Undesirable reactions produced by the normal

immune system, including allergies & autoimmunity

damaging, uncomfortable, or occasionally fatal
The four-group classification was expounded by P.H
Gell & Robin Coombs in 1963
TYPE I REACTION (IgE dependent)
Histamine
Eosinophil chemotactic factor of anaphylaxis
Leukotriene C4
Prostaglandin D2
Cytokines
Mast cell
Basophil
Skin Respiratory tract Cardiovascular
Pruritus
Urticaria
Contraction
- Smooth muscle
- Mucous secretion
- Laryngeal edema
Dilatation /permeability

- Edema
- Hypotension

Vascular reaction
Wheal Localized edema
(superficial of the dermis)
White/red evanescence plaques
Red halo / flare
Itching / Stinging / prickling sensitivity
Angioedema
(Suubcutaneous tissue/ submucosa)
Minggu, 15 Juni 2014
5
Minggu, 15 Juni 2014
6
EPIDERMIOLISIS +
Cell damage
(cytolysis)

TYPE II REACTION (Ab mediated)














Drug
Cell
Ig Complement
(IgG, IgM)



BULLOUS DISEASE
Pemphigus vulgaris
Bullous Phemphigoid
Complement activation


anaphylatoxin
(C3a, C5a)


mast cell
basophil


mediators
release
TYPE III REACTION (Immune complex)
Immune complex
Sistemic lupus Erythematosus
SKLERODERMA
TYPE IV REACTION (cell mediated)
T lymphocytes / CMI
DERMATITIS KONTAK
defenisi :
Peradangan kulit yang disebabkan karena kulit
berinteraksi dengan bahan kimia yang kontak
atau terpajan pada kulit
DERMATITIS
KONTAK
DERMATITIS KONTAK
IRITAN (DKI)
DERMATITIS KONTAK
ALERGI (DKA)

Irritant CD : produced by substance that has direct toxic
effect on the skin.

Allergic : trigger an immunologic reaction tissue
inflamation

Foto Contact :
- Irritant
- Allergic

~ 80 % CDI
1.
2.
3.
Pathogenesis
Irritant CD : non specific inflammatory reactions due toxic
injury of the skin.

Allergic CD :cell mediated immunity/type IV
A. Sensitization phase
B. Elicitation phase

Sensitization : hapten + protein LCs Th1

.
.
Type IV
antigens
lymphokines
activated macrophage
Inflammatory
mediators
Dermatitis atau eczema: inflamasi kulit
Fase akut Fase khronis

Erithem
Vesikel
Gatal
Kulit kering
Skuama
Fisura
DKIrespon kulit terhadap bahan kontak, baik
faktor eksogen maupun endogen
Faktor eksogen

Reaksi iritan dermatitis iritan kumulatif
DKI akut
Reaksi iritan akut tipe lambat
DKI kronis kumulatif
Subjective (symptomatic, sensory) irritancy
Iritasi non erithematus
Frictional dermatitis
Traumatic reaction
Pustular/acneiform reactions
Exsiccation eczematid




Irritants
Substances direct toxic effect of the skin
Acids
Alkalis
Solvents
Detergents

.
.
.
.
MANIFESTASI KLINIS IRITAN
AKUT / KRONIS
Akut
Tipe reaksi :
- Bahan
- Lamanya
- Konsentrasi
Bercak/plak merah, edema dan rasa panas, papula, vesikula,
pustula, bula yang purulen dengan kulit disekitarnya normal.
Kronis

- SIDM I : kering dan pecah-pecah
- SIDM II : merah, bengkak, terasa
panas, papula, vesikel, krusta,
likenifikasi


Reaksi hipersensitifitas tipe IV (delayed
hypersensitivity)
Ada 2 fase:

1. Fase sensitisasi (induksi)
2. Fase elisitasi
Allergens
Triggers immunologic reaction tissue inflammation
Metals
Plants
Rubber chemicals
Medicines
.
.
.
.
Incidence :
Frequent problem
50 % occupational illness
.
DERMATITIS FOTO KONTAK
Toksik Kuman
Allergic

Fotosensitizer
Fenotiazin
Sulfonamid
Topikal Non Steroid Anti Inflamasi
Bitionol
Hexakhlorofen
Tabir Surya
Eosin
Ter
Zat Warna
Hair Tonik
Parfum
.
Anamnesis
Pemeriksaan fisik
Test tempel (Patch test)
Anamnese
Iritan yang kuat beberapa jam kerusakan kulit
Iritan lemah pemakaian berulang-ulang beberapa hari
Dermatitis
Riwayat pekerjaan
Obat-obatan
Efek matahari
Hobbless
Lokasi :
Head & neck: :cosmetics, hair dyes, permanent waves,
shampoos
Eyelid :eye cosmetic, nail polish
Photo allergic :produce by a photoreaction between
SUV & allergen, of the neck, arms.

Patch Test
Bahan :
Alergen standart konsentrasi tertentu
Bahan yang dicurigai
Ditempelkan pada kulit punggung
Dibaca 48 72 jam Dibaca Reaksi (+) :
Eritema,Papula,Vesikula
6 atau 7 hari reaksi (-)
DD DKA DKI
1. Effloresensi polimorf monomorf
2. Bentuk kontak ~kontakta
3. Batas tidak jelas jelas
4. Penghindaran reaksi tetap (+) cepat hilang
5. Keluhan gatal perih
6. Fase sensitasi (+) (-)
LOKALISASI DAN KEMUNGKINAN FAKTOR
PENYEBAB DERMATITIS KONTAK
LOKALISASI KEMUNGKINAN FAKTOR PENYEBAB
Muka

Telinga
Bibir
Leher
Ketiak
Dada Belakang
Buah Dada
Pinggang
Daerah Perianal
Lengan dan kaki
Pergelangan Tangan
Badan
Kaki
Tangan
Kosmetik, cat rambut, semprot rambut, cat kuku, fotokontak, bahan-bahan dari
udara, kacamata.
Nikel, bahan-bahan topikal, bahan penyebab fotosensitif, cat rambut.
Pastagigi, obat kumur-kumur, lipstik,.
Minyak wangi, perhiasan, cat kuku, baju, cat rambut.
Pewangi, anti keringat, obat-obat topikal, bedak, baju.
Klip BH.
Logam, bahan-bahan topikal.
Karet celana, kepala tali pinggang, kancing jeans/rok.
Bahan topikal.
Tumbuh-tumbuhan.
Jam tangan, perhiasan.
Baju.
Kaus kaki, sepatu, bahan-bahan topikal.
Macam-macam kemungkinan.
.
PENGOBATAN
Preventive ; merubah life style, pekerjaan dan
protektif
Akut : Kompres

Oral Kortikost ( 35 50 mg/hr)

Topikal Kortikost

Anti Histamin


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ALLERGIC CONTACT DERMATITIS
Dermatosis Akibat Kerja
ALLERGIC CONTACT DERMATITIS
IRRITANT CONTACT DERMATITIS