Penanganan Dermatitis Atopik

Prof Ariyanto Harsono MD PhD SpA(K)

Atopic dermatitis is a disease that begin to arise at
the age of infants and children
characterized by itching of the skin.
chronic and relapsing
inflammatory reaction
based on hereditary factors and environmental
factors,
the symptoms are chronic recurrent erythema,
papules, vesicles, crusting, and skuama.
2 Prof DR Dr Ariyanto Harsono SpA(K)
Atopic Dermatitis:

Itch that erupts

Not eruption that itches
3 Prof DR Dr Ariyanto Harsono SpA(K)
4 Prof DR Dr Ariyanto Harsono SpA(K)
Major criteria (minimal 3)
Pruritus
Characteristic Distribution and morphology of skin lesions
Flexural Lichenification
Facial and extensor Lichenification in babies and children
Chronic
History of family atopy
5 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Pruritus
Characteristic Distribution
and morphology of skin lesions
Flexural Lichenification
Facial and extensor
Lichenification in babies and children
Kronik
History of family atopy
Riwayat atopi dan keluarga atopi
6 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
Pruritus
Characteristic Distribution
and morphology of skin lesions
Flexural Lichenification
Facial and extensor
Lichenification in babies and
children
Kronik
History of family atopy

7 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
Pruritus
Characteristic Distribution
and morphology of skin lesions
Flexural Lichenification
Facial dan ekstensor pada bayi
dan anak
Kronik
History of family atopy

8 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
Kriteria Hanifin and Rajka
Pruritus
Characteristic Distribution
and morphology of skin lesions
Flexural Lichenification
Facial and extensor in babies
and children
Chronic
History of family atopy

9 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
10 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
11 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
12
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
13
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
14 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
15 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
16 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Minor criteria (minimal 3)
17 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
18
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive

High IgE levels
Early Onset of age
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Vulnerable of infections (Stafilokokus/herpes)
19 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Staphylococcus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
20 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
21 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
22
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
23 Prof DR Dr Ariyanto Harsono SpA(K)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Skin Test positive
High IgE levels
Early Onset of age
Vulnerable of infections (Stafilokokus/herpes)
Tend to nonspesific dermatitis
Nipple eczema
Cheilitis
Recurrent Conjunctivitis
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Ichtyosis , palmar hyperlinearity, keratosis pilaris
Xerosis
Tes kulit positif
Peningkatan IgE serum
Onset usia muda
Mudah infeksi kulit (Stafilokokus/herpes)
Kecenderungan nonspesific dermatitis
Nipple eczema
Cheilitis
Reccurent conjunctivitis
24 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Minor criteria (minimal 3)
Kriteria Hanifin and Rajka
25 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
26 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
27 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
28 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
29 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

30 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

31 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
32 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
33 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
34 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
Kriteria Hanifin and Rajka
35 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria
Minor criteria
Hanifin and Rajka criteria
Minor criteria
36 Prof DR Dr Ariyanto Harsono SpA(K)
Dennie Morgan infraorbital fold
Keratoconus
Anterior subcapsular cataract
Orbital darkening
Facial pallor/erythem
Pityriasis alba
Itch when sweating
Wool intolerant /lipid solvent
Perifollicular accentuation
Food Intolerant
Emotional and environmental influence
White dermatographism

Hanifin and Rajka criteria for baby
Kriteria mayor (minimal 2 mayor)
History of family atopy
Evidence of pruritic Dermatitis
Dermatitis fasial, ekstensor, lichenification
Minor criteria (minimal 1 minor)
Xerosis/ichtyosis/hyperlinear palm
Perifollicular accentuation
Chronic scalp scalling
Periauricular fissures

37 Prof DR Dr Ariyanto Harsono SpA(K)
Major criteria(minimal 2 major)
Hanifin and Rajka criteria for baby
Kriteria mayor (minimal 2 mayor)
History of family atopy
Evidence of pruritic Dermatitis
Dermatitis fasial, ekstensor, lichenification
Minor criteria (minimal 1 minor)
Xerosis/ichtyosis/hyperlinear palm
Perifollicular accentuation
Chronic scalp scalling
Periauricular fissures

38 Prof DR Dr Ariyanto Harsono SpA(K)
Major criteria(minimal 2 major)
Hanifin and Rajka criteria for baby
Kriteria mayor (minimal 2 mayor)
History of family atopy
Evidence of pruritic Dermatitis
Dermatitis fasial, ekstensor, lichenification
Minor criteria(minimal 1 minor)
Xerosis/ichtyosis/hyperlinear palm
Perifollicular accentuation
Chronic scalp scalling
Periauricular fissures

39 Prof DR Dr Ariyanto Harsono SpA(K)
Major criteria(minimal 2 major)
Hanifin and Rajka criteria for baby
Major criteria(minimal 2 major)
History of family atopy
Evidence of pruritic Dermatitis
Dermatitis fasial, ekstensor, lichenification
Minor criteria (minimal 1 minor)
Xerosis/ichtyosis/hyperlinear palm
Perifollicular accentuation
Chronic scalp scalling
Periauricular fissures

40 Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin criteria for children
Major criteria (minimal 3 major)
Pruritus
Characteristic Distribution and morphology of skin lesions
Dermatitis fasial, ekstensor selama bayi dan awal usia anak
Flexural lichenification dan linearity by adolescence
Chronic Dermatitis
Minor criteria(minimal 1 minor)
Xerosis/ichtyosis/hyperlinear palm/keratosis pilaris
IgE reactivity
Chronic scalp scalling
Perifollicular accentuation
Periauricular fissures

41 Prof DR Dr Ariyanto Harsono SpA(K)
Minor criteria(minimal 1 minor)
Hand/foot dermatitis
Cheilitis
Vulnerable to infection (Herpes/Strep/S aureus)
42 Prof DR Dr Ariyanto Harsono SpA(K)
Minor criteria(minimal 1 minor)
Hand/foot dermatitis
Cheilitis
Vulnerable to skin infetions (Herpes/Strep/S aureus)
43 Prof DR Dr Ariyanto Harsono SpA(K)
Minor criteria(minimal 1 minor)
Hand/foot dermatitis
Cheilitis
Vulnerable to skin infetions (Herpes/Strep/S aureus)
44 Prof DR Dr Ariyanto Harsono SpA(K)
Minor criteria(minimal 1 minor)
Hand/foot dermatitis
Cheilitis
Vulnerable to skin infetions (Herpes/Strep/staphilococcus)
45 Prof DR Dr Ariyanto Harsono SpA(K)
46 Prof DR Dr Ariyanto Harsono SpA(K)
Seborrhoic dermatitis
47 Prof DR Dr Ariyanto Harsono SpA(K)
Pompholix
48 Prof DR Dr Ariyanto Harsono SpA(K)
Principle of Conventional Therapy
Barrier defect
Cytokine release
Dermal inflammation
Eczema
Target for skin care
Target for anti
inflammatory
49 Prof DR Dr Ariyanto Harsono SpA(K)
Education
Hidration
Emolient
Moisturizer
Wet dressing
Allergen/irritants avoidance
Antihistamine
Topical Steroid
50
Prof DR Dr Ariyanto Harsono SpA(K)
Conventional Therapy
is not always safe
Topical steroid: cutaneous atrophy, striae, bruisability, telangiectasia

High-potency topical steroids can cause
systemic side effects in children.
51
Prof DR Dr Ariyanto Harsono SpA(K)
Mild Moderate Severe
Mild to Moderate Potency Topical Steroids
Pimecrolimus
Tacrolimus
Oral Steroids
Cyclosporine, mycophenolate
Light treatment
New Treatment Strategy in AD
Emolient
Dry
skin
Itching and/or early sign of
inflammation
Flare
E
d
u
c
a
t
i
o
n

52 Prof DR Dr Ariyanto Harsono SpA(K)
IVIG
53 Prof DR Dr Ariyanto Harsono
SpA(K)
Thank you