. I%ter%atio%al our%al o$ Dermatolog6 &!!"@ #0: 3!# – -
7.
)im J=8 Shi% =A8 Lee =S8 et al. Case report childhhood granulomatous periorificial dermatitis. %% Dermatol &!11@ &3: 30- – 0
0.
/uimir B8 /railo B8 la,eg I8 et al. Case report allergic contact cheilitis and perioral dermatitis cause by propolis . 9ta (ermatoe%erol 9roati9a &!1&@ &! >3?: 107 – "!
".
,e9k D8 +eise%$el(er /8 Nram(t O. Physical sunscreens "ith high sun protection factor may cause perioral dermatitis in children. =our%al o$ the +erma% So9iet6 o$ Dermatolog6 &!!"@ 0: 7!1 – 3
1!.
Ju J8 S9hei%ma% 2L. .ip and perioral dermatitis caused by propyl gallate. mero9a% 9o%ta9t (ermatitis so9iet6 &!1!@ &1 >&?: 110 – &&
11.
5leme%tso% /8 Smi(t . Case report periorificial dermatitis due to systemic corticosteroid in children. 2e(iatri9 (ermatolog6 &!1&@ &" >3?: 331 – &
1&.
Aolle%,erg a%( O''el . /coring of lesions "ith the perioral dermatitis secverity index 0P1'/I). 9ta (ermatoe%ereologi9a &!!-@ 0-: &*1 – 3
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