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LCD Kuliah Dermatitis Wa2008

LCD Kuliah Dermatitis Wa2008

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Published by Made Wardhana

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Published by: Made Wardhana on Nov 02, 2008
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02/04/2013

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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, LTs, PAF bradykinin

Blood Vessels

Urticaria, Angioedema Laryngeal edema, Shock Bronchospasm Abd. pain, Vomiting Diarrhea, Rhinorhea Bronchial secretion Itching

Smooth Muscles
H, PGD2, LTs, PAF

H Mast Cell Basophil
LTB4 PAF IL3, IL5 Chemokines

Mucus Glands

Sensory Nerves

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 3. Hiperlinearitas palmar 5. Ig E meningkat 7. Kheilitis 9. Mudah terjadi infeksi 11. Pitiriasis alba 13. White dermographism 15. Uji kulit positif 17. Kepucatan wajah 19. Faktor emosi 2. Fisura periaurikuler 4. Keratosia pilaris 6. Dermatitis tangan 8. Dermatitis Scalp 10. Keratosis pilaris 12. Dermatitis niple 14. Katarak/keratokones 16. Garis Dennie-Morgan 18. Awitan dini 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 cari penyebabnya Steroid topikal kuat

• Terapi :

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

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