Rabbi zidni ilman

Assalamualaikum wr wb
DERMATITIS
Inflammation of the skin as a
response of stimulus
induced by a wide range of
external and internal factors
Symptoms: Itching, blister,
redness, swelling and often
oozing, scabbing and scalling
In the past Dermatitis used to
inflammation caused by factors
outside the body
DERMATITIS
Definisi
Dermatitis adl : inflamasi pd kompartemen
dermo-epidermal, sbg reaksi dari
rangsang/injuri eksogen atau endogen
dengan manifestasi kx. objektif : UKK yang
polimorfi dan gejala subjektif : gatal.

Inflamasi ini biasanya berdasarkan reaksi

alergi/respons imun.
ECZEMA
Form the Greek term ekzein relates
to the spongiatic vesiculation of epid.
Used to describe inflammation that
had no obvious external cause

Eczema sometime use for dermatitis

Accepted to mean the same thing
They are generally regarded as
synonymous
The cause of most forms of dermatitis is not fully
understood
A defect in the production of the lipids of the skin

Weakens Epidermal barrier

Water loss dryness & crecking

Irritans and / or allergens enter more easily

Inflammatory response of the skin

Characteristic feature of eczema

(Clinical Presentation of Dermatitis)
 Protection to External
substance, chemical
material and microorganism

Stratum Corneum

To prevent water body loss,

TEWL
 Stratum Corneum Damage and
Symptom +
Protection to External
substance, chemical
material and
microorganism

Infection, Eczema
To prevent water body
loss, TEWL

Dry, breaks, TEWL

increase
 Itch Scratch Cycle
Eczematous Skin

itchy

scratching

Release Inflam.mediator in the skin

Itching
Inflammation
Excoriation

Penetration of staph.aureus Drying of the skin

to skin
 ACUTE DERMATITIS

Reaction to substance symptoms for a

few hours or for only a day or two

CHRONIC DERMATITIS

Persist over a period of time

Repeated rubbing and scratching thickening &

hardening of the skin & lichenified (e.g. In chronic atopic
dermatitis)
Klasifikasi Dermatitis :

I. Dermatitis Eksogen : - Der Kontak Alergik (DKA)

- Der Kontak Foto alergik
(DKFA)
II. Dermatitis endogen :- Der. Medikamentosa
- Der. Alimentosa
- Dermatofitid (Id reaksi)
III. Dermatitis dng. Kausa tidak diketahui
:- Der. Atopik
- Der. Sebore
- Der. Stasis
- Neuro dermatitis
- Prurigo nodularis
- Der. Numularis
Endogenous eczema Exogenous eczema
Irritant contact
Atopic eczema
dermatitis

Allergic contact
Seborrhoeic eczema
dermatitis

Photosensitive
Nummular eczema
dermatitis

Pompholyx Dermatophytid

Lichen simplex
chronicus

Asteatotic eczema

Gravitational
eczema

Juvenile plantar
dermatitis
 Dermatitis Atopik
DEFINISI
DA adalah penyakit kulit inflamasi yang kronis dan
residif, biasanya pada bayi dan anak- anak,ditandai
dengan peningkatan kadar IgE dan riwayat rhinitis
allergik dan atau asma pada keluarga/penderita
sendiri.

- ATOPI Atopia=sesuatu yang tak lazim / berle

bihan
1923 Coca dan Cooke: istilah atopik pertama kali
= Respon hipersensitivitas tipe lingkungan cenderung
diturunkan
 KLINIS
-DA :tipe infant (<2 tahun)
:tipe anak (3-11 thn)
:tipe dewasa (12-24 thn)
- usia awitan : <1 tahun (60%)
1-5 tahun (30%)
dewasa (Jarang)
DA : - Biasanya disertai sindroma atopi yang lain
- IgE total meningkat (60-80%)
- IgE Spesifik terhadap bermacam alergen
- Eosinofilia

DA : - tipe Ekstrinsik & tipe intrinsik

 Atopic Syndrome
(polygenic inheritance)

Allergen specific IgE Production Enviromental factors

(facultative)

Atopic dermatitis (eczema)

Positive skin test, Negative skin test,
Positive RAST, Bronchial asthma
Negative RAST,
High or Rhinitis Low levels
Intermediate levels Of total serum IgE
Of total serum IgE

extrinsic type, intrinsic type,

IgE - mediated Non IgE - mediated
 Dermatitis Atopik
- Inflamasi kompartemen dermo-epidermal yang
spesifik
- Kulit penderita Atopi bereaksi abnormal
- Rasa gatal dengan lesi kulit eksematosa
(Rajka, 1989)

Sinonim :
- Atopic eczema
- Infantile eczema
- Neurodermatitis disseminata
- Besniers prurigo,dsb.
Etiologi dan Patogenesis : ?
- Faktor yang berperan :
1. Herediter
2. Lin gkungan :
-Inhalan allergen
:Pollen, bulu hewan,,tungau debu
rumah, serpihan kulit, debu
rumah, kecoa
-Makanan (Food Alergen) :
:Ikan laut, susu, telor,ayam,
kacang-kacangan dsb-
-Faktor non imunologi :
:sekresi keringat, sebum,stress
Gejala Klinik : keluhan gatal menonjol

UKK : Polimorfi,bermacam-macam UKK seperti

eritem, papula, likenifikasi, Hertogh Sign,Dennie
Morgan sign.

1. Fs Infantil ; UKK eksudatif

Predileksi :pipi ,scalp,leher,ekstrim ekstensor.

2. Fs Anak/dewasa : UKK Likenifikasi, kering

lokasi : Ekst.fleksor, leher ,pergelangan
tangan/kaki
Table Hanifin and rajkas diagnostic criteria for
atopic dermatitis
Major Criteria
Pruritus
Typical morphology and distribution
Adult : Flexural lichenification or linearity
Children and infant : Facial, extensor
Chronic or relapsing dermatitis
Personal or family history of atopy
Minor criteria
Xerosis
Ichthyosis/keratosis pilaris/palmar hyperlinearity
Type I skin test reactivity
Elevated serum IgE
Early age at onset
Tendency to skin infection (Staphylococcus aureus, herpes
simplex)/ impaired cell-mediated immunity
Hand/foot dermatitis
Nipple eczema
Conjunctivitis
Dennie-Morgan fold
keratoconus
Anterior subcapsular cataracts
Orbital darkening
Facial pallor/erithema
Pityriasis alba
Anterior neck folds
itch when sweating
Intolerance to wool and lipid solvents
Perifolliculer accentuation
Food intolerance
course influenced by enviromental/emotional factors
White dermatographism/delayed blach.

* must have>3 major criteria and>3 minor criteria

 Diagnosis : kumpulan gejala-gejala klinik yang
spesifik (kriteria Hanifin & Rajka)

Laboratorium :
-Eosinophilia, IgE total
-Test allergi : uji tusuk pada kulit

Kriteria mayor :
1 Riwayat atopi keluarga
2 Pruritus
3 Kronis residif
4 Distribusi ruam yang khas
Kriteria minor
1 Timbulnya peny sesuai std
2 Adanya stigmata :Hertoghe sign./
Dennie Morgan sign
3 Food intolerance
4 Eosinophilia
5 Meningkatnya IgE
6 Menurunnya IgA
7 Menurunnya Fgs SIS
8 Intolerance bhn wol dll
 TERAPI DERMATITIS ATOPIK
I Menghindari kekambuhan (cegah faktor pencetus)
II Pengobatan terhadap gejala :
Topikal : stad.akut Kompres : -BWC: 2%
-Sol Riv 1/2000
stad kronik :- Krim
- Oinment (salep)
- Bedak
Sistemik : - Antihistamin
- Anti biotika
- Minor Tranquilizers, bila perlu
- kortikosteroid: prednison,
Triamsinolone, methil prednisolon
untuk DA berat
 KORTIKOSTEROID TOPIKAL (untuk DA
ringan &sedang):

Gol. Lemah : Hidrokort1%

Hidrokort 2,5%
Anti Inflamasi
Anti Mitosis Gol.sedang:- Flumetason Pivalen
-Flucinolone acetonid
0.2%/0.05%
Gol. Kuat :- Halcinonid
- Desoximet
TOPICAL CORTICOSTEROIDS TREATMENT

MILDPREPARATIONS
MODERATELY POTENT
POTENT
VERY POTENT
SIDE-EFFECTS OF SYSTEMIC STEROID
Cataracs (damage to the to
the lens of the eye)
Delayed growth in children
Easy bruising
Excess body fluid (ankle
swelling)
Mental disturbances
Muscle weakness
Raised blood pressure
9hypertension)
Raised blood sugar
(diabetes)
Reduce immune resistance
to infections and cancers
Skin changes (as with topical
steroid)
Suppresion of the adrenal
glands
Thinning of bones
(osteoporosis)
Weight gain
Patient education : skin care, Emollients/moisturizer
Avoidance of trigger factors
Topical corticosteroids
Calcineurin inhibitor (topical)
Non-steroid cream (eudermic,anti inflammation,
antioxydant, anti proteasic) :
If skin infection (+): systemic antiviral , antibiotic
or anti fungal
Sedative or non-sedative antihistamines
Severe refractory AD :
Expert referral is recommended
Potent corticosteroids (topical)
Systemic corticosteroids
Phototherapy
Immuno suppressant (oral) :
- Cyclosporine A