Alida HarahapDepartemen Patologi Klinik

FKUI-RSCM

Kelainan Kulit

Infeksi

Inflamasi

Autoimun

Diagnosis Anamnesis Gambaran Klinis Pemeriksaan Lab

INFEKSI KULITINFEKSI KULIT

MIKROORGANISME PENYAKIT

FungalFungalCandidiasisCandidiasis

TineaTinea

ViralViralHerpes simplexHerpes simplex

Varicella zosterVaricella zoster

BakterialBakterialImpetigoImpetigo

FolikulitisFolikulitis

Pemeriksaan Lab pada infeksi kulitPemeriksaan Lab pada infeksi kulit

Bakterial/FungalBakterial/Fungal MetodaMetoda

DeteksiDeteksiLangsung (mikroskopis)Langsung (mikroskopis)

IsolasiIsolasi

Asam nukleatAsam nukleat

KOH: Candida, Trichophyton spKOH: Candida, Trichophyton sp

Biakan: agar darah, SaboraudBiakan: agar darah, Saboraud

PCRPCR

SerologiSerologi

Deteksi antibodiDeteksi antibodi

Deteksi antigenDeteksi antigenIgM, IgGIgM, IgG

Lain-lainLain-lain

HematologiHematologi

Protein fase akutProtein fase akut

Hitung lekosit, hitung jenis,Hitung lekosit, hitung jenis,

Hitung trombositHitung trombosit

CRP = C reactive proteinCRP = C reactive protein

ASSAYASSAY SPECIMENSPECIMEN

microscopic isolation nucleic acid serology hematology acute phase protein

skin scraping, hair, nail

skin scraping, hair, nail

blood

blood

blood

blood

Biakan

PCR

Deteksi Antigen

P O S I T I F

Konfirmasi diagnosis

Respons Imunoglobulin

Infeksi Primer

IgM (+), IgG (-)IgM (+), IgG (+)

IgM (-), IgG (+)IgM (+), IgG (+)

DeteksiAntibodi

Infeksi Sekunder

Pemeriksaan Hematologi

ASSAYASSAY INFEKSIINFEKSI

BAKTERIALBAKTERIAL

INFEKSIINFEKSI

VIRALVIRAL

Hitung lekositHitung lekosit

Hitung jenisHitung jenis NeutrofiliaNeutrofilia

Shift to the leftShift to the left

LimfositosisLimfositosis

Hitung trombositHitung trombosit

monositlimfosit

neutrofilsegmen

neutrofilbatang eosinofil

basofil

trombosit

JENIS SELJENIS SEL %% JUMLAHJUMLAH

ABSOLUTABSOLUT

BasofilBasofil

EosinofilEosinofil

0-10-1

1-31-3

= % x hitung = % x hitung lekosit/lekosit/LL

Neutrofil batangNeutrofil batang

Neutrofil segmenNeutrofil segmen

2-62-6

50-7050-70

LimfositLimfosit

MonositMonosit

20-4020-40

4-84-8

Hitung Jenis

Granulocyte maturation

Blast

Promyelocyte

Myelocyte

Metamyelocyte

Stab

Segmen

Shift to the rightShift to the left

JENIS SELJENIS SEL %% JUMLAHJUMLAH

ABSOLUTABSOLUT

BasofilBasofil

EosinofilEosinofil

0-10-1

1-31-3

= % x hitung = % x hitung lekosit/lekosit/LL

Neutrofil batangNeutrofil batang

Neutrofil segmenNeutrofil segmen

2-62-6

50-7050-70

LimfositLimfosit

MonositMonosit

20-4020-40

4-84-8

Hitung Jenis

INFLAMASI KULITINFLAMASI KULIT

REAKSI HIPERSENSITIVITASREAKSI HIPERSENSITIVITAS

HYPERSENSITIVITYHYPERSENSITIVITY DISEASESDISEASES

TYPE I

TYPE IV

Atopic eczemaAtopic eczema

Acute urticariaAcute urticaria

Allergic contact Allergic contact - dermatitis- dermatitis

TYPE OF PATHOLOGIC MECHANISM OFHYPERSENS IMMUNE MECH TISSUE INJURYImmediate hypersensType I

Ab mediatedType II

Immune complex mediatedType III

T cell mediatedType IV

IgE Ab

IgM, IgG against cell surfaceor extracellular matrix Ag

Immune complexes of circulating Ag & IgM or IgG Ab

CD4 T cell (delayed type hypersensitivity )CD8 T cell (T cell mediated cytolysis )

Mast cells & mediators (vasoactive amine, lipid mediators, cytokines)

Opsonization & phagocytosisComplement & Fc receptor mediated recruitment & activation of leucocyte

Complement & Fc receptor mediated recruitment & activation of leucocyte

Macrophage activation, cytokine mediated inflammationDirect cell killing, cytokinemediated inflammation

REAKSIHIPER-SENSITIVITAS

REAKSIHIPER-SENSITIVITAS

REAKSIHIPER-SENSITIVITAS

REAKSIHIPER-SENSITIVITAS

Sequence of type 1 hypersensitivity

Pemeriksaan Lab

PEMERIKSAANPEMERIKSAAN HASILHASIL

HipersensitivitasTipe IHipersensitivitasTipe I

Kadar IgE totalKadar IgE total

Kadar IgE spesifikKadar IgE spesifik

Hitung eosinofilHitung eosinofil

MeningkatMeningkat

PositifPositif

MeningkatMeningkat

Reaksi InflamasiReaksi Inflamasi

Sitokin inflamatoriSitokin inflamatori

Protein Fase AkutProtein Fase Akut

IL-4, IL-5, IL-10 IL-4, IL-5, IL-10 CRP CRP

AUTOIMMUNESKIN DISEASE

SKIN DAMAGETRIGGERED BY

• AUTOANTIBODIES TO SKIN ANTIGEN

BULLOUS SKIN DISEASES

• DEPOSITION OFIMMUNE COMPLEXES VASCULITIS, SLE

AUTOANTIBODIESAUTOANTIBODIES DISEASESDISEASES

SKIN ANTIGENSKIN ANTIGEN

EPIDERMAL INTEREPIDERMAL INTER

CELLULAR CEMENTCELLULAR CEMENT

BASEMENT BASEMENT MEMBRANEMEMBRANE

SYSTEMIC ANTIGENSYSTEMIC ANTIGEN

NUCLEARNUCLEAR

PEMPHIGUS VULGARISPEMPHIGUS VULGARIS

BULLOUS PEMPHIGOIDBULLOUS PEMPHIGOID

SUBACUTE CUTANEOUS LESUBACUTE CUTANEOUS LE

DISCOID LEDISCOID LE

ASSAYASSAY RESULTRESULT

AUTOANTIBODIESAUTOANTIBODIES

COMPLEMENT COMPLEMENT

LEVELLEVEL

POSITIVEPOSITIVE

DECREASEDDECREASED

DISEASESDISEASES ASSAYASSAY

LELE

STAPHYLOCOCCALSTAPHYLOCOCCAL

SCALDED SKINSCALDED SKIN

SYNDROME (SSSS) SYNDROME (SSSS)

TOXIC SHOCK TOXIC SHOCK

SYNDROME (TSS)SYNDROME (TSS)

RENAL FUNCTION:RENAL FUNCTION:

CREATININE CREATININE LIVER FUNCTION :LIVER FUNCTION :

SGOT SGOT SGPT SGPT

KOMPLIKASI