dermatitis & eczema 2007

8/8/2019 Dermatitis & Eczema 2007

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DERMATITISDERMATITIS EczemaEczema

EkoEko KrisnartoKrisnartoRSU Kota SemarangRSU Kota Semarang


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Dermatitis or eczema ?


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Dermatitis or eczema ?


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DermatitisDermatitis oror eczemaeczema ??


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DERMATITIS & ECZEMADERMATITIS & ECZEMA

The term dermatitis and eczemaThe term dermatitis and eczemaare frequently used interchangeablyare frequently used interchangeably

It is simply and clearly defined asIt is simply and clearly defined asinflammation of the skin, withoutinflammation of the skin, withoutinfection.infection.

Eczematous also connote : scalingEczematous also connote : scalingcrusting, or serious oozingcrusting, or serious oozing


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The appearance ofThe appearance of dermatitisdermatitis

Erythema

Vesicles/Pustules

Papules

Squama

Oozing/Exudation

Crust


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DERMATITIS & ECZEMADERMATITIS & ECZEMA

Three large categories :Three large categories :

1.1. Contact Dermatitis :Contact Dermatitis :

--Allergic Contact Dermatitis /ACD,Allergic Contact Dermatitis /ACD,-- Irritant Contact Dermatitis /ICDIrritant Contact Dermatitis /ICD

2. Atopic Dermatitis2. Atopic Dermatitis

3. The other eczemas3. The other eczemas


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Irritant Contact Dermatitis( ICD)Irritant Contact Dermatitis( ICD)

(ICD) is caused by external(ICD) is caused by external

factors/irritation of variablefactors/irritation of variabledegree,depend on individualdegree,depend on individual

characteristics of chemicalscharacteristics of chemicals & time& time

The most common causative agent :The most common causative agent :

solvent,detergents,petroleum oil andsolvent,detergents,petroleum oil and

grease,cutting fluid and lubricant, foods,grease,cutting fluid and lubricant, foods,plants and particular dust, e,g.fiberglassplants and particular dust, e,g.fiberglass


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Irritant CDIrritant CD--22

Clinical features:Clinical features:

AcuteAcute ,skin,skinreddishreddish--brown, vesicles developbrown, vesicles develop, painful and itchy, usually accidental :, painful and itchy, usually accidental :

acid,alkali,phenol,ammonium compounds Theacid,alkali,phenol,ammonium compounds Theonset is rapid and lesions appear exactly atonset is rapid and lesions appear exactly atthe site of contactthe site of contact

SubacuteSubacute :due to repeated exposures of a:due to repeated exposures of a

small area ( e.g.napkin rash),Skin : erythema,small area ( e.g.napkin rash),Skin : erythema,sometimes blister, erosionsometimes blister, erosion

ChronicChronic :skin dry, hacked, or fissure:skin dry, hacked, or fissure


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Irritant CDIrritant CD--33

Treatment :Treatment :

Elimination of exposureElimination of exposure

Local humectantsLocal humectants Topical steroid ( mild/medium) ( acute),Topical steroid ( mild/medium) ( acute),

stronger( chronic )stronger( chronic )


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Irritant Contact DermatitisIrritant Contact Dermatitis


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CONTACT DERMATITIS


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Allergic Contact Dermatitis ( ACDAllergic Contact Dermatitis ( ACD ))

ACD: a delayed type of allergic reaction ofACD: a delayed type of allergic reaction ofthe skin resulting from contact withthe skin resulting from contact withspecific allergenspecific allergen

Affects 1Affects 1--2% population in great risk2% population in great riskcertain group ( workers, housecertain group ( workers, house--wife,wife,chronic skin condition ,such as leg ulcerchronic skin condition ,such as leg ulcer,etc.),etc.)

Clinical features: acute or sub acuteClinical features: acute or sub acutedermatitis lesion, at the site s where thedermatitis lesion, at the site s where theallergen is, or distant areas ( indirectly)allergen is, or distant areas ( indirectly)


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Common site of ACDCommon site of ACD

Scalp ( hair dyes), the ear lobes ,the neckScalp ( hair dyes), the ear lobes ,the neck( nickel containing jewellary ) ,the wrist (( nickel containing jewellary ) ,the wrist (metal/leather watch straps, feet ( leather,metal/leather watch straps, feet ( leather,

plastics, glue ,dye), and hand( plants,plastics, glue ,dye), and hand( plants,nickels, latex glovenickels, latex glove hand eczemahand eczemapersistent problem. In all cases ofpersistent problem. In all cases ofpersistent hand eczemapersistent hand eczema a patch testa patch testshould be performed , and to examineshould be performed , and to examinescraping for fungi.scraping for fungi.


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ALLERGIC CONTACT DERMATITISALLERGIC CONTACT DERMATITIS

RUBBER FOAM

METAL


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ALLERGIC CONTACT DERMATITISALLERGIC CONTACT DERMATITIS

RUBBER

LEATHER


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Management of ACDManagement of ACD

Detection of the likely sensitizing agentDetection of the likely sensitizing agent

( history has an important role!)( history has an important role!)

Topical steroid ( the strength should beTopical steroid ( the strength should bechosen according to the site involved)chosen according to the site involved)

AntihistamineAntihistamine

Systemic steroid ( in severe conditions and inSystemic steroid ( in severe conditions and in

short time)short time) Patch test : when the lesion is subside/ freePatch test : when the lesion is subside/ free

from inflammation 4from inflammation 4--6 weeks6 weeks


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PATCH TESTPATCH TEST


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Differences between ICD and ACDDifferences between ICD and ACD

ICDICD ACDACD Prevalence Verycommon MuchlessPrevalence Verycommon Muchless

PriortoPriorto

Exposure Not required EssentialExposure Not required Essential

Affectedarea Sitesofcontact Siteofcont.Affectedarea Sitesofcontact Siteofcont.

,littleextension distant site,littleextension distant site

Susceptibility Everyone SomeSusceptibility Everyone Some

Associated Atopic predisposes Chronicskindis.Associated Atopic predisposes Chronicskindis.

skindis.skindis.

Timing 4Timing 4--12 hours >24 hrs12 hours >24 hrs

Lesiondevelop NolesionLesiondevelop Nolesion

on first exposure on first expon first exposure on first exp


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Terms associated withTerms associated with

Contact DermatitisContact Dermatitis Photocontact dermatitis: Photo allergicPhotocontact dermatitis: Photo allergic--

CD, photo irritant CDCD, photo irritant CD

Diaper dermatitisDiaper dermatitis Housewife dermatitisHousewife dermatitis

Occupational contact dermatitisOccupational contact dermatitis

Hand eczemaHand eczema Berloques dermatitisBerloques dermatitis


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Diaper dermatitisDiaper dermatitis


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Berloques dermatitisBerloques dermatitis


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Atopic Dermatitis ( AD )Atopic Dermatitis ( AD )

Definition :Definition :

Atopic Dermatitis is a chronicAtopic Dermatitis is a chronicinflammatory skin disease thatinflammatory skin disease thatfrequently occur in patients with afrequently occur in patients with apersonal or family history of atopy (personal or family history of atopy (Triad atopy : Atopic dermatitisTriad atopy : Atopic dermatitis-- allergicallergic

rhinitisrhinitis--asthma bronchiale )asthma bronchiale )Very common among infants andVery common among infants and

children( but adult can be)children( but adult can be)


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Atopic DermatitisAtopic Dermatitis--22

Etiology : unknown. MultifactorialsEtiology : unknown. MultifactorialsGeneticsGenetics--environmentenvironment--immunologicimmunologic --pharmacologicpharmacologic

Phase:Phase:

-- infantile AD: 2infantile AD: 2--6 months6 months -- 2 years2 years

-- childhood : 2childhood : 2 10 years10 years-- adolescence/adultadolescence/adult


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Diagnosis criteria of ADDiagnosis criteria of AD

Diagnosis criterias ( Hanifin & Rajka ) :Diagnosis criterias ( Hanifin & Rajka ) :

Mayor :Mayor :prurituspruritus--early onsetearly onset--typical morphology &typical morphology &

distribution of lesiondistribution of lesion--chronic/relapschronic/relaps--personal/family history of atopypersonal/family history of atopy

Minor :Minor :xerosisxerosis--ichtyosis/palmar hyperlinearity/ichtyosis/palmar hyperlinearity/--keratosis pilariskeratosis pilaris--IgEIgE --hand/foot dermatitishand/foot dermatitis--

cheilitischeilitis--nipple eczemanipple eczema--susceptibility tosusceptibility tocutaneous infectioncutaneous infection--white dermographismwhite dermographism


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Clinical features of ADClinical features of AD

Depend on the phaseDepend on the phase

Infant typeInfant type : itchy scaly red lesion on: itchy scaly red lesion onface(cheek),nose and scalp( sites offace(cheek),nose and scalp( sites ofpredilection)predilection)upper trunk, diaper,extremitiesupper trunk, diaper,extremities

,,wrists and hand.There is a tendency awrists and hand.There is a tendency aspontaneous clearing at the age of 2spontaneous clearing at the age of 2--4 years4 years

Childhood phaseChildhood phase

-- flexural types of dermatitisflexural types of dermatitis

-- Predilection : fosa poplitea, fosa cubiti ,thePredilection : fosa poplitea, fosa cubiti ,thebend of the elbows, wrist and ankles;bend of the elbows, wrist and ankles;

-- Itching( some times severe)Itching( some times severe) scratchingscratching--rubbingrubbing lichenificationslichenifications


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DADA


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ATOPIC ECZEMAATOPIC ECZEMA


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Clinical features of A DClinical features of A D

Adolescence/Adult phaseAdolescence/Adult phase

-- the continuation of flexural type of childhoodthe continuation of flexural type of childhood

--In the most cases

,the intensity of of the diseaseIn the most cases

,the intensity of of the diseasedecreases in the twenties and gradually fades indecreases in the twenties and gradually fades in

thirtiesthirties

-- It is often exacerbated by stress and nervousIt is often exacerbated by stress and nervous

tension,etc.tension,etc.


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ADAD


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Problems associated withProblems associated with

atopic dermatitisatopic dermatitisa.Dermatologic : infection ( viral,a.Dermatologic : infection ( viral,staphyllococcus), dry skin ,nipplestaphyllococcus), dry skin ,nippledermatitis,etcdermatitis,etc

b.Ophthalmologic : cataract/keratoconusb.Ophthalmologic : cataract/keratoconusc.Gastroenterologic : food intolerance, foodc.Gastroenterologic : food intolerance, food

allergyallergy

d.Immunologic : increased IgEd.Immunologic : increased IgEhypersentivityhypersentivity


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PRICK TESTPRICK TEST


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The other eczemas ( 1 )The other eczemas ( 1 )

1.1. Seborrhoic dermatitisSeborrhoic dermatitis

2. Stasis dermatitis2. Stasis dermatitis

3.Lichen simplex chronicus /3.Lichen simplex chronicus /

NeurodermatitisNeurodermatitis4.Nummular eczema/ Discoid eczema4.Nummular eczema/ Discoid eczema

5.Infectious Eczematous Dermatitis (5.Infectious Eczematous Dermatitis (Infective eczematoid dermatitis )Infective eczematoid dermatitis )

6.Asteatotic eczema6.Asteatotic eczema

7. Dyshidrotic eczema7. Dyshidrotic eczema


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Seborrhoic dermatitis / eczemaSeborrhoic dermatitis / eczema--11

A common scaly, superficial eczematousA common scaly, superficial eczematousdermatitis showing a predilection for areas ofdermatitis showing a predilection for areas ofincreased sebaceous gland activity ( scalp, faceincreased sebaceous gland activity ( scalp, face,ear

,back

,axillary

,inguinal

,ear

,back

,axillary

,inguinal

A disease entity with many clinical variationA disease entity with many clinical variation

Affect 1Affect 1--3% general population and 33% general population and 3--5% young5% youngadultadult

Its more common in males than in females (Its more common in males than in females (seborrhoic diathesis!)seborrhoic diathesis!)


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Seborrhoic dermatitis / eczemaSeborrhoic dermatitis / eczema--22

EtiologyEtiology : UNKNOWN !: UNKNOWN ! Some of hypothesesSome of hypotheses::

-- SeborrheaSeborrhea

-- Pityrosporum ovalePityrosporum ovale infectioninfection

-- Hypersensitivity to bacterial or epidermalHypersensitivity to bacterial or epidermalantigensantigens

-- Emotional responses to stress or fatigueEmotional responses to stress or fatigue

-- Abnormal dietAbnormal diet-- Epidermal proliferationEpidermal proliferation

-- Neurotransmitter abnormalitiesNeurotransmitter abnormalities


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Seborrhoic dermatitis /eczemaSeborrhoic dermatitis /eczema--33

Some of Clinical variants ofSD:Some of Clinical variants ofSD:

-- cradel cap ( infancy)cradel cap ( infancy)

-- Dermatitis : scalp,eyebrows, blepharitis,Dermatitis : scalp,eyebrows, blepharitis,nasolabial fold, forehead , otitis externa,nasolabial fold, forehead , otitis externa,flexuralflexural

--Pityriasis sicca: dandruff ( withoutPityriasis sicca: dandruff ( withoutinflammation!)inflammation!)


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SEBORRHEIC DERMATITISSEBORRHEIC DERMATITIS


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Pityriasis siccaPityriasis sicca


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Cradle Cap


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Seborrhoic dermatitis /eczemaSeborrhoic dermatitis /eczema--44


-- Conservative : emolient, shampoo ( zincConservative : emolient, shampoo ( zinc

pyrithion,selenium sulfide 1%pyrithion

,selenium sulfide 1%

-- Intensive : Weak steroid: hydrocortison 1Intensive : Weak steroid: hydrocortison 1--22 % and or Ketoconazol 2%% and or Ketoconazol 2%

--Blepharitis : hot compresses ( cottonBlepharitis : hot compresses ( cotton--tipped applicator)tipped applicator)


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Stasis Dermatitis ( St D )Stasis Dermatitis ( St D )

Synonim :Synonim :

Stasis eczema, Gravitational dermatitis,Stasis eczema, Gravitational dermatitis,

Varicose eczema, Hypostatic DermatitisVaricose eczema, Hypostatic Dermatitis Eczema secondary to venous hypertensionEczema secondary to venous hypertension

of the low extremitiesof the low extremities

MiddleMiddle--aged to elderly femalesaged to elderly females The exact mechanism : ?The exact mechanism : ?


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Several theories ( St D)Several theories ( St D)

increased hydrostatic pressure in theincreased hydrostatic pressure in thevenous system, fibrinogen leaks into thevenous system, fibrinogen leaks into thedermisdermis a layer of fibrin forms arounda layer of fibrin forms aroundcapillariescapillariesa barrier to diffusion of oxygena barrier to diffusion of oxygenand other nutrientand other nutrient

Arteriovenous shunts form in the affectedArteriovenous shunts form in the affected

regionregion hypoxia and poor skin nutritionhypoxia and poor skin nutrition


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Clinical featuresClinical features (St D )(St D )

Dermatitis ( begin rapidly/insidiously)Dermatitis ( begin rapidly/insidiously)lowerlowerleg swells rapidlyleg swells rapidly erythematous, warm ,erythematous, warm ,eczematous.eczematous. acute, subacute, or chronicacute, subacute, or chronic

Location :medial or lateral surface of lowerLocation :medial or lateral surface of lowerleg, posterior and superior of malleoli.;leg, posterior and superior of malleoli.;dermatitis, gradually, encompasses the entiredermatitis, gradually, encompasses the entireleg and migrates proximally.leg and migrates proximally.

Recurrent inflammationRecurrent inflammation deposit ofdeposit ofhemosiderin ( extravasation of RBC ) , poor ofhemosiderin ( extravasation of RBC ) , poor ofoxigenation, Fibrosis of subcutan ( fatoxigenation, Fibrosis of subcutan ( fatnecrosisnecrosis ))

Pruritus : variable.Pruritus : variable.


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STASIS ECZEMASTASIS ECZEMA


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Treatment ofTreatment of St DSt D

Treatment of underlying varicose veinsTreatment of underlying varicose veins

Steroid topical, is not recommendedSteroid topical, is not recommendedlonglong--term ( atrophic change!,term ( atrophic change!,

epidermis is already thin!)epidermis is already thin!) Protective bandages( preventingProtective bandages( preventing

scratching and trauma!)scratching and trauma!)

EmollientEmollient Sleep with pillow under lower legsSleep with pillow under lower legs

Be careful not to injureBe careful not to injure ulcer !ulcer !


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Lichen Simplex ChronicusLichen Simplex Chronicus

( LSC)( LSC)

SynonimsSynonims :Neurodermatitis, Circumscribed:Neurodermatitis, Circumscribedlichen simplex )lichen simplex )

DefinitionDefinition::

A wellA well--demarcated areas of chronic lichenifieddemarcated areas of chronic lichenifieddermatitis which is not due to eitherdermatitis which is not due to eitherexternal irritation or identified allergen.external irritation or identified allergen.

Etiology:Etiology:

StressStressitchitch itchitch--scratchscratch--itch cycleitch cycleepidermal hyperplasiaepidermal hyperplasia as lichenificationas lichenification


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Clinical featuresClinical features LSCLSC

Isolated,wellIsolated,well--circumscribed,circumscribed,lichenified,lichenified,

slightly elevated plaques :on the napeslightly elevated plaques :on the nape

of neck , the forearms, or leg.of neck , the forearms, or leg.The patient are often tense andThe patient are often tense and

obsessive, there appears to beobsessive, there appears to beassociation with atopyassociation with atopy

DD : psoriasis, nummular eczema,DD : psoriasis, nummular eczema,lichen planus, tinea,contact dermatitislichen planus, tinea,contact dermatitis

recurrencerecurrence


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Treatment of LSCTreatment of LSC


-- breaking the itchbreaking the itch--scratchscratch--itch cycleitch cycle

antihistamin / mild tranquilizerantihistamin / mild tranquilizer-- Topical steroid ( moderateTopical steroid ( moderate strong)/strong)/

intra lesion , keratolytic substance (intra lesion , keratolytic substance (

salycilic acid, tar).salycilic acid, tar).


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LSCLSC


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Nummular eczemaNummular eczema Synonim: Discoid dermatitisSynonim: Discoid dermatitis Def: A chronic, recurrent pattern of dermatitisDef: A chronic, recurrent pattern of dermatitis

with discrete coinwith discrete coin--shaped lesion tending toshaped lesion tending toinvolve most often on the legs and arms, butinvolve most often on the legs and arms, but

can spread to other bodycan spread to other body The skin are red in color, itchy,SecondaryThe skin are red in color, itchy,Secondary

infection is common( Bacterial eczema)infection is common( Bacterial eczema)

Usually affects adultsUsually affects adults

Many of whom will have a past history ofMany of whom will have a past history ofatopic dermatitisatopic dermatitis

The etiology : unknownThe etiology : unknown


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Nummular eczemaNummular eczema--22

Diagnosis :It is generally easy toDiagnosis :It is generally easy to

diagnose, however, atypical cases maydiagnose, however, atypical cases may

resemble other dermatoses( ACD,resemble other dermatoses( ACD,

psoriasis,tinea)psoriasis,tinea)

Treatment : topical steroidTreatment : topical steroid

alone/combine with antibiotics.alone/combine with antibiotics.

Systemic antipruritics are rarelySystemic antipruritics are rarelyrequiredrequired


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NUMMULAR ECZEMANUMMULAR ECZEMA


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Infectious Eczematous Dermatitis /Infectious Eczematous Dermatitis /

Infective eczematoid dermatitisInfective eczematoid dermatitis

( I E D )( I E D )

Def.:An eczematous skin reactionDef.:An eczematous skin reactionappearing in association with a preappearing in association with a pre--existingexistingcutaneous infection( otitis external, chroniccutaneous infection( otitis external, chroniculcer) at sites in contact with infectiousulcer) at sites in contact with infectiousexudateexudate

Etiology/pathogenesis : poorly understoodEtiology/pathogenesis : poorly understood

Clinical features: hallmarks: erythema,Clinical features: hallmarks: erythema,scaling, crusting, oozing.The epidermis isscaling, crusting, oozing.The epidermis isoften eroded.The margin of eczematousoften eroded.The margin of eczematousinvolvement are usually sharply defineinvolvement are usually sharply define


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Treatment of IEDTreatment of IED

Underlying disorder should be treatedUnderlying disorder should be treatedfirst!first!

AntibioticAntibiotic steroid combined topicallysteroid combined topically

compressescompresses


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INFECTIVE ECZEMATOID DERMATITISINFECTIVE ECZEMATOID DERMATITIS


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Asteatotic eczemaAsteatotic eczema

Sin. Eczema crequle.Sin. Eczema crequle. Def. Eczema associated with, and possiblyDef. Eczema associated with, and possibly

caused by, a decrease in skin surface lipidcaused by, a decrease in skin surface lipidSenile eczema ( not always!)Senile eczema ( not always!)

Exact pathogenesis of skin change is obscureExact pathogenesis of skin change is obscure The dry irritable skin seen mainly on the limbsThe dry irritable skin seen mainly on the limbs

of elderly patients.The skin dry , large scaleof elderly patients.The skin dry , large scalewith a crazywith a crazy--pavingappearance ( lost ofpavingappearance ( lost of

epidermal lubricatin)epidermal lubricatin)


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Treatment :Treatment : moisturizier/emollientsmoisturizier/emollientsregularly, reduction in bathing ( especiallyregularly, reduction in bathing ( especiallyhot water!).hot water!).

be careful with steroid topical!(Skin isbe careful with steroid topical!(Skin isalready thin and fragilealready thin and fragile


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Dyshydrotic eczema ( DE )Dyshydrotic eczema ( DE )

A vesicular eruption of hands; acuteA vesicular eruption of hands; acute--sub acutesub acute--chronic and feetchronic and feet

DeepDeep--seated vesicles with little or no erythemaseated vesicles with little or no erythema

on the lateral or dorsal aspect of fingers or toes,on the lateral or dorsal aspect of fingers or toes,p[alms and soles.p[alms and soles.

The eruption is usually bilateral andThe eruption is usually bilateral andsymmetrical;if vesicles ruptursymmetrical;if vesicles ruptur discharging adischarging agelatinous fluidgelatinous fluid drydry browning scaly crustbrowning scaly crust

Pruritus /burning sensation in early stagePruritus /burning sensation in early stage


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Dyshydrotic eczema ( DEDyshydrotic eczema ( DE

It more common in individual who perspireIt more common in individual who perspireprofusely and in emotionally tense personsprofusely and in emotionally tense persons


-- antihistamine/tranquilizer for pruritus ,antihistamine/tranquilizer for pruritus ,-- antibiotics if secondary infectedantibiotics if secondary infected

-- some cases will respond to small dosessome cases will respond to small doses

of corticosteroidof corticosteroid

-- topical :acute :compresses( Sol Burow 1:20)topical :acute :compresses( Sol Burow 1:20)

steroid with or without antibioticsteroid with or without antibiotic


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Dishydrotic eczema


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URTIKARIAURTIKARIA

EkoEko krisnartokrisnarto

RSU KOTA SEMARANGRSU KOTA SEMARANG


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DefinisiDefinisi

PenyakitPenyakit kulitkulit dengandengan gejalagejala gatal,gatal, edemaedema

setempat,setempat, warnawarna kemerahan,kemerahan, tengahtengah pucat,pucat,

dikelilingidikelilingi halohalo eritematosaeritematosa


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UrtikariaUrtikaria


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EtiologiEtiologi urtikariaurtikaria


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PatogenesisPatogenesis

PencetusPencetus selmast / basofilselmast / basofil degranulasidegranulasi

pelepasanmediator( histamin, serotonin,pelepasanmediator( histamin, serotonin,

kinin, PG, dll )kinin, PG, dll ) vasodilatasivasodilatasi peningkatanpeningkatan

permeabilitaspermeabilitas transudasitransudasi pengumpulanpengumpulancairancairan urtikariaurtikaria


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DiagnosisDiagnosis

1.1. Anamnesis : mencarietiologiAnamnesis : mencarietiologi

2.2. Pemeriksaan fisik : gambaranklinikPemeriksaan fisik : gambaranklinik

dugaan penyebabdugaan penyebab

3.3. Pemeriksaan penunjang :Pemeriksaan penunjang :

LaboratoriumLaboratorium

Test kulitTest kulit

Test pembantuTest pembantu


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TerapiTerapi

MengetahuiMengetahui dandan menghindarimenghindari penyebabpenyebab

PendekatanPendekatan teoritisteoritis adaada 3 :3 :

1.1. Hambat

Hambat efe

kefe

khistaminhistamin padapada organ

targetorgantarget

2.2. HambatHambat pelepasanpelepasan histaminhistamin drdr selsel mastmast

33 HambatHambat mediatorlainmediatorlain


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AntihistaminAntihistamin

AH1 (AH1 (klasikklasik))

EtanolaminEtanolamin//difenhidramindifenhidramin

EtilendiaminEtilendiamin

AlkilaminAlkilamin

PiperazinPiperazin

FenotiazinFenotiazin//prometazinprometazin

HidroksizinHidroksizin &&siproheptadinsiproheptadin

AH1 (nonAH1 (nonklasikklasik))

TerfenadinTerfenadin

AstemizolAstemizol

LoratadinLoratadin

SetirizinSetirizin

AH2AH2

CimetidinCimetidin


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KerjaKerja

AHAH

KompetitifKompetitifinhibitorinhibitorpadapada reseptorreseptor

PadaPada AH2 (nonAH2 (nonklasikklasik)) efekefek sampingsamping sedasisedasi

ditiadakanditiadakan


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Diagnosis ?Diagnosis ?


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dermatitis & eczema 2007

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