5. FURUNCLE
• Deep seated inflamatory nodule that develop
around hair folicle
• Predilextion: area of friction & occlusion (neck,
face, axillae & buttocks)
• Preexisting lession: atopic dermatitis, scabies,
pediculosis
• Variety systemic host factor:obesity, diabetes,
treatment with corticosteroid or cytotoxic agent
• Etiology: gram possitive coccus (staphylococcus)
6. FURUNCLE
Clinical manifestation
Hard, tender red foliculocentric nodule in hair bearing
skin enlarge & become painful and fluctuant after
several day
Ruptur discharge pus & core of necrotic material
Multiple furuncle discret location furunculosis
Multiple confluent furuncle draining pus from multiple
opening carbuncles
9. management
• If the lession in a wide area
• Amoxycillin n clavulinic acid
• Cefalosporin third generation
SISTEMIK
antibiotic
• Warm dressing
• Topical antibiotic: natrium fusidat,
mupirosin
LOKAL
• Incision and drainase : if
fluktuation (+)
OTHERS
MODALITY
10.
11. Erysipelas
• acute β-hemolytic group A streptococcal infection of the
skin involving the superficial dermal lymphatics
• Streptococcal group B & C adult
• Streptococcal group A newborn
• Predilection: face, leg,
• Predisposing causes are
operative wounds,
fissures (in the auditory meatus, under the lobes of the ears, onthe
anus or penis, and between or under the toes, usually the little
toe),
abrasions or scratches,
venous insufficiency,
obesity,
lymphedema, and
chronic leg ulcers
12. Clinical manifestation
• Prodromal symptom of malaise for several hours,
• ± a severe constitutional reaction with chills,high fever,
headache, vomiting, and joint pains
Skin lession
• The plaque like edema, sharply defined margin, bright
red erythema
• The surface finding describe as Peau d’ orange
13. Erisipelas selulitis
• Well defined
margin
• Bright red
• peau de oranges
• Warm on
palpation
• ill defined border
18. Clinical manifestation
Prodromal symptom fever,
chills, malaise, headache,
anorexia, sore throat, dry
cough
The rash begins on face,
scalp, trunk (centrolateral
distribution)
Erythematous
macules/papules typically
vesicel as dew drop on a rose
petal pustulcrust
Polimorfic pattern
Vesicles develop in the
mucous membranrupture
rapidly ulcer
Scar trauma dan secondary
infection
19.
20. Varicella complication
Normal child: rarely
adult: ensefalitis, pneumonia, glomerulonefritis,
carditis, hepatitis, keratitis, konjungtivitis,
otitis, artritis, purpura
In pregnancy:
23. Clinical manifestation of
Herpes Zoster
Prodromal pain, paresthesia,
burning/tingling sensation in
the involved dermatome
Always unilateral & limited to
the area of skin innervated by
a single sensory ganglion
trigeminal nerve & trunk:T3-
L2 the most common area
Skin manifestation: multiple
group of vesicles on
erythematous skin with normal
skin betwen group vesicles.
Vesicles in one group have a
different age with another
group
24.
25.
26.
27. • involvement of the facial and
auditory nerves by VSV
• zoster of the external ear or tympanic
membrane; herpes auricularis with
ipsilateral facial paralysis; or herpes
auricularis, facial paralysis, and
auditory symptoms with or without
tinitus, vertigo, deafnes, nausea
Sindrom
Ramsay
Hunt
• 20-70% of zoster oftalmika
• Inervasi intraokular structure
• Vesikel of the tip and lateral nose
• ophtalmology involvement
Nasocilliary
Branch
Involvement
28. • Any pain after rash healing or any pain,one
month – years after rash healing
• Risk factor of PHN age, ophtalmic &
trigeminal HZ, neuralgia preherpetik, severe
pain during the acut phase,
immunocompromised host
Post herpetic
neuralgia
(PHN)
• Malignansi, kemoterapi dan radiasi, high
dose & long treatment of corticosteroid,
resipien organ transplantation, HIV
• recurrent, atipical manifestation, more severe
and delay of healing process
• Generalized HZ HZ dermatomal +eruption
>20 vesicles lession all over the bodies
HZ in the
immunocompromised
host
29. Terapi
Anti viral:
- Acyclovir 5x800 mg PO for 7-10 hari
- Valacyclovir 3x1 gr PO for 7-10 hari
- Famcyclovir 3x500 mg for 7-10 hari
Pediatric dosage Acyclovir 20 mg/kgbw PO 4x/day
Simtomatik : antipiretik, analgetik, HZ
neurotropic vitamin, sedatif
Local : talk + anti pruritic ( mentol, kamfora)
Wet erosion: NaCl wet dressing
Secondary infection: oral/ topcal antibiotic
Topical acyclovir not efektif
Sindrom Ramsay Hunt : corticosteroid for prevent
nerve paralysis: prednison 3 x 10-20 mg /day for 1
week and than tappering off
30. Vaccine
Varicella vaccine
• Life attenuated (Oka Strain)
• Protecting the susceptible
children against varicella
• Vaccinated adult & children
develop varicella in mild type
• The immunity to varicella
induced by varicella vaccine
not as strong as immunity
induce by nature VZV
Zoster vaccine
• Life attenuated (Oka
Strain)
• Recommended for older
adult
• To prevent morbidity
and HZ complication
( PHN)
31.
32. Herpes Simplex Virus (HSV)infection caused by type I or type
II HSV, main clinical manifestation of mucocutaneous
Herpes Simpleks
• Associated of orofacial diseases
• Mostly in children
HSV
Type I
• Associated with genital and perigenital
diseases
• On adult, correlates with sexual behavior
HSV
Type II
33. Clinical manifestation
First episode/
Primary
infection
• More severe lession with prodromal symptom such as, mlaise,
fever, myalgia, itchy, burning regional lymphadenitis
• Erythema-> papul group vesicles on erythematous based
erotion/ ulcer crust heal on 10 – 15 days
Laten
phase
• No clinical manifestation
• Virus dorman of dorsalis ganglia
Reccurent
• Less severe than primary infection
• Trigger by phisical trauma, stress, menstrual period, sun
exsposure
• May recurr at the same site(loco), or change location
• Heralded by prodrome tenderness, tingling, itching and burning
34. • A : primary infection: viral replication in the orofaringeal epitel , spead to
sensory nerve terminal, travel by retrograde axonal transport to regional
sensory ganglia
• B : Laten phase: HSV will persist in patient life time
• C :recurrenceantrograde axonal transport of newly assemble virus to a
peripheral site (lips and perioral)
35.
36.
37. Herpetic Whitlow
• Inokulasi langsung HSV pada jari, terutama pada populasi berisiko
trauma jari mis. tenaga kesehatan, anak yang suka menghisap jari,
kontak seksual manual-genital
• Eritema, edema, nyeri, dengan limfadenopati, lesi>> pada ujung
jari
Herpes gladiatorum/Herpes Rugbiaforum/ Scrum
Pox
• Herpes kutaneous yang ditransmisikan secara langsung pada atlet
gulat atau rugbi
• Lesi herpes terjadi pada leher, thoraks, telinga, wajah, lengan,
tangan
Eksema Herpetikum
• Infeksi HSV yang meluas akibat inokulasi langsung pada kulit yang
tidak utuh akibat dermatitis, terutama pada pasien dengan
dermatitis atopi
• Lesi berat, gejala sistemik dengan deman dan adenopati,
superinfeksi bakterial
Bentuk Lain Herpes Kutaneus
39. • Anti viral:
- Acyclovir 5x200 mg or 3x400 mg PO for7-10
days
- Famcyklovir 3x250 mg PO for 7-10
Days
- Valasiklovir 2x1 gr PO for 7-10 days
Paediatric dose acyclovir 15 mg/kgBW PO
5x/day
• Topical:
- wet erotion NaCl dressing
- topical antibiotic
Topical acyclovir will be effectif of reccurent
infection, before skin lession arise
Management
