Skenario A blok 19 tahun 2013 Mr.

Squid, a 64 years old man, came to outpatient clinic bari hospital with chief complaint progressive itchy thick erythematous plaques in both legs, arms, buttocks, and lower lumbrosacral since 6 months ago. The condition initially manifested on his left leg as a papule with thick white scales then rapidly spread to both legs, scalp, buttocks, lumbosacral, and arms. His fingers and toe nails showed destruction of the nail plate. He feel pain and rigidity on his knees since 3 months ago. He had been treated himself with topical bethamethasone oinment and moisturizer irregularly.

Physical examination : General status : compos mentis, vital sign within normal limit Dermatological status : Well dermacated, erythematous papules to plaques with a white adherent thick scales; on both of his legs, arms, buttocks, lumbosacal. Erythematous plaque with thick white scales on his scalp.

I. Klarifikasi istilah 1. Gatal : sensasi kulit yang tidak nyaman menimbulkan keinginan menggaruk/menggosokkan kulit 2. Eritematous : kemerahan pada kulit yang disebabkan pelebaran pembulh darah kapiler yang reversible 3. Plaque : lesi kulit yang superficial, padat dan menonjol, diameternya 2cm atau lebih 4. Papule : lesi menonjol yang kecil berbatas tegas dan padat pada kulit berukuran diameter kurang dari 0,5 cm 5. Scales : struktur seperti piring yang kompak atau serpihan kecil seperti sel epitel bertanduk pada permukaan tubuh 6. Bethamethasone : glukokortikoid sintetik, steroid anti inflamasi yang paling aktif, digunakan secara topikal dalam bentuk garam benzoat, garam dipropionat atau garam palerat sebagai anti inflamasi 7. Moisturizer : 8. Dermacated : II. Identifikasi masalah 1. Mr. Squid, a 64 years old man, came to outpatient clinic bari hospital with chief complaint progressive itchy thick erythematous plaques in both legs, arms, buttocks, and lower lumbrosacral since 6 months ago 2. The condition initially manifested on his left leg as a papule with thick white scales then rapidly spread to both legs, scalp, buttocks, lumbosacral, and arms

3. His fingers and toe nails showed destruction of the nail plate. 4. He feel pain and rigidity on his knees since 3 months ago 5. He had been treated himself with topical bethamethasone oinment and moisturizer irregularly 6. Physical examination : General status : compos mentis, vital sign within normal limit Dermatological status : Well dermacated, erythematous papules to plaques with a white adherent thick scales; on both of his legs, arms, buttocks, lumbosacal. Erythematous plaque with thick white scales on his scalp.

III. analisis masalah 1. 2. 3. 4. Organ/jaringan apa saja yang terlibat? Restya, tika Apa yang terjadi pada kulit dan kukunya? Lina, farida Pengaruh obat yang tidak adekuat terhadap perjalanan penyakitnya? Inne, ferry Apakah pengaruh moisturizer memberi manfaat/memperparah penyakitnya? Agung, meylinda 5. Bagaimana cara menegakkan diagnosis dan pemeriksaan penunjang pada kasus ini? Melinda R, suci 6. Apa diagnosis dan DD (berdasarkan interpretasi pem.fisik) pada kasus ini? Febri, restya 7. Etiologi infeksi/non infeksi? Tika, lina 8. Faktor resiko? Farida, inne 9. Faktor predisposisi? Ferry,agung 10. Apa gejala dan tanda khas pada kasus ini? meylinda, Melinda r 11. Predileksi kasus ini?suci, febri 12. Patofisiologi itchy, erythematous plaques restya, tika destruction of nail plate, papule lina, farida thick white scales, nyeri sendi Ine, Ferry 13. Patogenesis kasus ini?agung , meylinda 14. Scoring psoriasis? Melinda r, suci 15. Jenis-jenis psoriasis? Febri, restya 16. Tatalaksana? ( pemakaian bethamethasone sudah tepat/belum?) tika, lina 17. Preventif? Farida, inne 18. Prognosis? Ferry , agung 19. KDU? Meylinda, Melinda r

IV. Learning issue

Anatomi dan histologi kulit restya,tika, lina, Farida , inne, ferry Psoriasis (histopatologi, epidem, etiologi, jenis-jenis, manifestasi klinis, tatalaksana,preventif ) agung, meylinda, Melinda r, suci, febri

V. hipotesis Mr.squid mengalami psoriasis + psoriasis arthritis

Masalah kulit pada kasus ini : Plaques, papule, scale, erythematous,