D E R M A T I T I SD E R M A T I T I S

by :by :Dr. Endang Sutedja, dr, Dr. Endang Sutedja, dr,

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D E R M A T I T I S

Definition : skin inflammation (epidermodermitis) subjective : itchy objective : polymorph

CATCH BASKET TERM* Eczema :• UNITARIS ( Europe ) : Eczema & dermatitis synonim • DUALISTIS ( United State ) : Eczema & dermatitis not synonim

Dermatitis consist of several stages :• I Erythema - edematous• II Vesico - bullous• III Madidans (wet)• IV Desquamation (crust & dry)

CLASSIFICATION :

1. Etiology

• Exogen : contact dermatitis, dermatitis caused by drug

• Endogen : atopic dermatitis, neurodermatitis, stasis dermatitis

2. Form :

numular dermatitis

3. Course of the disease :

• Acute : several days - 1 week

• Subacute

• Chronic : 1,5 months or more

caused by exogenous material

• 2 forms :

* Irritant contact dermatitis (ICD)

* Allergic contact dermatitis (ACD)

IRRITANT CONTACT DERMATITIS

• Etiology : primary irritant contact• Onset : first contact• Subjective : burning• Lesion : more severe than ACD, circumscribed,

oedema erythematous acute, blister • Contactant ( - ) : heal rapidly

CONTACT DERMATITIS

Irritant Contact Dermatitis

Divided based on the type of irritant :

* Strong irritant : strong acid and alkali agent

rapid and more severe dermatitis (toxic contact dermatitis)* Weak irritant : soap, detergent, dye (hair dye, shoes polish) chronic, etiologic agent depend on concentration and skin thickness

Several Etiologies & Terms of Contact Dermatitis

Dermatitis Venenata Insect and plants

secretion

House Wife Dermatitis house wife

Occupational Dermatitis occupation

Industrial Dermatitis from factory

IRRITANT CONTACT DERMATITIS

ALLERGIC CONTACT DERMATITIS

• Etiology : sensitizer

• Onset : repeatly contacts

• Subject : allergic patient

• Subjective : itchy

• Lesion : uncircumsribed

• Contactant (-) : exist / increase

ALLERGIC CONTACT DERMATITIS

* Occurred only at certain patient* Hypersensitivity type IV* Allergen :

* Metal : jewellery, watch, glasses* Cosmetic

* Diagnosis : History : burning / itchy after contact • Clinical manifestation : * More toxic * Localization depend on contact location * Subjective : polymorph

ALLERGIC CONTACT DERMATITIS

Supporting examination:PATCH TEST

* For allergic contact dermatitis patient

• Suspected agent patch at volar or interscapular region

covered by impermeable material

* Read after 24 - 48 hours

* Criteria :# Erythema +# Erythema + oedema + +# Vesicle + + +# Confluent vesicles + + + +# Necrosis + + + + +

Patch test conditions• Skin lesion has already cleared • During occlusion do not exposure to water and sweating• 3 days before : do not consume any drugs, esp antihistamin and corticosteroid

TREATMENT OF CONTACT DERMATITIS* Stop contact with causative agent* Drugs :

*Topical depend on lesion : Wet dressing Dry corticosteroid ointment Subacute cream *Systemic antihistamine

if severe corticosteroid

PATCH TEST

PATCH TEST

PATCH TEST

23

PRICK TEST

ATOPIC DERMATITIS

* Atopic term from atopy• ATOPY : a group of hereditary disease with hypersensitivity allergic symptoms

* asthma* hay fever* allergic rhinitis* hives* drug/food allergic

* Only occurred at certain people

CRITERIAS OF ATOPIC DERMATITIS

• Skin inflammation with atopy base in patient or family who has symptoms, i.e erythema, oedema and scales

* Synonims : Eczema flexurarum Disseminated lichen chronicum simplex Prurigo diasthetique

Wise & Sulzberger ( 1923 ) :

* Scratch/ trauma

* Allergen, air pollution, wool, fabrics

* Physical stress

* Temperature changes ( climates changes )

* Sweat retention

* etc.

* Etiology : poorly understood, multifactorial

* Genetic

* Organ sensitivity (level of itchy sensation > lower )

D I A G N O S I S

* History : chronic recurrent (remission)

* Symptom : divide into 3 phases (Sulzberger) based on age :

I. Infantile ( 2 months - 2 years )

II. Childhood phase ( 3 - 13 years )

III. Adolescent + adulthood (> 13 years)

* Primary symptoms :

severe itching, caused by scratching skin lesions :

erythema, edema, vesicles, crusts, lichenification

sign of chronic skin disease caused by longtime scratching

PREDILECTION & CLINICAL APPEARENCEI. INFANTILE Face : both cheeks Neck oozing, erythema, oedema Scalp crusts, scalesII. CHILDHOOD PHASE Skin fold : Elbows Knees dry, erythema, papules, Neck lichenificationIII. ADOLESCENCE / ADULTHOOD Skin fold : Elbows Knees dry, lichenification Neck

diagnosis of atopic stigmata / atopic signs patient/family

Special criteria : subjective, clinical symptoms, laboratory MAJOR CRITERIA * Familiy history of atopic* Combination : severe and persistant itchy + symptom on the predilection site* Elevated Ig E* GI track atopic, ichthyosis, cataract* Patient’s skin : dry, itchy sweating * Remission chronic reccurent* Skin test : (+) more than 1

RAJKA ( 1975 )

MINOR CRITERIA :* Onset : fast* Alergy : food or drug* Immunity to bacterial and viral infection decrease of T cell function* Food intolerance* Influenced by : hot weather, emotion, infection * Sensitive to wool, special fabrics* Lab : eosinophilia

DIAGNOSIS* Minimal 3 major or* 2 major and several minors

HANIFIN ( 1976 ) I. * Itchy sensation * Characteristic morphology & distribution * Chronic course

II. * Patient and family history of atopy (+) * Skin test (+) * White dermatographism (+) scratch on normal skin triple responds i.e. white line, erythema, edema atopic skin : white line, erythema, white line, because of vasoconstriction * Cataract

III. * Xerosis (dry skin)

* Ichthyosis

* Pityriasis alba

* Keratosis follicularis

* Elevated IgE

* Recurrent skin infection

DIAGNOSIS

* One of group I

> 2 of group II

* One of group I

> 4 of group III

SVENSON’S CRITERIA ( 1985 )

• Influenced by season• Xerosis • Influenced by stress• Itchy• Elevated Ig E ( N = 8 ) IU • Allergic rhinitis• History of rhinitis• Toxic irritation• Acrodermatitis in childhood• Atopic dermatitis in family

I

* Pale / redness on facial skin* Knuckle dermatitis ( skin fold )* Asthma* Keratosis follicularis* Food allergic* Numular dermatitis* Nipple eczema

* Pompholic ( papules on palm) * Ichthyosis* Dennie Morgan’s fold (inferior palpebrae fold)

II.

III.

DIAGNOSIS : score 15

Group I = 3

Group II = 2

Group III = 1

TREATMENT OF ATOPIC DERMATITIS Avoid allergenDrugs :

Topical : depend on stage : infantile, childhood, adulthood tar preparation as an antimitotic

Sistemic : antihistamine corticosteroid ( severe )

5

ATOPIC DERMATITIS IN INFANT

ATOPIC DERMATITIS IN CHILDHOOD

ATOPIC DERMATITIS IN ADULT

NEURODERMATITIS CIRCUMSCRIPTA* Synonim : lichen simplex chronicus Vidal* Usually related with physical, stress, anxiety disorder* Predilection :

* Knuckle / lateral* Anterior ankle* Foot

* Lesion : hiperpigmentation, lichenifikation, circumscribed

TREATMENT* Avoid : pshycologic disorder* Drug :

* Topical : corticosteroid* Systemic : antihistamine

NEURODERMATITIS

NUMULAR DERMATITIS

* Name : round lesion coin size* Predilection :

* Extensor part of lower leg * Shoulder and buttocks

* Recurrent chronic disease healed with hyperpigmented

macule

* Predisposing factors :Infection : - teeth

- ENT

- Internal disease : TB

NUMULAR DERMATITIS

STASIS DERMATITIS

* Synonim : circulatory dermatitis, major etiology : circulation disorder

* Etiology : stasis at lower leg circulation, varices, pregnant

woman, often standing for long periode

* Clinical manifestation :

* Subjective : itchy

* Scratch painful ulcer occures* Initial : edema at ankle region, evening after work

* Due to blockage hemosiderin outflows pigmentation macule at 1/3 distal lower leg * Chronic : wet/madidans dermatitis ulcer

DIAGNOSIS

* History : itchy, standing for long periode

* Predilection : dermatitis / ulcer

TREATMENT The most important : recirculation

if severe consult to Dept. of Surgery

STATIS DERMATITIS