Terapi Perbaikan Klinis Minggu Ke

Pemfigus Vulgaris (PV) : Penyakit autoimun dengan karakteristik berupa lepuh dan ulser pada membran mukosa/kulit. 1,2
Etiologi PV dipengaruhi oleh faktor genetik & eksogen misalnya infeksi Virus Herpes Simpleks tipe 1 (HSV-1)
Hipotesis hubungan HSV dengan Pemfigus Vulgaris
HSV menginduksi upregulasi faktor proinflamasi
PV > 3
tahun
Tidak ada
lesi di
tubuh
bagian lain
HSV merusak self-tolerance dengan menginduksi keluarnya
sitokin interferon pada keratinosit
Sakit,
sulit
makan &
berbicara
Ikatan glikoprotein D HSV dengan Herpes Virus Entry Mediator
(HVEM) pada infeksi HSV dapat mencegah hilangnya
autoreaktif sel T
Kunjungan I I
Penatalaksanaan
Kortikosteroid
sistemik
Pemeriksaan Laboratorium
Pemeriksaan
darah 8
parameter
IgG anti HSV-1
reaktif
IgE DBN
• Dosis 1-2
mg/kgBB/hari)
• Mengendalikan
akantolisis  sifat
imunosupresif &
efek langsung
antiakantolisis
Kortikosteroid
topikal
• Triamsinolon
asetonid in
orabase 0,1%
• Fluosinolon
asetonid 0,05 %
• Klobetasol
propionat 0,05 %
• Halobetasol 0.05
%
Terapi lain
• Analgetik
• Antiseptik kumur
• Antijamur
• Antivirus
• Terapi HSV
• Multivitamin
mineral
Perbaikan Klinis Minggu Ke-7
Pemfigus vulgaris dengan lesi rekuren/persisten/terapi
kortikosteroid jangka panjang beresiko terjadi
ko-infeksi
Antijamur
suspensi
oral
Krim
Kortikosteroid
sistemik &
topikal
NaCl 0,9%
(kompres
bibir)
Infeksi virus menjadi pemicu rekurensi, memperlambat
proses penyembuhan atau memperparah lesi PV
antivirus
Antiseptik
kumur
Terapi
Multivitamin
mineral
Penyembuhan Lesi Oral Minggu ke-38
Keterlibatan virus dideteksi  pemeriksaan penunjang
 penatalaksanaan adekuat
DAFTAR PUSTAKA
1. Oliveira-Batista DP, Janini MER, Fernandes NC, Santos N. Laboratory diagnosis of herpesvirus infections in patients with pemphigus vulgaris lesions. Intervirology.
2013;56(4):231–6.
2. Brandão MLFB, Fernandes NC, Batista DPDO, Santos N. Refractory pemphigus vulgaris associated with herpes infection: case report and review. Rev Inst Med Trop Sao
Paulo. 2011;53(2):113–7.
3. Anatomy P. Manifestation of pemphigus vulgaris in the orofacial region . Case report. 2003;76(January):55–62.
4. Dag S, Goregen M, Milog O, Çakur B, Dagistan S, Goregen M, et al. Oral pemphigus vulgaris: a case report with review of the literature. J Oral Sci [Internet].
2008;50(3):359–62. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18818476
5. Chaudhary N, Chaudhary V, Goswami GK, Pathak AN. Oral Pemphigus Vulgaris: A Case which was Misdiagnosed as Stomatitis. J Infect Dis Ther [Internet]. 2014;2(22):
6. Gupta N, Agarwal P, Mohan S. Case report Pemphigus foliaceous associated with Herpes simplex virus infection. 2015;10(2):32–8.
7. Black M, Mignogna MD, Scully C. Number II. Pemphigus vulgaris. Oral Dis. 2005;11(3):119–30.
8. Hasan S, Khan NI, Sherwani OA, Bhatt V, Srivastava H. Pemphigus Vulgaris: an Insight on Conventional and Emerging Treatment Modalities. Int Res J Pharm [Internet].
2013;4(3):8–12. Available from: http://www.irjponline.com/admin/php/uploads/1659_pdf.pdf
9. Jaehwan Kim, Michael Hertl, Neil J. Korman DFM. Pemphigus Vulgaris. 2015;1(1):283–8. Available from: http://link.springer.com/10.1007/978-3-662-45698-9
10. Vega-memíje ME, García-vázquez FJ, Cuevas-gonzález JC, Rodríguez-lobato E, Aguilar-urbano MA. Is there a causal relationship between HSV-1 and pemphigus vulgaris?
Springerplus [Internet]. 2015;4:15–7. Available from: "http://dx.doi.org/10.1186/s40064-015-1414-8
11. Ata-Ali F, Ata-Ali J. Pemphigus vulgaris and mucous membrane pemphigoid: Update on etiopathogenesis, oral manifestations and management.J Clin Exp Dent. 2011;3(3)
12. Chiu HY, Chang CY, Hsiao CH, Wang LF. Concurrent cytomegalovirus and herpes simplex virus infection in pemphigus vulgaris treated with rituximab and prednisolone. Acta
Derm Venereol. 2013;93(2):200–1.
13. Chayavichitsilp P, Buckwalter J, Krakowski A, Friedlander S. Herpes simplex. Pediatr Rev. 2009;30(4).
14. Shamim T, Varghese VI, Shameena PM, Sudha S. Pemphigus vulgaris in oral cavity: Clinical analysis of 71 cases. Med Oral Patol Oral Cir Bucal. 2008;13(10).
15. Caldarola G, Kneisel A, Hertl M, Feliciani C. Herpes simplex virus infection in pemphigus vulgaris: clinical and immunological considerations. Eur J Dermatol [Internet].
2008;18(4):440–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18573719
16. Kalra A, Ratho RK, Kaur I, Kumar B. Role of herpes simplex and cytomegalo viruses in recalcitrant oral lesions of pemphigus vulgaris. Int J Dermatol [Internet].
2005;44(3):259–60. Available from: http://doi.wiley.com/10.1111/j.1365-4632.2004.02370.x
17. Ercolini AM, Miller SD. The role of infections in autoimmune disease. Clin Exp Immunol. 2009;155(1):1–15.
18. Kurata M, Mizukawa Y, Aoyama Y, Shiohara T. Herpes simplex virus reactivation as a trigger of mucous lesions in pemphigus vulgaris. Br J Dermatol. 2014;171(3):554–60.
19. Tackett B. Pemphigus Vulgaris. 2010;(258474):311. Available from: http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-6643-9..00231-9-20. Di Bisceglie MB, Lucchese A, Crincoli V. Pemphigus: the promises of peptide immunotherapy. Immunopharmacol Immunotoxicol [Internet]. 2009;31(4):509–15.