L O N G C A S E

ATOPIC DERMATITIS
 CONTENTS

1 2 3 4
 IDENTITY

Inisial :T
Age : 7 month-old
Sex : Female
Adress : Yogyakarta
 SUBJECTIVE
01
 ANAMNESIS

PRESENT :
A 7 month-old girl, is brought to DV clinic by her mother, who is concerned about her
daughter’s pruritic rashes. The rashes started about 1 week ago, and initially on her
cheeks. Since that time, it seem in her arms and legs. Baby frequently scratches the
affected area. She has treated the condition with “pigeon baby soap and lotion”, but it
doesn’t help her. She notes that she and her husband are not affected by any itchy rashes.
Baby’s grandma and aunty have a history of asthma.
 ANAMNESIS

PAST Have no past history

HISTORY

FAMILY History of asthma : grandma and aunty

HISTORY

PERSONAL N
She is the first daughter of a couple
SOCIAL
HISTORY BW 3,1 kg, at term, breastfeed
 OBJECTIVE
02
 CLINICAL E XAMINATION
Vital signs : normal limits
Weight : 7 kg
Attentive and interactive
Dermatology examination
Multiple erythematous papules and patches, scaling, round-shaped, well-defined, localization on her
cheeks, arms, and legs
 CLINICAL E XAMINATION
Biomarker/laboratory examination (-)
 ASSESSMENT
03
 DIAGNOSIS

• Atopic dermatitis

• Differential diagnosis :
• irritant contact dermatitis
• allergy contact dermatitis
 PLANNING
04
 PLAN

Non pharmacology Pharmacology

 Non Pharmacology

• Life style modification

• Discover and avoid the risk factors
• Avoid irritant materials
• Using neutral PH soap and moisturizer
• Avoid using chemical materials and antibacterial soap.
• Avoid psychological stress
• Maintain cleanliness of clothing material, diaper area, face, and body.
 Pharmacology

Topical
Topical corticosteroid : desonide cream 0,05% or flousinolone asetonide cream 0,025%,
max 2 weeks
Lichenification and hyperpigmentation manifestation : betamethasone valerat cream 0,1%
or momethasone furoat cream 0,1%
Secondary infection : topical antibiotic
Systemic/oral
Antihistamin : chlorfeniramine maleat, cetirizine, loratadine
 Pharmacology

R/ desonide cream 0,05% tube I

S 2 dd ue

R/ Cetirizine syr no I
S 1 dd cth 1/2
R S U D Y O G Y A 2 0 1 9

Thank you

Definition
AD is a chronic, pruritic inflammatory skin disease that occurs most
frequently in children, but also affects many adults. It follows a relapsing
course. AD is often associated with elevated serum immunoglobulin (IgE)
levels and a personal or family history of type I allergies, allergic rhinitis, and
asthma.
• AD onset is most common between 3 and 6 months of age, with
approximately 60% of patients developing the eruption in the first year of
life and 90% by 5 years of age. While the majority of affected individuals
have resolution of disease by adulthood, 10% to 30% do not, and a
smaller percentage first develop symptoms as adults.
Risk factors
• Female > male
• Atopy history
• Environmental
• Hypersensitivity/allergy history
Pathophysiology
Diagnosis
• The diagnosis of AD is made clinically and is based on historical features,
morphology and distribution of skin lesions, and associated clinical signs.
Hanifin Rajka criteria
Major criteria Minor criteria
- History of flexural dermatitis - Xerosis
- Onset < age 2 years old - Skin infection (s. aureus an h. simplex)
- Presence of an itchy rash - Icthyosis
- Atopy (Personal and/or family history) - Pitiriasis alba
- History of dry skin - Nipple eczema
- Visible flexural eczema - White demographism or delayed blanch
- Cheilitis
- Dennie morgan infraorbital fold
- Conjungtivitis
- Keratoconus
- Cataract
- Orbital darkening
- Facial pallor/facial erythema
- Itch when sweating
- Intolerance to wool and lipid solvent
- Perifollicular accentuation
- Food intolerance
- Course influence by environmental and
emotional
- Skin test +increased serum IgE
Hanifin-Rajka criteria for infant

• Major criteria
• Atopy (Personal and/or family history)
• Eczema (Facial, neck, and extensor involvement in infants and children)
• Pruritus
• Minor criteria
• Xerosis
• Other regional findings (eg, perioral changes/periauricular lesions)
• Chronic scalp scaling
• Perifollicular accentuation
William criteria

• Major criteria
• Pruritus
• Minor criteria (3 or more)
• xerosis
• Atopy
• History of dry skin
• Flexural eczema
• <2 y.o
Predilection

• Infant type (0-2 y.o)

• Acute lesion, erythema, papule, vesicle, erosion, exudate, crust
• Location : cheeks, forehead, ears, neck, extensor
• Child type (2 y.o-puberty)
• Subacute lesion, drier, plaque, erythema, scaling, exudate, crust, excoriation
• Location : symmetrical lesions, flexural wrist, ankle, antecubital, popliteal, neck, and infraglutea
area
• Adult type
• Chronic and dry lesions, erythema, scaling, papule/plaques.
• Location : flexural fold, face, neck, upper arms, dorsal hands, feet, finger, toes.
Severity
• AD mild : < 10% of skin surface
• AD moderate : 10-50% of skin surface
• AD severe : >50% of skin surface
Biomarkers
• No specific biomarkers for diagnosis or severity assessment
• Immunoglobulin E levels not routinely recommended
Complication
• Secondary infection
• Erythroderma
Management
• Life style modification

• Find and avoid the risk factors

• Avoid irritant materials

• Using neutral PH soap and moisturizer

• Avoid using chemical materials and antibacterial soap,

• Avoid psychological stress

• Maintain cleanliness of clothing material, diaper area, face, and body

• Topical
• Topical corticosteroid : desonide cream 0,05% or flousinolone asetonide
cream 0,025%, max 2 weeks
• Lichenification dan hyperpigmentation manifestation : betamethasone valerat
cream 0,1% or momethasone furoat cream 0,1%
• Secondary infection : topical antibiotic

• Systemic
• Antihistamin : chlorfeniramine maleat, cetirizine, loratadine