DERMATITIS – ECZEMA

DERMATITIS -Eczema Inflamasi kulit yang sering terjadi akibat mikroorganisme Gejala utama gatal

Erythem

Papule

Vesicle

Pustule

“Oozing”

Crust

Squama

Tipe of Dermatitis- eczema

Atopic dermatitis Contact dermatitis Seborrhoic dermatitis Statis dermatitis Neurodermatitis Nummular eczema Dishidrosis Asteatotic eczema Infective Eczematoid Dermatitis

Atopic Dermatitis / Eczema

A.D 3 stadium

• Infantil ( 2 months – 2 years)

• anak-anak ( 2 years – 10 years)

• Dewasa

Infantile Awal : eritem &gatal pada pipi vesikel

krusta

Lesi dapat meneyebar ke badan, dahi, pergelangan tangan, extremitas

Dapat Melibatkan bokong dan area popok

Dapat menyebar dan menjadi eritroderma

Anak-anak AD

Lesi lebih eksudatif

Lokasi yg sering terkena : antekubiti, poplitea, pergelangan tangan, kelopak mata, wajah, leher.

Gatal

Frekuensi meningkat karena sensitisasi oleh telur, susu, gandum . Dapat meningkat oleh karena wool, bulu kucing & anjing, pollen

Remaja & dewasa AD

Predileksi antekubiti, poplitea, dahi, sekitar mata

Resiko dermatitis tangan pada daerah dorsum

Sifat Gatal : paroksismal, nokturnal, dicetuskan oleh stres.

Trigger faktor : iritasi wool & bahan lainnya, makanan, ketegangan

Diagnosis

Hanifin & Rajka , Svenson, SCORAD criterias

Hanifin & Rajka criteria :

Major criteria 1. Pruritus2. Typical morphology and distribution3. Tendency toward chronics or chronically relapsing dermatitis4. Personal or family history of atopic diseases (asthma, allergic

rhinitis, AD)

Minor criteria :1. Xerosis / ichthyosis/ hyperlinear palms2. Pityriasis alba3. Keratosis pilaris4. Facial pallor / infraorbital darkening5. Elevated serum IgE6. Keratoconus7. Tendency to non spesific hand eczema8. Tendency to repeat cutaneous infections

DD/ :

• Dermatitis numularis

• Dermatitis seboroik

• Dermatitis kontak

• Psoriasis

• Skabies

General management

1. Bayi & anak2 Mencegah:

Iritasi eksternal Infeksi lokal

Menghindari : makanan yang dapat mencetuskanTerapi : -antihistamin sistemik-Minyak zaitun-Topikal kortikosteroid potensi lemah

2. Dewasa:

a. Mengontrol stres

b. Mencegah suhu ekstrim

c. Hidrasi kulit kering

d. Antihistamin

e. Topikal steroid

f. Antiobiotik (jika perlu)

Dermatitis Kontak

Dermatitis yang dicetuskan oleh reaksi kulit yang kontak dengan benda asing / lingkungan baik iritan maupun alergik

Dicetuskan oleh sinar UV 2 reaksi : fotoalergik & fototoksik

Kontak Dermatitis Alergika

Hanya terjadi pada individu yang memiliki predisposisi Sensitisasi terjadi dalam seminggu setelah kontak dengan

alergen , tetapi tidak menunjukkan kelainan kulit Kontak kedua, dengan alergen yang sedikit dapat

mencetuskan dermatitis Sensitisasi akan bertahan dalam beberapa bulan, tahun

bahkan seumur hidup.

Dermatitis Kontak Iritan

Terjadi pada individu yang terpapar bahan iritan kimia dalam waktu yang lama

Peradangan terjadi pada bagian tubuh yang terpapar

Tidak ada reaksi alergi, kerusakan akibat reaksi kimia langsung

Bahan Iritan: Iritan kuat radang berat saat pertama kali terpapar Iritan lemah konsentrasi kecil yang berulang

(detergen, )

Sign

Dermatitis alergi

dasar kulit eritem, udem, papul, vesikel,bula. Singel/ multipel, berbagai ukuran.

Iritan kuat luka bakar, ulkus, nekrosis.

Patch Test

Terapi Preventive :

Menghindari kontak Topikal :

Akut : Balut basah ( Burowi solution 1/20 –1/40), Permanganat 1/10.000 dilanjutkan kortikosteroid topikal.

Kronik : steroid topikal potensi sedang Sistemik :

Antihistamin dan steroid

Contact Dermatitis

Dermatitis Seboroik

Dua bentuk:

* Infantil* Skuama kuning berminyak pada kulit kepala, wajah, aksila

dan daerah popok. Tidak ada hubungan antara bentuk infantil dan bentuk

dewasa No pruritus eat & sleep well

“Infantil form” Seborrhoeic Dermatitis

Cradle Cap

* The adult form * Affect the face, scalp, anterior chest, axilla, sub

mammary fold, groins, external ear Facial lesion, particularly in the nasolabial fold, in

men, maybe very persistent the scalp is frequently involved presenting

complaint, esp severe and persistent dandruff Eyebrow/ eyelid stickness of the eyelid in

early morning

Differential diagnosis :

Contact dermatitis, psoriasis and Pityriasis versicolor

Treatment : Tends to recure whatever treatment is chosen Topical : imidazol antifungal ketokonazol

(cream/shampoo) , weak potency topical steroid

“Adult form” Seborrhoeic Dermatitis

Stasis dermatitis

dermatitis on the lower legs, commonly seen in association with venous insufficiency

inner aspects of boths lower legs above and around the medial malleous are chiefly involved

the skin is shinny, atrophic and large numbers of small blood vessels clearly visible, purpura, pigmentation (due to haemosiderin)

pruritus may be severe and cause scratch marks which are slow to heal

Treatment :treatment of underlying varicose veins, topical steroid (weak) be ware of side effects atrophy

Stasis Dermatitis

Neurodermatitis(liken simplex chronicus)

a well demarcated are of chronic lichenified dermatitis which is not due to either external irritants or identified allergens

In predisposed persons, the lesions are induced by continual scratching or rubbing of a localized area of itching skin

stress / emotional disturbance pruritic stimulus scratch itch-scratch-itch cycle stimulate a reactive hyperplasia, recognized clinically as lichenification

clinically, neurodermatitis are seen as a well-circumscribe, lichenified, slightly elevated plaque, seen on the nape of neck, forearm, or the legs

Treatment :

Reduce pruritus, topical steroid (ointment/ intra lesion)

Neurodermatitis

Asteatotic aczema(eczema craquele)

The dry irritable skin seen mainly on the limbs of elderly patients.

The skin is dry and has large scale with a “crazy-paving” appearance.

Treatment : - lubrication - steroid topical should be avoided (skin is already thin and fragile)

Asteatotic Eczema

Dishydrotic (eczema dishydrosticum)

a very characteristic pattern of intensely itchy vesicles of the skin of the hands and occasionally the feet and also the side of finger

Deep-seated vesicle ; often easier to feel than to see The cause is not understood ( contact dermatitis /

stress? ) Treatment ; systemic antihistamins ( control the need

to scratch) prevent secondary infection, potent topical steroid ( a short time) ; for the moist lesion calamine lot.

Dishydrotic

Nummular or Discoid dermatitis

a chronic, recurrent pattern of dermatitis with discrete coin-shape lesions tending to to involve the limbs

Usually affects adults (many of whom will have a past history of AD) ; The aetiology is unknown

Clinically : subacute with erythema, edema, vesiculation; the surface may be moist and appear infected bacterial eczema

Pruritus is variable Treatment : topical steroid + antibiotic

Nummular or Discoid Dermatitis

INFECTIVE ECZEMATOID DERMATITIS

IED is exogen in nature, can be defined as fluid/ exudate which originates from inflammation or disorders such as: OMP, sinusitis, chronic ulcers, etc

IED is thought as autosensitisation dermatitis which occurs from skin’s sensitivity toward chemical substances originating from tissues/ bacteria in the body’s own exudate

Clinical appearances : Erythema & exudation In a dry state, there is crust. If crust is peeled, we would

see erythema & often pustules on the edgesExamples : The earlobes of children suffering from OMP. The area around the nose of maxilaris sinusitis sufferers

Therapy : Rivanol 1/1000, Betadine dressing When cleared Hidrocortisone 1 % or combination with

antibiotic

Infective Eczematoid Dermatitis