Dermatitis

• Definisi:
• Peradangan kulit (epidermis, dermis)
sebagai respons terhadap pengaruh faktor
eksogen dan atau faktor endogen.
Menimbulkan kelainan polimorfik (eritema,
edema, papul, vesikel, skuama,
likenifikasi)
 Etiologi

Faktor eksogen: bahan kimia

fisik (SUV)
Faktor endogen: Dermatitis Atopik
 Klinis
Keluhan gatal
Kelainan kulit bergantung pada stadium
• Akut : eritema, edema, vesikel/ bula, erosi,
eksudasi
• Subakut: eritema ber (-), eksudat kering krusta
• Kronis : lesi kering, skuama, papul, likenifikasi,
erosi, ekskoriasi
 Tatanama/Klasifikasi
• Belum seragam
• Ada yg berdasarkan:
etiologi (DK, D. Medikamentosa)
morfologi (papulosa, eksfoliativa)
bentuk (D. Nummularis)
lokalisasi (D. intertrigenous)
 DERMATITIS

Eczema Contact Dermatitis

Atopic Dermatitis Non Allergic

Non Atopic Allergic Contact
(Eczema / Contact
Dermatitis Dermatitis
Atopic Eczema) Dermatitis
DERMATITIS
1. Nonspecific Eczemaous
Dermatitis
2. Atopic Dermatitis
3. Contact Dermatitis
4. Seborrheic Dermatitis
5. Stasis Dermatitis
6. Lichen Simplex Chronicus
 Histological Dermatitis
Histological:
Intercellular edema (spongiosis)
inflammatory infiltrate in dermis
- Acute dermatitis: erythema, edema, spongiosis
causing vesicular
- Subacute dermatitis: less spongiosis, juicy
papules
- Chronic dermatitis: thickened epidermis
(lichenification)/acanthotic, slight spongiosis,
scalling
 The hallmarks of Eczematous
Dermatitis
• 1. Marked pruritus
• 2. Indistinct border
• 3. Epidermal changes by vesicles, juicy
papules/lichenification
• 4. Localized/ diffuse
• 5. Idiopathic/ cause by specific ethiology
 Regional Dermatitis
• Ear Eczema
• Eyelid dermatitis
• Breast Eczema
• Hand Eczema Irritant hand dermatitis
• Vesicobullous Hand Eczema (Pompholyx, Dyshydrosis)
• Chronic vesicobullous hand eczema
• Hyperkeratotic Dermatitis of the palms
• Autosensitization Dermatitis
• Xerotic Eczema
• Nummular Eczema
 Nummular eczema
• Nummular dermatitis
• Predominantly a disease of adulthood (50-
65 years), rare in infancy, childhood
• Man>Women
• Characteristic: Oval patches with crusted
papulovesicles
Localisation: Trunk
Extremities
 Nummular Eczema
• Also known as discoid eczema
• A chronic disorder of unknown etiology
• Papules and papulo vesicles cialescence to
form nummular plazues with oozing, crust
and scale
• Commone sites: upper extremities, dorsal
hands in women lower extremities in man
• Pathology acute, subacute, chronic eczema
 Etiology and Pathogenesis
• Pathog. Is unknown
• Family history atopy (-)
• Hydration of the skin is decreased
• Role of infection
• Role of invironmental allergen: HDM,
Cand
 Clinical Manifestation
• Well demarcated, coin-shape plaques from
coalescing papules and papulovesicles
• Pinpoint oozing, crusted entire surface
• Plaque 1-3 cm in size
• Surrounding skin is normal/ xerotic
• Pruritus
• Central resolution annular form
 Clinical Manifestation
• Chronic plaque are dry, scaly and
lichenified
• Laboratory test: patch test maybe seful in
chronic recalcitrant– rule out
superimposed CD
Dermatitis Numularis
 Differential Diagnosis
Acute vesico papular dermatitis:
Contact dermatitis
Infections: Dermatophyte, HS virus,
Varicella Zoster, Bacteria
Chronic vesico papular dermatitis:
Chronic CD, psoriasis, drug eruption,
fungal infect
 Therapy
1. Corticosteroid:
- topically (under occlution)
- injectable intralesional
- sistemic
2. Calceneurin inhibitors: tacrolimus,
pimecrolimus
3. Wide spread acute/ subacute eczematous:
prednisone/ triamcinolone 40 mg/i m
wet dressing/bath: acute dermatitis
4. Chronic: baths containing oil moisturizers/emmolient
5. Itching: hydroxyzine/ diphenhydramine
Atopic Dermatitis in Child
 Lichen Simplex Chronicus
• Also known as neurodermatitis
circumcripta/ circumscribed
neurodermatitis
• Chronic, severely pruritic characterized by
one or more lichenified plaques the skin
is thickend
• Most common sites: scalp, nape of neck,
extensor aspects of extremities, ankles,
• Anogenital region
 Etiology and Pathogenesis
• Induced by rubbing and scratching
secondary to itch
• Environmental factors inducing itch
• ( heat, sweat, irritation)
• Emotional/ psychological factors
(depression, anxiety)
 Clinical Finding
• Severe itching (the hallmark of LSC)
• Paroxysmal, continous/ sporadic
• Rubbing and scratching
• Itch severity is worse with sweating, heat/
irritation from clothing/ psychological
distress
 Cutaneous Lesions
• Repeating rubbing and scratchlichenified
(thikened skin with accentuated skin
marking)
• Scally plaque with excoriations
• Hyper and hypopigmentation chronicity
• One plaque or more
• Sites: scalp, the nape of neck (women)
ankles, extensor aspect o/t extremities,
anogenital
 Pathology LSC

• Hyperkeratosis, hypergranulosis,
psoriasisform epidermal hyperplasia,
thickened papillary dermal collagen
Liken Simplek Kronikus/
Neurodermatitis
 Therapy

Difficult
Tranquilizer and anti depressants
Topical steroid and intralesional steroid
 Xerotic Eczema

• Is the results of low humidity and dry skin

• Clinis: dry fissure skin trunk, extremities

(lower leg)
 Autosensitization/Id eruption

• - generalized sub acute dermatitis

• - feet/hands
• - Hypersensitivity reaction to substance
produced by the acute dermatitis
 Dyshidrotic Eczema

• -Characteristic: deep seated vesicles

(which resemble the pearls in tapioca
pudding)
• -Palm, soles, side of fingers
• -Bilaterally, symmetrically
 CONTACT DERMATITIS

An inflammatory reaction of
the skin precipitated by an
exogenous chemical
Contact Dermatitis
1. Irritant CD: produced by
substance that has direct toxic
effect on the skin
2. Allergic: trigger an
immunologic reaction tissue
inflammation
 Pathogenesis
• Irritant CD: nonspecific 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

inflammatory
mediators
lymphokines

activated macrophage
 Irritants

Subtances  direct toxic effect of the skin

• Acids
• Alkalis
• Solvents
• Detergents
 Allergens
Triggers immunologic reaction tissue
inflammation

• Metals
• Plants
• Rubber chemicals
• Medicines
Incidence:

- Frequent problem
- 50% occupational illness
 History
First determine: ACD/ICD
• Strong irritant several hours  skin damage
• Weaker irritants multiple application & days
dermatitis
• Allergic Contact Dermatitis:
– Requires 24-48 hours
– Often exposure Clinical disease
– Occasionally dermatitis (8-12 hours) up to 4-7 hours
– Detailed history of occupation, hygiene habits, hobbies
 The most common Sensitizers
• Poison Ivy
• Para phenylenediamine
• Nickel
• Rubber compounds
• Ethylenediamine
• Poison ivy: in the summer
– Allergen: pentadecylcatechol (oleoresin of the plant)
 PPD

• Permanent coloring of hair

• Cross reaction : Azo, aniline dye,
Benzocaine, procaine,
Hydrochlorothiazine
Sulfonamides
When completely oxidized (fur coat), PPD not allergenic
 Nickel
• Most commonly in woman
• Ear piercing
• In all metals
• “Hypoallergenic” earring: one cannot be
certain that they are free of nickel
• Stainless steel: nickel bound so tightly
ACD (-)
 Rubber compound

• Shoes ACD on dorsa of the feet

• Allergen: Mercaptobenzothiazole
Thiurams
 Ethylenediamine

Preservative in Mycolog cream, ointment (-)

Dyes, insecticides,
Rubber accelerators,
Synthetic waxes,
In aminophyllin
Sensitive individual generalized
eczematous dermatitis
 Physical Examination
• Acute/chronic
• Depend upon the nature of the exposure
 patches/plaque, angular corner, geometric on
lines, sharp margin
• Localization:
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
 Physical Examination
• The dorsum of the hands: industrial
chemicals (irritants): petroleum, solvents
• The dorsum of the feet: shoes (rubber,
leather tanning agents)
• Groins and buttocks in infants: Diaper
dermatitis: moisture and feces
 Diagnosis
• Patch test: The test material, in different vehicles
(commonly white petrolatum)
• Is applied to the skin under a metal disc, called a
Finn chamber
• A test battery of 20-24 allergens is used as
standard allergens
• The sheet is placed on the upper back, scaled
with adhesive tape
• The patch is removed after 48 hours read
 Therapy
• Prevention
• Avoidance of irritant/allergen change in life
style & occupation
• Protective clothing
• Occupational: protective, barrier cream little
benefit
• Substituted
• Topical steroid
• Antihistamine
Dermatitis Kontak Iritan

DKI pd tangan & ujung-ujung jari akibat asam

Dermatitis Kontak Alergi

DKA akibat kalung nikel DKA akibat semen

 Fotoalergi
(Dermatitis Berloque)
 Seborrheic Dermatitis/ Morbus
Unna
• Definition: a chronic, superficial, inflammatory
process affecting the hairy regions of the body

• Etiology: unknown/ Pityrosporum ovale

Dandruff is scaling of the scalp without

inflammation
• Incidence: a common problem, 2-5%
adult 18-40 years, baby (cradle cap),
children 6-10 years, woman> man
 Seborrheic Dermatitis
• Predilection hairy
region: scalp, eyebrow
• eyelid
• Nasolabial creases,
ears, chest
 History

• The occurrence of Seborrheic

Dermatitis parallels the increased
sebaceous gland activity occurring in
infant, after puberty, pruritus
 Physical examination
• Predilection for the hairy regions where there are
numerous sebaceous gland: scalp, eyebrows,
eyelids, nasolabial creases, ears, chest,
intertriginous area: axilla, groin, buttocks, infra
mammary folds
• Bilateral and symmetrically
• Most mild form, dandruff, fine whittis scaling
without erythema.
• Patch/plaque: indistinct margin, erythema,
yellowish, greasy scaling, uncommon hair loss
 Physical examination S.D
• Mild form: dandruff fine whitish scaling
without erythema / Pityriasis sica
• Mild Moderate: erythema, yellowish
greasy scaling
 DD
1. A.D (infantile eczema)
if infant Loc: diaper area & axilla
diagnosis S.D
If lesion: forearms, shins AD
2. Psoriasis: scalp, groin, other area
papilosquamous patches &
plaque
3. T. capitis: hair loss, urban black
Biopsy : non diagnostic
 Therapy S.D
• Anti seborrheic shampoos (sulfur, salicylic
acid, selenium sulfide, zinc pyrithione)
• Shampoos must be rubbed in to the
scalp 5-10 minutes
• Inflam. Seborrrheic:
• topical steroid lot/gel  in hairy area;
hydrocortisone cream non hairy skin
 STASIS DERMATITIS

Defination:

An eczematous eruption of the lower

leg secondary to peripheral
venous disease
 STASIS DERMATITIS

 Venous incompetence  hydrostatic

pressure, capillary damage extravasation of
red blood cell & serum inflammatory
eczematous process
 Incidence

• Adults (middle age old age)

• History: Chronic
pruritic eruption
precede by edema & swelling
Patients with Stasis dermatitis have often
had thrombophlebitis
 Physical examination

Varicose vein are prominent

1. Edema
2. Brown pigmentation
3. Petechiae
4. Sub acute and chronic dermatitis
5. Thickened skin, scaling and /or weeping
6. Any portion of the leg prominent site is
above the medial malleolus
 Therapy
- Prevention of venous stasis and edema  use of
supportive hose
- Standing should be restricted
- Patients who are obese weight reduction
- If this fails bed rest with elevation of legs
- Topical steroid
- Wet compresses if there is oozing or crusting
 History

- Patient may have history of emotional or

psychiatric problem
 Physical Examinations

• Patients: anxious
• Lichenified plaque, scratching (+)
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