Dermatitis = Eczema

1. Dermatitis Atopik
2. Dermatitis Kontak
3. Dermatitis Numularis
4. Dermatitis Seboroik
5. Dermatitis Statis
6. Eczema Infantum
7. Neurodermatitis
( Likhen Simpleks Kronikus)
8. Dermatitis Tangan & Kaki

made wardhana
Atopic dermatitis (AD) or atopic eczema is a
• Chronically relapsing, pruritic, skin inflammation
• Characterized primarily by an allergic diathesis
• IgE mediated sensitization to environment allergen
• Sometimes first appears in infancy.
• Spesific clinical features: infant, child and adult
Prevalence
• Doubled or tripled in industrialized
countries during the past three
decades;
• 15 to 30% of children and 2 to 10% of
adults are affected.
• Atopic dermatitis frequently starts in
early infancy (early- onset atopic
dermatitis). in adults (late-onset atopic
dermatitis).
• A total of 45% of all cases of atopic
dermatitis begin within the first 6
months of life, 60% begin during the
first year, and 85% begin before 5 years
of age.
Etiology
• The etiology of AD has not been fully
unknow
• Hereditary/genetic and environmental
factors
Pathophysiology - Immunopathogenesis
• Hyperactive Th2 subset Thelper cells (associated with
promotion of IgE production from B lymphocytes,
differentiation of CD-4 T lymphocytes, suppression of Th1
cell activities, stimulation of proliferation, and
differentiation of B lymphocytes)
• Increased levels of serum IgE
• Upregulation of IL-4
• Increased eosinophils
• Elevated levels of IgE activated mast cells
• Disturbances in fatty acid metabolism/deficiencies of omega-6
fatty acids in plasma, adipose tissues, and formed blood
elements
Mediators of Mast Cells and Allergy

H, PGD2, Blood Vessels Urticaria, Angioedema

LTs, PAF Laryngeal edema, Shock
bradykinin

Smooth Muscles Bronchospasm

Abd. pain, Vomiting
H, PGD2,
LTs, PAF

Mucus Glands Diarrhea, Rhinorhea

H Bronchial secretion
Mast Cell
Basophil Sensory Nerves Itching
LTB4
PAF
IL3, IL5
Chemokines Leukocytes Inflammation - LPAR

AllergyChula
 Clinical Feature
The natural history of the illness may be described under the
different age groups:

1. Infancy (2 mo – 2 yr)
Cheek & others, symetrical, erythem macule, papulo-vesicle
‘oozing’, moist crust
2. Childhood (> 2 y)
antecubital and popliteal fossae, symetrical
less exudattive, drier and more papular , Lichenified, slightly scaly

3. Adolescence and adulthood (> 12 y)

localised erythematous macule or plaque, scaly,
hyperkeratosis and lichenification
 Kriteria Diagnosis
Hanifin & Lobitz
Hanifin & Rajka
Svenson
William

Kriteria Hanifin & Rajka (modifikasi, 1990)

Major (basic) criteria - 3 or more of the

following:
1. pruritus
2. typical morphology and distribution (flexural
lichenification or linearity in adults; facial and
extensor involvement in infants and children)
3. chronic or chronically-relapsing dermatitis
4. Personal or family history of atopy (asthma,
Kriteria Minor ( 3 atau lebih)

1. Xerosis 2. Fisura periaurikuler

3. Hiperlinearitas palmar 4. Keratosia pilaris
5. Ig E meningkat 6. Dermatitis tangan
7. Kheilitis 8. Dermatitis Scalp
9. Mudah terjadi infeksi 10. Keratosis pilaris
11. Pitiriasis alba 12. Dermatitis niple
13. White dermographism 14. Katarak/keratokones
15. Uji kulit positif 16. Garis Dennie-Morgan
17. Kepucatan wajah 18. Awitan dini
19. Faktor emosi 20. Tanda Hertog
Treatment Guidelines for Atopic Dermatitis

• Moisturizers
• For mild flare, mild (class VI or VII) corticosteroid
to affected areas twice daily
• For severe eczema, short term (no more than 2 wk)
of medium- to high-potency topical
corticosteroids (class III through V)
• Oral antibiotics for widespread, infected, flaring
eczema
• Topical antimicrobials, including mupirocin, bacitracin,
3% precipitated sulfur in petrolatum, 1%
hydrocortisone, applied twice daily for infected
eczema of the trunk and extremities
• Antihistamines for pruritis
• Eliminate precipitating environmental factors
Contact dermatitis refers to dermatitis caused by
skin contact with an environmental agent.
Contact dermatitis (CD) is an altered state of skin
reactivity induced by exposure to an external
agent.

According to the mechanism of elicitation, the

following types of contact reactions may be
distinguished:
2. allergic contact dermatitis (ACD),
3. irritant contact dermatitis (ICD),
4. phototoxic and photoallergic contact dermatitis,
Chemicals or physical agents (primary irritants) damage the
surface of the skin faster than the skin is able to repair the
damage.
Well demarcated with a glazed surface but there may be
redness, itching, swelling, blistering and scaling of the
damaged area.
• Amount and strength of the irritant
• Length and frequency of exposure (eg. short heavy exposure
or repeated/prolonged low exposure)
• Skin susceptibility (eg. thick, thin, oily, dry, very fair,
previously damaged skin or pre-existing atopic tendency)
• Environmental factors (eg. high or low temperature or
humidity)
Allergic contact dermatitisis (ACD) an immunologic
inflammatory reaction of the skin due to contact
with an allergen.
ACD is a cell mediated (delayed type) hypersensitivity
reaction to environmental chemical or
“sensitisers.”
Different substances have different sensitizing
potential, and there is individual susceptibility to
sensitization by an allergen.
The 2 distinct phases in a type IV hypersensitivity
reaction are the induction (ie, sensitization)
phase and the elicitation phase.
Treatment ACD

The only available etiologic treatment of

ACD is elimination of the contact allergen.
Systemic
Antihistamine
Corticosteroid
Topical
Acute phase (papulo-vesiculo, oozing)
 wet bandage solutio NaCl 0,9 %
Chronic phase  topical steroid
 Dermatitis Numularis
The term nummular means coin-shaped, so
both terms describe the characteristic round
(or oval) erythematous skin plaques.
Numuler, Eksim Diskoid
Penyebab → ???
Dermatitis atopik
Infeksi :Stafilokokus
Iritasi/kontaktan
reaksi Id
Prevalensi : semua umur, semua jenis
Klinis: gatal
polimorf → akut, subakut, kronis
numuler : uang logan, soliter, mutipel
Neurodermatitis Sirkumskripta
Likhen Simplek kronikus = Likhen Vidal

• orang dewasa
• Penyebab ???
• Faktor stres
• Garukan yang berulang-ulang di suatu tempat
pergelangan, tangan, kuduk, betis
• Klinis : lesi kronis
hiperkeratosis, likhenifikasi,
hiperpigmentasi
• Terapi : cari penyebabnya
Steroid topikal kuat
Stasis Dermatitis

Stasis dermatitis is a rash of the

lower legs which is due to poor return
of blood to the heart. Usually the
inner leg is more involved than the
outer lower leg. Sometimes the rash
breaks down into a sore resulting in a
stasis ulcer. It affects people with
varicose veins.
Stasis Dermatitis

Stasis dermatitis is a rash of the

lower legs which is due to poor
return of blood to the heart.

Usually the inner leg is more involved

than the outer lower leg. Sometimes
the rash breaks down into a sore
resulting in a stasis ulcer. It affects
people with varicose veins.
Seborrheic
Dermatitis
Seborrheic dermatitis affects the
scalp, central face, and anterior
chest.
In adolescents and adults, it often
presents as scalp scaling
(dandruff).

Seborrheic dermatitis also may cause

mild to marked erythema of the
nasolabial fold, often with scaling.
Stress can cause flare-ups.

The scales are greasy, not dry, as

commonly thought. An uncommon
generalized form in infants may be
linked to immunodeficiencies.
• Gaangguan aliran darah vena daerah tungkai bawah
(inkompeten katup vena)
• Tekanan vena meningkat → ekstravasasi → udem
• lebih berat → varises
• faktor risiko : wanita gemuk, sering melahirkan,
pekerjaan berdiri, keturunan, ras
• Prevalensi : >>> wanita setengah baya, gemuk
• Klinis :
Lok : maleolus perifer
ulkus kecil sukar sembuh/ kambuhan
tepi lesi hiperpigmentasi, varises
lebih besar ulkus landai, pucat, melebar tak teratur
• Terapi : dermatitis secara umum
untuk varises : Sclerozing agent operasi
Seborrheic eczema (also called
seborrheic dermatitis, infantile
seborrheic eczema, child/infantile
eczema)
Most commonly associated with flaking
and sometimes redness of the skin
(www.medinfo.co.uk).
Occurs when there is inflammation of
the skin where sebaceous glands are
concentrated (Rouse).
Seborhheic or baby eczema is
genetically determined, and
therefore is not contagious.  cradle
Penyebab:
Penyebab pasti ?????
Peningkatan aktivitas kel.sebum
Hormonal
Infeksi P. ovale
Stafilokakus
Stres
Klinis
D Seboroika sicca – ketombe
Terutama kulit kepala -- skuama halus putih

D Seboroika oleosa
Wajah, sternum, interscapula
skuama tebal berminyak (warna kuning)
Bayi baru lahir  cradle cap : Leiner disease

Penatalaksanaan
Cari penyebabnya
Antihistamin
Topikal krim hidrokortison
Kulit kepala : sampo : selenium sulfida, ketokonazol
sulfur
Stres  sedatif, penenang