DERMATITIS - ECZEMA

Eko Krisnarto
RSU Kota Semarang
 IMUNOLOGI

 Definisi : mekanisme faal --- kenal & respon

 Sistem imun kulit bagian dr imun tubuh
 Ada 2 ------ imun non spesifik & spesifik
 Ciri spesifik : spesifisitas, heterogen, memori
 Sistem imunitas kulit
 A. sistem pertahanan bawaan kulit
a. sawar kimia :
lapisan lemak kulit dan adneksa kulit
b. sawar mekanik
c. imunitas bawaan ----fagositosis
 B. sistem pertahanan spesifik kulit
sel keratinosit, sel limfosit,
sel langerhans dan sel endotelial.
 REAKSI HIPERSENSITIVITAS

 GELL dan COOMB ----- 4 TIPE

1. Tipe 1 / tipe cepat
2. Tipe 2 / sitotoksik
3. Tipe 3 / kompleks imun
4. Tipe 4 / tipe lambat
Dermatitis or eczema ?
Dermatitis or eczema ?
Dermatitis or eczema ?
 DERMATITIS & ECZEMA
 The term “ dermatitis” and “eczema”
are frequently used interchangeably
 It is simply and clearly defined as
inflammation of the skin, without
infection.
 “Eczematous” also connote : scaling
crusting, or serious oozing
The appearance of dermatitis

Erythema
Papules
Vesicles/Pustules
Oozing/Exudation
Crust

Squama
 DERMATITIS & ECZEMA
Three large categories :
1. Contact Dermatitis :
- Allergic Contact Dermatitis /ACD,
- Irritant Contact Dermatitis /ICD
2. Atopic Dermatitis
3. The other eczemas
Irritant Contact Dermatitis( ICD)

 (ICD) is caused by external

factors/irritation of variable
degree,depend on individual
characteristics of chemicals & time
 The most common causative agent :
solvent,detergents,petroleum oil and
grease,cutting fluid and lubricant, foods,
plants and particular dust, e,g.fiberglass
 Irritant CD-2
Clinical features:
 Acute ,skinreddish-brown, vesicles develop
, painful and itchy, usually accidental :
acid,alkali,phenol,ammonium compounds The
onset is rapid and lesions appear exactly at
the site of contact
 Subacute :due to repeated exposures of a
small area ( e.g.napkin rash),Skin : erythema,
sometimes blister, erosion
 Chronic :skin dry, hacked, or fissure
 Irritant CD-3
Treatment :
 Elimination of exposure
 Local humectants
 Topical steroid ( mild/medium) ( acute),
stronger( chronic )
Irritant Contact Dermatitis
CONTACT DERMATITIS
 Allergic Contact Dermatitis ( ACD )

 ACD: a delayed type of allergic reaction of

the skin resulting from contact with
specific allergen
 Affects 1-2% population in great risk
certain group ( workers, house-wife,
chronic skin condition ,such as leg ulcer
,etc.)
 Clinical features: acute or sub acute
dermatitis lesion, at the site s where the
allergen is, or distant areas ( indirectly)
 Common site of ACD
 Scalp ( hair dyes), the ear lobes ,the neck
( nickel containing jewellary ) ,the wrist (
metal/leather watch straps, feet ( leather,
plastics, glue ,dye), and hand( plants,
nickels, latex glove hand eczema
persistent problem. In all cases of
persistent hand eczema a patch test
should be performed , and to examine
scraping for fungi.
ALLERGIC CONTACT DERMATITIS

RUBBER FOAM

METAL
 ALLERGIC CONTACT DERMATITIS

LEATHER

RUBBER
 Management of ACD

 Detection of the likely sensitizing agent

( history has an important role!)
 Topical steroid ( the strength should be
chosen according to the site involved)
 Antihistamine
 Systemic steroid ( in severe conditions and in
short time)
 Patch test : when the lesion is subside/ free
from inflammation 4-6 weeks
PATCH TEST
 Differences between ICD and ACD

ICD ACD
 Prevalence Very common Much less
 Prior to
Exposure Not required Essential
 Affected area Sites of contact Site of cont.
,little extension distant site
 Susceptibility Everyone Some
 Associated Atopic predisposes Chronic skin dis.
skin dis.
 Timing 4-12 hours >24 hrs
Lesion develop No lesion
on first exposure on first exp
 Terms associated with
Contact Dermatitis
 Photocontact dermatitis: Photo allergic-
CD, photo irritant CD
 Diaper dermatitis
 Housewife dermatitis
 Occupational contact dermatitis
 Hand eczema
 Berloque’s dermatitis
 Atopic Dermatitis ( AD )

 Definition :
Atopic Dermatitis is a chronic
inflammatory skin disease that
frequently occur in patients with a
personal or family history of atopy (
Triad atopy : Atopic dermatitis- allergic
rhinitis-asthma bronchiale )
 Very common among infants and
children( but adult can be)
* Ring J, Huss-Marp J. Atopic Eczema. Karger Gazette 2004: 7-9.
 Atopic Dermatitis-2

 Etiology : unknown. Multifactorials

Genetics-environment-immunologic -
pharmacologic
 Phase:
- infantile AD: 2-6 months - 2 years
- childhood : 2 – 10 years
- adolescence/adult
 Diagnosis criteria of AD

Diagnosis criterias ( Hanifin & Rajka ) :

Mayor :pruritus-early onset-typical morphology &
distribution of lesion-chronic/relaps-
personal/family history of atopy
Minor :xerosis-ichtyosis/palmar hyperlinearity/-
keratosis pilaris-IgE -hand/foot dermatitis-
cheilitis-nipple eczema-susceptibility to
cutaneous infection-white dermographism
Atopic Dermatitis: Cause

(Charlesworth, Am J Med, 2002)

 Clinical features of AD
Depend on the phase
 Infant type : itchy scaly red lesion on
face(cheek),nose and scalp( sites of
predilection)upper trunk, diaper,extremities
,wrists and hand.There is a tendency a
spontaneous clearing at the age of 2-4 years
 Childhood phase
- flexural types of dermatitis
- Predilection : fosa poplitea, fosa cubiti ,the
bend of the elbows, wrist and ankles;
- Itching( some times severe) scratching-
rubbing lichenifications
DA
ATOPIC ECZEMA
 Clinical features of A D

Adolescence/Adult phase
- the continuation of flexural type of childhood
- In the most cases, the intensity of of the disease
decreases in the twenties and gradually fades in
thirties
- It is often exacerbated by stress and nervous
tension,etc.
AD
 Problems associated with
atopic dermatitis
a.Dermatologic : infection ( viral,
staphyllococcus), dry skin ,nipple
dermatitis,etc
b.Ophthalmologic : cataract/keratoconus
c.Gastroenterologic : food intolerance, food
allergy
d.Immunologic : increased IgE
hypersentivity
 Atopic Dermatitis: Treatment
1. Reduce contact with irritants (soap substitutes)
2. Reduce exposure to allergens
3. Emollients
4. Topical Steroids
5. Antihistamines
6. Antibiotics
7. Steroid sparing
8. Other (herbals, soaps)
PRICK TEST
 KUNCI KEBERHASILAN
PENGOBATAN dermatitis pada
bayi dan anak
 The other eczemas ( 1 )
1. Seborrhoic dermatitis
2. Stasis dermatitis
3.Lichen simplex chronicus /
Neurodermatitis
4.Nummular eczema/ Discoid eczema
5.Infectious Eczematous Dermatitis (
Infective eczematoid dermatitis )
6.Asteatotic eczema
7. Dyshidrotic eczema
SEBORRHEIC DERMATITIS
 SEBORRHEIC DERMATITIS

Pityriasis sicca
SEBORRHEIC DERMATITIS
Cradle Cap
 Stasis Dermatitis ( St D )
 Synonim :
Stasis eczema, Gravitational dermatitis,
Varicose eczema, Hypostatic Dermatitis
 Eczema secondary to venous hypertension
of the low extremities
 Middle-aged to elderly females
 The exact mechanism : ?
 Several theories ( St D)
 increased hydrostatic pressure in the
venous system, fibrinogen leaks into the
dermis a layer of fibrin forms around
capillariesa barrier to diffusion of
oxygen and other nutrient
 Arteriovenous shunts form in the affected
region hypoxia and poor skin nutrition
 Clinical features (St D )
 Dermatitis ( begin rapidly/insidiously)lower
leg swells rapidly  erythematous, warm ,
eczematous. acute, subacute, or chronic
 Location :medial or lateral surface of lower
leg, posterior and superior of malleoli.;
dermatitis, gradually, encompasses the entire
leg and migrates proximally.
 Recurrent inflammation deposit of
hemosiderin ( extravasation of RBC ) , poor of
oxigenation, Fibrosis of subcutan ( fat
necrosis )
 Pruritus : variable.
STASIS ECZEMA
 Treatment of St D
 Treatment of underlying varicose veins
 Steroid topical, is not recommended
long-term ( atrophic change!,
epidermis is already thin!)
 Protective bandages( preventing
scratching and trauma!)
 Emollient
 Sleep with pillow under lower legs
 Be careful not to injure ulcer !
 Lichen Simplex Chronicus
( LSC)
Synonims :Neurodermatitis, Circumscribed
lichen simplex )
Definition:
A well-demarcated areas of chronic lichenified
dermatitis which is not due to either
external irritation or identified allergen.
Etiology:
Stressitch itch-scratch-itch cycle
epidermal hyperplasia as lichenification
 Clinical features LSC
 Isolated,well-circumscribed,
lichenified,
slightly elevated plaques :on the nape
of neck , the forearms, or leg.
 The patient are often tense and
obsessive, there appears to be
association with atopy
 DD : psoriasis, nummular eczema,
lichen planus, tinea,contact dermatitis
 recurrence
 Treatment of LSC
Treatment :
- breaking the itch-scratch-itch cycle
antihistamin / mild tranquilizer
- Topical steroid ( moderate strong)/
intra lesion , keratolytic substance (
salycilic acid, tar).
LSC
 Nummular eczema
 Synonim: Discoid dermatitis
 Def: A chronic, recurrent pattern of dermatitis
with discrete coin-shaped lesion tending to
involve most often on the legs and arms, but
can spread to other body
 The skin are red in color, itchy, Secondary
infection is common( Bacterial eczema)
 Usually affects adults
 Many of whom will have a past history of
atopic dermatitis
 The etiology : unknown
 Nummular eczema-2
 Diagnosis : It is generally easy to
diagnose, however, atypical cases may
resemble other dermatoses( ACD,
psoriasis,tinea)
 Treatment : topical steroid
alone/combine with antibiotics.
Systemic antipruritics are rarely
required
NUMMULAR ECZEMA
 Infectious Eczematous Dermatitis /
Infective eczematoid dermatitis
(IED)
 Def.: An eczematous skin reaction
appearing in association with a pre-existing
cutaneous infection( otitis external, chronic
ulcer) at sites in contact with infectious
exudate
 Etiology/pathogenesis : poorly understood
 Clinical features: hallmarks: erythema,
scaling, crusting, oozing.The epidermis is
often eroded.The margin of eczematous
involvement are usually sharply define
 Treatment of IED
 Underlying disorder should be treated
first!
 Antibiotic – steroid combined topically
 compresses
INFECTIVE ECZEMATOID DERMATITIS
 Asteatotic eczema
 Sin. Eczema crequle.
 Def. Eczema associated with, and possibly
caused by, a decrease in skin surface lipid
Senile eczema ( not always!)
 Exact pathogenesis of skin change is obscure
 The dry irritable skin seen mainly on the limbs
of elderly patients.The skin dry , large scale
with a ‘crazy-paving”appearance ( lost of
epidermal lubricatin)
 Asteatotic eczema
 Treatment : moisturizier/emollients
regularly, reduction in bathing ( especially
hot water!).
 be careful with steroid topical!(Skin is
already thin and fragile
Asteatotic eczema
 Dyshydrotic eczema ( DE )
 A vesicular eruption of hands; acute-sub acute-
chronic and feet
 Deep-seated vesicles with little or no erythema
on the lateral or dorsal aspect of fingers or toes,
p[alms and soles.
 The eruption is usually bilateral and
symmetrical;if vesicles ruptur discharging a
gelatinous fluid  dry browning scaly crust
 Pruritus /burning sensation in early stage
 Dyshydrotic eczema ( DE
 It more common in individual who perspire
profusely and in emotionally tense persons
 Treatment :
- antihistamine/tranquilizer for pruritus ,
- antibiotics if secondary infected
- some cases will respond to small doses
of corticosteroid
- topical :acute :compresses( Sol Burow 1:20)
steroid with or without antibiotic
Dishydrotic eczema
 URTIKARIA

Eko krisnarto
RSU KOTA SEMARANG
 Definisi

Penyakit kulit dengan gejala gatal, edema

setempat, warna kemerahan, tengah pucat,
dikelilingi halo eritematosa
Urtikaria
Etiologi urtikaria
 Patogenesis

Pencetus  sel mast / basofil  degranulasi

 pelepasan mediator ( histamin, serotonin,
kinin, PG, dll )  vasodilatasi  peningkatan
permeabilitas  transudasi  pengumpulan
cairan  urtikaria
 Diagnosis

1. Anamnesis : mencari etiologi

2. Pemeriksaan fisik : gambaran klinik 
dugaan penyebab
3. Pemeriksaan penunjang :
Laboratorium
Test kulit
Test pembantu
 Terapi

 Mengetahui dan menghindari penyebab

 Pendekatan teoritis ada 3 :
1. Hambat efek histamin pada organ target
2. Hambat pelepasan histamin dr sel mast
3 Hambat mediator lain
 Antihistamin
AH1 (klasik)
Etanolamin/difenhidramin
Etilendiamin
Alkilamin
Piperazin
Fenotiazin/prometazin
Hidroksizin & siproheptadin

AH1 (non klasik)

Terfenadin
Astemizol
Loratadin
Setirizin

AH2
Cimetidin
 Kerja
AH
Kompetitif inhibitor pada reseptor
Pada AH2 (non klasik) efek samping sedasi
ditiadakan
 kortikosteroid
 Khasiat KS topikal ---- antiinflamasi,
antiproliferasi dan imonosupresi

 Mekanisme kerja KS topikal :

 Vasokonstriksi pembuluh darah dermis atas
 Antiproliferasi lapisan basal, kapiler, fibroblast
 Antiinflamasi ok rangsangan mekanis, kimia, dll
 Kortikosteroid
 pemilihan jenis kortikosteroid yg tepat
 BSO dan cara pemakaiannya
 Indikasi pengobatan
 Efek samping
 Potensi KS
 Potensi lemah ------ hidrokortison

 Potensi sedang ------ mometason

 Potensi kuat ------ betametason

 Potensi sangat kuat ------ klobetasol

 indikasi
 Potensi rendah sd sedang :
 Gigitan serangga, dermatitis atopik, xerosis,
lupus eritematosus diskoid, dermatitis
numularis, dsb

 Potensi kuat sd sangat kuat :

 Liken planus, pemfigus, psoriasis, keloid,
alopesia areata, neurodermatitis, dsb
 Bso & cara pemakaian
 Tgntng penetrasi ke epidermis :
 Tempat pengolesan
 Bahan tambahan spt asam salisilat
 Bahan pembawa ( vehikulum )
 Bebat oklusif ----- suhu dan hidrasi epidermis
naik
 Efek samping
 Atrofi
 Infeksi
 Dermatitis perioral
 Hipertrikosis
 Takifilaksis
 Katarak
 Glukoma
 Gangguan penyembuan luka..
Wanita 30 thn sakit kulit spt ini, rasa gatal tu malam hari. Gatal akan

muncul bila wanita tsb stress.

A. diagnosisnya apa ?

B. Terapinya apa ?
Wanita 16 thn, kira-kira 3 bln yll timbul warna kehitaman disekitar mulut .

Warna hitam semakin jelas bila minum obat..

A. diagnosis apa ?

B. golongan obat apa dan contohnya yg bisa menyebabkan diagnosis tsb ?

Bayi 2 bulan sering memakai pampers tu malam hari.

Sakit seperti ini sejak 3 hari

a. diagnosis penyakit ini ?

b. terapinya apa ?
Laki-laki 25 thn, timbul daging tumbuh di penis dimana makin lama makin

banyak dan membesar. Sekitar 8 bln yll pernah berhubungan seksual dgn

WTS (+).

A. diagnosis penyakit ini ?

B. penyebab penyakit ini apa ?

Wanita, 30 thn mempunyai sakit kulit spt ini, gatal , riwayat alergi
makan udang (+).

A. Diagnosis penyakit ini

B. Pemeriksaan yg dianjurkan utk tegakkan diagnosis

c. syarat apa sebelum dilakukan pemeriksaan lab.

Wanita 50 thn punya riwayat DM, sakit kulit seperti ini sejak 6 bln yll

A. Diagnosisnya apa ?

B. pemeriksaan lab apa untuk menegakkan diagnosisnya

C. Hasil apa yg anda harapkan dari pem laborat tsb

 Laki-laki 40 tahun menderita penyakit kulit seperti ini sejak lama.

Penyakit akan kambuh bila penderita mempunyai masalah di kantor.

A. diagnosis penyakit ini ?

B. apa tanda spesifik dari penyakit tsb ? ( bukan pemeriksaan lab )

Laki-laki 50 tahun seminggu yll sakit plenting bergerombol di dada kiri.
Plenting dimulai dari papila mama trus menyebar sampai ke punggung.
Sebelumnya ditandai nyeri otot dan merasa tdk enak badan.

A. diagnosisnya apa ?

B. terapinya apa ?
Bayi 3 bln sakit kulit seperti ini. Orang tua mempunyai riwayat asma

a. Diagnosisnya apa ?

B. apa terapinya
Anak 8 thn, timbul kelainan kulit spt dibawah ini dimana sebelumnya sakit
ISPA

a. Diagnosisnya apa ?

B. terapinya apa ?
Bayi 2 bulan sering memakai pampers tu malam hari.

Sakit seperti ini sejak 3 hari

a. diagnosis penyakit ini

b. terapinya apa ?
 Laki-laki 40 tahun menderita penyakit kulit seperti ini sejak lama.

Penyakit akan kambuh bila penderita mempunyai masalah di kantor.

A. diagnosis penyakit ini ?

B. apa tanda spesifik dari penyakit tsb ? ( bukan pemeriksaan lab )

Wanita 40 thn ( BB 50 kg ) sakit flu dan berobat ke dokter. Diberikan
obat pamol, amoksisilin, vit B dan OBH. 2 hari kemudian sakit spt ini
dan dibawa ke UGD. Anda sbg satu satunya dokter di RS tersebut.

A. diagnosisnya apa ?

B. Penatalaksananya bagaimana ( bukan teori )

Bayi 3 bln sakit kulit seperti ini. Orang tua mempunyai riwayat asma

a. Diagnosisnya apa ?

B. apa terapinya
Wanita 16 thn, timbul warna kehitaman disekitar mulut setelah minum obat

akibat sakit flu

A. diagnosis apa ?

B. golongan obat apa dan contoh obat yg bisa menyebabkan diagnosis tsb ?
Laki-laki 50 thn, sakit kulit seperti ini sejak lama sekali.

A. diagnosisnya apa ?

B. terapinya apa ?
Laki-laki 50 tahun seminggu yll sakit plenting bergerombol di dada kiri.
Plenting dimulai dari papila mama trus menyebar sampai ke punggung.
Sebelumnya ditandai nyeri otot dan merasa tdk enak badan.

A. diagnosisnya apa ?

B. terapinya apa ?
Laki-laki 25 thn, timbul daging tumbuh di penis dimana makin lama makin
banyak dan membesar. Sekitar 8 bln yll pernah berhubungan seksual dgn
WTS (+).

A. diagnosis penyakit ini ?

B. penyebab penyakit ini apa ?

Laki-laki 40 thn sakit kulit seperti ini, tidak gatal. Sebelumnya sakit flu.

A. Diagnosisnya apa ?

B. tanda spesifik dari penyakit tersebut apa ?

Wanita 30 thn sakit kulit spt ini, rasa gatal tu malam hari. Gatal akan
muncul bila wanita tsb stress.

A. diagnosisnya apa ?

B. Terapinya apa ?
Diagnosis ?
Diagnosis ?
Diagnosis ?
Diagnosis ?
Diagnosis ?