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TINEA Unguium (onychomycosis)Tutorial D-1Blok DMSAngkatan 2014

DefinisiInfeksi Dermatofita pada kuku-Saripati Penyakit Kulit

Tinea pada kuku, awalnya menyerang permukaan dan tepi luar, lalu kemudian menyerang bagian bawah lempeng kuku.-Kamus Saku Dorland, Edisi 28

Tinea Unguium (Onychomycosis)Dapat ditularkan secara langsung maupun tidak langsung.Penyebab : Trichophyton Mentagrophytes dan T. Rubrum.Umur : Lebih sering pada orang dewasa, bersamaan dengan tinea pedis et manus.Jenis Kelamin : Pria & Wanita.Bangsa/ras : Semua bangsa/ras terutama di area tropis.Daerah : Daerah tropis.Kebersihan : Pada orang yang banyak bekerja dengan air kotorLingkungan : Lembab atau basah, dan sering kontak dengan air kotorGejala KlinisKeluhan utama berupa kerusakan kuku. Kuku menjadi suram, lapuk dan rapuh, dapat dimulai dari arah distal (perimarginal) atau proksimal. Bagian yang bebas tampak menebal.

Patofisiologi...Jamur menyebar dari plantar skin

Menginvasi kuku lewat hyponychium

Terjadi reaksi inflamasi

Timbul gejala klinisPemeriksaan KulitLokalisasi : Semua kuku jari tangan dan kaki.

Efloresensi : Kuku menjadi rusak dan rapuh serta suram warnanya, permukaan kuku menebal, dibawah kuku tampak detritus yang mengandung elemen-elemen jamur. Pada infeksi ringan hanya dijumpai bercak-bercak putih dan kasar di permukaan kuku.

Pemeriksaan LabKerokan Kuku + KOH 40%

Biakan kerokan skuama di bawah / diatas kuku menghasilkan koloni Jamur

Diagnosis BandingOnikodistrofi Candida Albicans : Biasanya dimulai dari proksimal

Onikodistrofi akibat trauma : Jelas dimulai dari trauma, disusul kerusakan kuku.

Psoriasis : Tampak tebal dan pada permukaan dapat terlihat pitsAntifungal, SistemicClass SummaryThe goals of pharmacotherapy for onychomycosis are to reduce morbidity and to prevent complications.Terbinafine (Lamisil)Terbinafine inhibits squalene epoxidase, which decreases ergosterol synthesis, causing fungal cell death. Use the medication until symptoms significantly improve. More studies are needed to establish the efficacy of pulse regimens and the optimal duration of treatment.Itraconazole (Sporanox)Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting CYP-450dependent synthesis of ergosterol, a vital component of fungal cell membranes.Fluconazole (Diflucan)Fluconazole has fungistatic activity. It is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal CYP-450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes. Treatment should continue until the infection resolves.Antifungal, TopicalClass SummaryTreatment of onychomycosis with topical antifungals is typically used as adjunctive therapy in combination with oral agents.Ciclopirox (Penlac)Ciclopirox interferes with the synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells.Efinaconazole (Jublia)Efinaconazole is a topical triazole antifungal agent. It inhibits fungal lanosterol 14-demethylase involved in the biosynthesis of ergosterol, a constituent of fungal cell membranes. It is indicated for onychomycosis of the toenail(s) due toTrichophyton rubrumandTrichophyton mentagrophytes.Tavaborole (Kerydin)Tavaborole, a topical oxaborole antifungal (boron-containing compound), is indicated for onychomycosis of the toenails due toTrichophyton rubrumorTrichophyton mentagrophytes. It is available as 0.5% topical solution.

Edukasi PasienPatients should be educated about the use of appropriate footwear, especially in high-exposure areas such as communal bathing facilities and health clubs.Following treatment, patients must be advised that nails may not appear normal for up to 1 year, and prophylactic antifungal therapy may be required to prevent reinfection of the skin and the nails. Patients may use topical terbinafine cream twice daily for 1-2 weeks for earlytinea pedisor a 1-week pulse of itraconazole (200 mg PO bid) at the first signs of onychomycosis.SekianTerima Kasih