UJIMANUAL

DERMATOLOGI

NIKOLSKYSIGN
Nikolsky'ssign(PyotrNikolsky,Russianphysician,
18581940):
askinconditioninwhichthetoplayersoftheskinslip
awayfromthelowerlayerswhenslightlyrubbedor
pressure.
Prosespatologisyangmendasari:hilangnyakohesi
keratinositepidermissehinggalapisanatasepidermis
easilymovelaterallywithslightpressureorrubbing
Tujuan:untukmembuktikanadanyaprosesakantolisis
(hilangnyakohesiantaraselkeratinositepidermis)

 Thelackofcohesionoftheskinmayalsobe
demonstratedwiththebullaspread
phenomenongentlepressureonanintactbulla
forcesthefluidtospreadundertheskinaway
fromthesiteofpressure(AsboeHansensignor
theindirectNikolskyorNikolskyIIsign).
Theextensionofablistertoadjacentunblistered
skinwhenpressureisputonthetopofthebulla

Nikolsky positif

Acantholytic
disorders
Pemfigus
Staphylococcal scalded skin syndrome
(SSSS)
Steven Johnson Syndrome
Toxic epidermal necrolysis
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Nikolskys sign

Lapisan superfisial layers

kulit terlepas dari lapisan
dibawahnya dgn gerakan
menekan & sedikit
menggosok. Pengelupasan
kulit meninggalkan daerah
basah, merah, dan nyeri
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Cara
melakukan

AUSPITZ SIGN
Diagnosticsignofpsoriasis
Tujuan:membuktikanadanyapapilomatosis
Gentlescrapingofthesurfaceofapsoriasisplaque
withaglassslidewillremovethelooselyattached
scalesandrevealashinysurfacewithfinebleeding
points.Thesebleedingpointsrepresentthedilated
andtortuouscapillarybloodvesselsinthepapillary
dermis(papilomatosis)

 PadafenomenaAuspitztampakserum
ataudarahberbintikbintikyang
disebabkanolehpapilomatosis.
Cara:skuamaberlapisdikerok,dengan
pinggirgelasalas/pisaubisturi.Setelah
skuamanyahabis,makapengerokan
harusdilakukanperlahanlahan,jika
terlaludalamtidakakantampak
perdarahanyangberbintikbintik
melainkanperdarahanyangmerata.

Menggunakan
pinggiran gelas
objek

Skuama dilepas
lapis demi lapis

scr lege artis lap

akhir skuama
digores

bintik
perdarahan
(pint point
bleeding)

Cara
melakukan

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Auspitz sign: point of bleeding

setelah skuama dilepas

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12

Pint point bleeding

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FENOMENA GORESAN LILIN

(Thecandlegreasesignor
Tachedebouge)

Diagnostic sign of psoriasis

When a psoriatic lesion is scratched
with the point of a dissecting forceps,
a candle-grease-like scale can be
repeatedly produced even from the
non-scaling lesions.
The scale appear more silver in
colour by introducing airkeratin
interfaces.

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 skuamayangberubahwarnanyamenjadi
putihpadagoresan,sepertililinyang
digoresdisebabkanolehberubahnya
indeksbias.Caramenggoresdapat
menggunakanpingirgelasalas/ujung
pisaubisturi.

Cara
melakukan
Pada lesi berskuama pasien psoriasis
dilakukan penggoresan menggunakan
tepi kaca objek / ujung pisau bisturi
secara perlahan.
Kemudian perhatikanlah perubahan
yang terjadi akibat goresan tersebut
Interpretasi : Positif jika terjadi
perubahan warna menjadi lebih putih
spt lilin yang digores
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FenomenaKoebners
(Isomorphicreaction)
TheKoebnerphenomenon(HeinrichKoebner,1872):
Thedevelopmentofisomorphicpathologiclesionsin
thetraumatizeduninvolvedskinofpatientscertain
skindiseases,especiallypsoriasis

traumaisfollowedbynewlesionsinthe
traumatizedbutotherwisenormalskin,andthesenew
lesionsareclinicallyandhistopathologicallyidentical
tothoseinthediseasedskin.

PATHOGENESIS OF KOEBNER
RESPONSE
The pathogenesis is not known.
Speculative pathogenetic factors involved
are immunologic, vascular, dermal,
enzymatic, inhibitory, neural, growth,
genetic & hormonal factors.
There is growing evidence that immunologic
factors are involved in the pathogenesis of
psoriasis and consequent Koebner response
to trauma. According to some investigators,
capillary changes in the dermis precede all
other morphologic changes.

TYPESOFKOEBNERPHENOMENON(BoydandNeldner)
ClassifiedofKoebnerphenomenoninto4differentgroups:
1. Trueisomorphicphenomenon:psoriasis,lichenplanusand
vitiligo;
2. Pseudoisomorphicphenomenon:infectiousdiseases,e.g.warts,
molluscumcontagiosum,Behcet'sdisease,&pyogangrenosum
3. Occasionallyoccurringisomorphicphenomenon:diseases
occasionallylocalizetositesoftrauma,e.g.cancer(gastric,
testicularormammary),Darier'sdisease,erythemamultiforme,
HaileyHaileydisease,Kaposi'ssarcoma,Kyrle'sdisease,lichen
sclerosusetatrophicus,pellagra,perforatingfolliculitis,reactive
perforatingcollagenosis,and
4. Questionableisomorphicphenomenon:manyconditionsthat
havebeenassociatedwiththeKoebnerphenomenon,includes:
anaphylactoidpurpura,bullouspemphigoid,dermatitis
herpetiformis,discoidlupuserythematosus,etc.

Fenomena Koebners
(Isomorphicreaction)
Trauma pada kulit penderita dapat
menyebabkan kelainan yang
sama respon isomorfik
Timbul kisaran 7 14 hari dari
saat trauma
Trauma dapat berupa garukan
(scratching) atau gosokan
(rubbing)
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