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DERMATITIS

DERMATITIS
= peradangan pada kulit (epidermodermitis) yang
memberikan gejala subjective berupa gatal dan
gejala objective berupa lesi yang polimorpi.


CATCH BASKET TERM
Two opinions about eczema and dermatitis :

UNITARIST (European) :
Eczema and Dermatitis synonimous

DUALIST (American) :
Eczema and Dermatitis differrent
Recently widely accepted
DERMATITIS stadium :

I. ERYTHEMA-OEDEMATOUS

II. VESICO-BULLOUS

III. MADIDANS (wet)

IV. DESQUAMATIVUM
(crusts and dry)
KLASIFIKASI :
Etiologi :
- Exogen : .dermatitis kontak
dermatitis medicamentosa

- Endogen : dermatitis atopik
neurodermatitis
dermatitis stasis
dermatitis seboroik


DERMATITIS KONTAK
= dermatitis yang terjasi karena
kontak dengan suatu bahan
2 tipe :
DERMATITIS KONTAK IRITAN (TOXIC)
DERMATITIS KONTAK ALERGI

DERMATITIS KONTAK IRITAN
Etiologi : iritan primer
Terjadi : pada kontak pertama
Keluhan : seperti rasa terbakar
Lesi : lebih berat
acute erythema, oedema,
bullae
Contactant (-) : cepat perbaikan
ETIOLOGY AND TERMS OF CONTACT DERMATITIS
Dermatitis Venenata :
insect secretions, plant
sap
Housewife Dermatitis :
housewives
Occupational Dermatitis:
job
Industrial Dermatitis :
factory
DERMATITIS KONTAK ALERGI
Etiologi : alergen
Terjadi : - pajanan berulang
- individu tertentu
Keluhan : gatal
Lesi : batas tidak jelas ,
eritem papel, skuama (polimorpi)
Contactant (-)/eliminated :
kelainan masih menetap/menyebar
Mekanisme : Reaksi tipe IV

PATCH TEST :
Penderita yang dicurigai dermatitis kontak alergi
Bahan yang diduga penyebab the volar /
interscapular area ditutup dg bahan impermeable
Dibaca setelah 24-48 jam
Kriteria :
erythema +
erythema + oedema ++
vesicle +++
confluent vesicles ++++
necrosis +++++
PENGOBATAN :
Hindari bahan penyebab
medicamentosa :
topical : tergantung kelainan kulit
Basah : kompres
Kering : corticosteroid ointment
Sub-acute : cream

systemic : antihistamine,
berat : corticosteroid

ATOPIC DERMATITIS
Ada riwayat atopy
Suatu kelompok kelainan herediter dengan
amanifestasi seperti reaksi hipersensitivitas :
Asthma
Hay fever
Allergic rhinitis
Urticaria
Foods/drugs allergy
Terjadi pada individu tertentu
ETIOLOGY :
UNKNOWN, MULTIFACTORIAL
Genetic
Organ-sensitive (lower itching- threshold)
Scratching/trauma
Allergen,dust,wool,substance
Psychological stress
Thermal alteration (climate changes)
Sweat retention
etc.
DIAGNOSIS
Bersifat chronic residif (remision)
Sulzberger : 3 phases :
infantile (2 months - 2 years)
childhood (3 - 13 years)
adolescence + adult (>13 years)

MAIN SYMPTOMS :
severe itching, scratches, skin erythema, oedema, vesicles, crusts,
lichenification
ATOPIC DERMATITIS
1. INFANTILE
face : both sides of cheeks
neck : oozing,erythema,oedema
head : crust,squama
2. CHILDHOOD
in the fold of:
Elbow
Knee
dry,erythema,papules,lichenificati
on
Neck
3. ADOLESCENCE/ADULT
in the fold of:
Elbow
Knee dry, lichenification
Neck

RAJ KA (1975)
Etiology & pathology : multifactorial
hereditary
immunology
non-immunology
specific criteria :
complains
clinical manifestations
laboratory findings
MAJOR CRITERIA :
family history of atopy
severe & persistent itching at the predilection sites
increased IgE
atopic gastrointestinal tract, ichthyosis, cataract
dry skin, itching when sweating
chronic residif-remission
more than one positive-skin test
MINOR CRITERIA :
Rapid onset
Drugs/foods allergy
Decreased host defense against bacterial/viral
infection reducing T-cell functions
Food intolerance
Influenced by heat, emotion, infection
Sensitive to wool, certain clothes
Lab : eosinophilia

DIAGNOSIS :
At least 3 major criterias
2 major and several minor criterias
HANIFIN (1976)
I - Itching sensation
- Specific distribution and morphology
- Chronic course of disease
II - Atopy in patient or family
- Positive skin test
- White dermatographism (+)
- Cataract

White dermatographism :
Scratching lines on normal skin triple reponses
(white lines, erythema, oedema)
Atopy : white lines, erythema,then re-whitening (vasoconstriction)
III - Xerosis
- Ichthyosis
- Pytiriasis alba
- Keratosis follicularis
- Increased IgE
- Recurrent skin infections

DIAGNOSIS :
One of group I
Two or more of group II,
One of group I
Four or more of group III
PENGOBATAN :
Hindari allergen
Medicamentosa :
Topical : ~ tergantung stadium,
Tar preparation: antimitotic,
thinning
Systemic : antihistamine
corticosteroid (severe)

NEURODERMATITIS CIRCUMSCRIPTA
= lichen simplex chronicus Vidal
psychological disturbances, stress, anxiety
dorsal lateral neck
anterior ankle
foot
hyperpigmentation, lichenification,
sharp border

NEURODERMATITIS CIRCUMSCRIPTA
THERAPY :
Avoiding psychological disturbances
Medicamentosa :
- Topical : corticosteroid
- Systemic : antihistamine