Tabel Perbedaan DKA dan DKI (Djuanda, et al, 2011)

DKA DKI
Definisi Suatu dermatitis ( peradangan Suatu dermatitis yang bisa terjadi pada semua orang,
kulit ) yang timbul pada timbul setelah kontak dengan paparan zat kimia
individu dengan kerentanan yang bersifat iritan / korosif.
setelah kontak dengan allergen
melalui proses sensitisasi.
Epidemiologi 1. Umur : dapat terjadi pada 1. Umur : pada semua umur bisa terjadi. Tetapi
semua umur. umumnya pada dewasa yang sudah bekerja.
2. Distribusi : penderita 2. distribusi : frekuensi sama anatara pria dan
Wanita lebih banyak wanita
dibandingkan pria.
Etiologi Alergen atau sensitizer yang Iritan primer seperti asam dan basa kuat, serta
umumnya berupa bahan logam pelarut organic.Iritan sekunder karena detergen,
berat, kosmetik, bahan pelarut organik, air terjadi karena paparan yang terus
perhiasan, jam tangan, karet, - menerus dan berulang.
obat-obatan (obat kumur,
sulfa, penisilin).

Faktor yang Berpengaruh besar lingkungan Lingkungan yang banyak mengandung basa atau
mempengaruhi pekerjaan dengan lingkungan asam kuat lebih.
yang basah, tempat – tempat
lembab atau panas, dan
pemakaian alat yang salah.
Gejala singkat Perjalanan penyakit termasuk Perjalanan penyakit termasuk keluhan utama dan
peyakit keluhan utama dan keluhan keluhan tambahan. Biasanya kelainan kulit timbul
tambahan. Awalanya beberapa saat sesudah kontak pertama dengan
kemerahan pada daerah kontaktan eksternal. Penderita akan mengeluh rasa
kontak, kemudian timbul panas, nyeri, ataupun gatal.
eritema, papula, vesikel dan
penderita selalu mengeluh
gatal
Pemeriksaan Uji temple (patch test) Uji tempel
penunjang Uji gores (scratch test)
Uji tusuk (prick test)
Pengobatan Kortikosteroid dapat diberikan Kortikosteroid topical, misalnya hidrokortison, atau
dalam jangka pendek untuk kelainan yang kronis dapat diawali dengan
mengatasi peradangan pada kortikosteroid yang lebih kuat.
DKA akut yang ditandai
dengan eritema, edema,
vesikel atau bula, serta
eksudatif, misalnya prednisone
30mg/hari. Umumnya
kelainan kulit mereda setelah
bebrapa hari.
Gambar Dermatitis Kontak Alergi terhadap logam pada jam tangan

Gambar Dermatitis Kontak Iritan terhadap detergen pencuci

Djuanda, Adhi, et al. 2011. Ilmu Penyakit Kulit dan Kelamin. Jakarta : Fakultas Kedokteran Universitas
Indonesia.

Skin allergy test

From Wikipedia, the free encyclopedia
This article is about the method for medical diagnosis of allergies. For other uses, see Scratch test
(disambiguation).
Skin allergy testing or Skin prick test is a method for medical diagnosis of allergies that attempts to provoke a
small, controlled, allergic response.

Why it's done

Information from allergy tests may help your doctor develop an allergy treatment plan that includes
allergen avoidance, medications or allergy shots (immunotherapy).
Allergy skin tests are widely used to help diagnose allergic conditions, including:

 Hay fever (allergic rhinitis)

 Allergic asthma

 Dermatitis (eczema)

 Food allergies

 Penicillin allergy

 Bee venom allergy

 Latex allergy

Methods[edit]
A microscopic amount of an allergen is introduced to a patient's skin by various means: [1]

A person receiving a skin allergy test

 Skin prick test: pricking the skin with a needle or pin containing a small amount of the allergen. [2]
 Skin scratch test: a deep dermic scratch is performed with help of the blunt bottom of a lancet. [3]
 Intradermic test: a tiny quantity of allergen is injected under the dermis with a hypodermic syringe.
 Skin scrape Test: a superficial scrape is performed with help of the bovel of a needle to remove the
superficial layer of the epidermis.[4]
 Patch test: applying a patch to the skin, where the patch contains the allergen
If an immuno-response is seen in the form of a rash, urticaria (hives), or (worse) anaphylaxis it can be concluded
that the patient has a hypersensitivity(or allergy) to that allergen. Further testing can be done to identify the
particular allergen.
The "skin scratch test" as it is called, is not very commonly used due to increased likelihood of infection. On the
other hand, the "skin scrape test" is painless, does not leave residual pigmentation and does not have a risk of
infection, since it is limited to the superficial layer of the skin.
Some allergies are identified in a few minutes but others may take several days. In all cases where the test is
positive, the skin will become raised, red and appear itchy. The results are recorded - larger wheals indicating
that the subject is more sensitive to that particular allergen. A negative test does not conclusively rule out an
allergy; occasionally, the concentration needs to be adjusted, or the body fails to elicit a response.
Immediate reactions tests[edit]

Skin testing on arm

In the prick, scratch and scrape tests, a few drops of the purified allergen are gently pricked on to the skin
surface, usually the forearm. This test is usually done in order to identify allergies to pet dander, dust, pollen,
foods or dust mites. Intradermal injections are done by injecting a small amount of allergen just beneath the skin
surface. The test is done to assess allergies to drugs like penicillin[5] or bee venom.

Skin testing on back

To ensure that the skin is reacting in the way it is supposed to, all skin allergy tests are also performed with
proven allergens like histamine or glycerin. The majority of people do react to histamine and do not react to
glycerin. If the skin does not react appropriately to these allergens then it most likely will not react to the other
allergens. These results are interpreted as falsely negative. [6]
Delayed reactions tests[edit]
See also: Patch test
Patch test

The patch test simply uses a large patch which has different allergens on it. The patch is applied onto the skin,
usually on the back. The allergens on the patch include latex, medications, preservatives, hair dyes, fragrances,
resins and various metals. When a patch is applied the subject should avoid bathing or exercise for at least 48
hours.
Skin end point titration[edit]
Also called an intradermal test, this skin end point titration (SET) uses intradermal injection of allergens at
increasing concentrations to measure allergic response. [7] To prevent a severe allergic reaction, the test is
started with a very dilute solution. After 10 minutes, the injection site is measured to look for growth of wheal, a
small swelling of the skin. Two millimeters of growth in 10 minutes is considered positive. If 2 mm of growth is
noted, then a second injection at a higher concentration is given to confirm the response. The end point is the
concentration of antigen that causes an increase in the size of the wheal followed by confirmatory whealing. If
the wheal grows larger than 13 mm, then no further injection are given since this is considered a major reaction.

Preparation[edit]
There are no major preparations required for skin testing. At the first consult, the subject's medical history is
obtained and physical examination is performed. All consumers should bring a list of their medications because
some may interfere with the testing. Other medications may increase the chance of a severe allergic reaction.
Medications that commonly interfere with skin testing include the following:

 Histamine antagonists like Allegra, Claritin, Benadryl, Zyrtec

 Antidepressants like Amitriptyline, Doxepin
 Antacid like Tagamet or Zantac
Consumers who undergo skin testing should know that anaphylaxis can occur anytime. So if any of the following
symptoms are experienced, a physician consultation is recommended immediately:

 Low grade Fever

 Lightheadedness or dizziness
 Wheezing or Shortness of breath
 Extensive skin rash
 Swelling of face, lips or mouth
 Difficulty swallowing or speaking
TARGETOID

WHORLED
Status Lokalis ULKUS :
Inspeksi : terdapat dua buah luka terbuka di kaki kanan, luka pertama pada telapak kaki dengan panjang 8
(delapan) sentimeter lebar 4 (empat) sentimeter. Terdapat jari nekrose berwarna hitam pada jari kelingking
pasien, mengenai lapisan dermis, epidermis, tidak mencapai tendo kaki dan tulang. Luka bernanah. Luka
kedua pada punggung kaki kanan dengan panjang 7 (tujuh) sentimeter lebar 4 (empat) sentimeter, luka
mengenai epidermis, dermis dan tendo. Luka bernanah
Palpasi : perabaan hangat pada kulit (+), krepitasi (-), pulsasi arteri dorsalis pedis melemah pada kaki
kanan.

Corticosteroid
From Wikipedia, the free encyclopedia

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well
as the synthetic analogues of these hormones. Two main classes of
corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes,
including stress response, immune response, and regulation
of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.[1]
Some common naturally occurring steroid hormones
are cortisol (C21H30O5), corticosterone (C21H30O4), cortisone (C21H28O5) and aldosterone(C21H28O5). (Note that
aldosterone and cortisone share the same chemical formula but the structures are different.) The main
corticosteroids produced by the adrenal cortex are cortisol and aldosterone.[2]

Classes[edit]
Cortisol

Corticosterone

Cortisone

Aldosterone

 Glucocorticoids such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti-
inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive effects.[3] Anti-inflammatory effects
are mediated by blocking the action of inflammatory mediators (transrepression) and inducing anti-
inflammatory mediators (transactivation).[3] Immunosuppressive effects are mediated by suppressing delayed
hypersensitivity reactions by direct action on T-lymphocytes.[3] Anti-proliferative effects are mediated by
inhibition of DNA synthesis and epidermal cell turnover.[3] Vasoconstrictive effects are mediated by inhibiting
the action of inflammatory mediators such as histidine.[3]
 Mineralocorticoids such as aldosterone are primarily involved in the regulation of electrolyte and water
balance by modulating ion transport in the epithelial cells of the renal tubules of the kidney.[3]

List of Corticosteroid Medications

Betamethasone
Betamethasone is a corticosteroid used to treat inflammation and other symptoms of skin conditions.
According to the National Institutes of Health, it is available in aerosol spray, lotion, ointment and cream
forms. Possible side effects of betamethasone include acne, burning, itching, dry skin, cracked skin and
changes in skin color.

Budesonide

Budesonide is a corticosteroid used to treat asthma. The University of Maryland Medical Center indicates
that this drug is available in oral capsule, oral inhalation and nasal spray forms. It can also be used in a
nebulizer. This drug can cause side affects that interfere with normal function of several body systems. The
most common side effects of budesonide are nausea, headache and respiratory infection.

Cortisone

Cortisone is used to treat inflammation and adrenal insufficiency. This drug can also be used to treat allergic
conditions, ulcerative colitis, lupus, arthritis, breathing disorders and psoriasis. Side effects of cortisone
include insomnia, increased sweating, nausea, bloating, stomach pain, slow wound healing, acne, dry skin
and changes in the location of fat in the body.

Dexamethasone

Dexamethasone is used to treat arthritis, asthma, severe allergies, inflammatory intestinal disorders and skin
disorders. According to the National Institutes of Health, it can also be used when the adrenal glands do not
function properly. Possible side effects of dexamethasone include stomach irritation, headache, insomnia,
dizziness, restlessness, anxiety, easy bruising, irregular menstrual periods, upset stomach, vomiting,
depression, acne and increased hair growth.

Hydrocortisone

Hydrocortisone is available as a spray, liquid, lotion, gel, cream, ointment and medicated towelette that can
be used on the skin. Suppositories, creams, enemas and ointments are available for use in treating anal
itching. This drug can relieve skin irritations, rashes and itching. Possible side effects of hydrocortisone
include acne, burning, changes in skin color, dry skin, itching and cracked skin.

Methylprednisolone

Methylprednisolone is used to treat inflammation caused by conditions such as arthritis, ulcerative colitis,
breathing disorders, psoriasis, allergic conditions and lupus. Methylprednisolone side effects can include
sweating, spinning sensation, bloating, nausea, acne, stomach pain, slow wound healing, thinning skin,
mood changes, bruising, changes in the location of body fat, headache, dizziness and insomnia.

Prednisolone

Prednisolone is used to treat endocrine disorders, collagen diseases, skin conditions, allergic conditions,
respiratory conditions, blood disorders, gastrointestinal diseases and diseases of the eye. According to the
University of Maryland Medical Center, insomnia, increased appetite, nervousness and indigestion occurred
in more than 10 percent of clinical trial subjects. Other possible side effects of prednisolone include
increased hair growth, diabetes, joint pain, glaucoma, cataracts and nosebleed.

Prednisone

Prednisone is used to treat inflammation associated with asthma, ulcerative colitis, arthritis, psoriasis, lupus,
skin conditions and allergic disorders. Johns Hopkins University indicates that this drug can have several
undesirable side effects. The possible side effects of prednisone include weight gain, high blood pressure,
bone thinning, mood changes, easy bruising, insomnia, stretch marks, acne, cataracts and glucose
intolerance.

A A A A I A L L E R G Y & A S T H M A M E D I C AT I O N
GUIDE

Topical Ointments & Creams

Class Generic Name Brand Name Dosage Product Links (if

available)

Mild Steroid Aclometasone 0.05% Aclovate Cream Apply thin film 2 Generic aclometasone
Aclovate Ointment to 3 times a day.
Generic Brand

Fluocinolone 0.01% Generic versions Apply thin film Fluocinolone cream

Synalar 0.01% 2 to 4 times a day.
(solution) Fluocinolone topical
solution

Fluocinonide Vanos Cream Apply thin film Vanos Website

once or twice a
day.

Hydrocortisone base or Generic and store Apply thin film 3 Hydrocortisone lotion
Acetate brands of to 4 times a day. 2.5%
Hydrocortisone
Less than 2.5% OTC available Hydrocortisone cream
(cream, ointment and ointment 2.5%
2.5% RX and lotion)

Triamcinolone 0.025% Generic versions Apply thin film Generic triamcinolone

Aristocort A 3 to 4 times a
0.025% cream and day.
ointment

Intermediate Desonide 0.05% Generic versions Adults: Desonide lotion

Potency DesOwen Apply thin film
Steroid (cream, ointment 2 to 3 times a day.
and lotion)
Fluocinolone 0.025% Generic versions Apply thin film Fluocinolone cream
Synalar 0.025% 2 to 4 times a day. 0.01% and 0.025%
(cream and
ointment)

Flurandrenolide Cordran-SP Apply thin film Cordran Website

0.025% (cream) 2 to 3 times a day.
Fluandrenolide 0.05% Cordran Ointment

Fluticasone 0.005% Generics Children > 3 Fluticasone 0.05%

Fluticasone 0.05% Cutivate Ointment months: cream
(0.005%) Thin coat 1 to 2
Cutivate Cream times a day for up Fluticasone propionate
(0.05%) to 4 weeks; ointment 0.005%
not in diaper area.

Adults: 1 to 2
times a day.

Hydrocortisone Locoid (cream, Apply thin film 2

Butyrate 0.1% ointment, solution) to 3 times a day.

Hydrocortisone Pandel Cream Age 18 and

Probutate 0.1% above:
Apply a thin film
1 to 2 times a day.

Hydrocortisone Generic versions Apply thin film

Valerate 0.2% 2 to 3 times a day.
Westcort (cream
and ointment)

Mometasone 0.1% Generic of Age 2 and above: Mometasone cream

ointment Apply thin film (generic)
once daily;
Elocon may use for up to Elocon Cream Package
(cream, ointment, 3 straight weeks Insert
lotion) in children before Elocon Lotion
stopping.

Prednicarbate 0.1% Generics Age >1: apply a Prednicarbate cream

Dermatope thin film twice a 0.1% emollient
(cream, ointment) day for up to 3
weeks. Prednicarbate
ointment 0.1%

Dermatop Cream
Package Insert

Dermatop Ointment
Package Insert
 Triamcinolone 0.1% Generic versions Apply a thin film Triamcinolone cream
3 to 4 times a day.
Aristocort A 0.1% Triamcinolone
(cream) ointment 0.1%
Kenalog
(cream, lotion)

Potent Amcinonide 0.1% Generic versions Apply a thin film Amcinonide cream
Steroids Cyclocort 2 to 3 times a day
(cream, ointment, (cream) Amcinonide lotion
lotion) 2 times a day
(ointment and Amcinonide ointment
lotion).

Betamethasone valerate Generic Thin film twice a Generic

day. betamethasone
valerate

Desoximetasone 0.05% Generic versions Age 10 and

Topicort (gel) above:
Apply a thin film
twice a day.
Desoximetasone 0.25% Generic versions Topicort Package
Topicort Insert
(emollient cream,
ointment)

Diflorasone 0.05% Generics Adults: Diflorasone cream

Apply a thin film
Psorcone 2 to 4 times a day. Diflorasone ointment
(emollient cream,
ointment)
Psorcon
(cream)

Fluocinonide 0.05% Generics Apply a thin film Fluocinonide cream

2 to 4 times a day.
Lidex Fluocononide gel
(cream, gel,
ointment, lotion) Fluocinonide ointment
Lidex-E
(emollient cream) Fluocinonide topical
solution

Halcononide 0.1% Halog Apply a thin film

(cream, ointment, 2 to 3 times a day
solution) for cream and
Halog-E ointment;
(emollient cream) 1 to 3 times a day
for Halog-E.
 Triamcinolone 0.5% Generic versions Thin film 3 to 4 Triamcinolone
Aristocort A times a day.
(cream)
Kenalog
(cream)

Super-potent Betamethasone Generic versions Adults: Betamethasone

Steroids Dipropionate Apply a thin film dipropionate 0.05%
augmented 0.05% Diprolene 1 to 2 times a day
(augmented) for up to two Betamethasone
Betamethasone weeks. dipropionate
Dipropionate 0.05% Diprosone (augmented)

Clobetasol Propionate Generic versions Age 16 and Clobetasol emollient

0.05% Temovate above: cream
(cream, gel, Apply a thin
ointment) layer, twice daily Clobetasol cream /
Temovate-E for up to 2 weeks. ointment
(emollient cream)
Clobetasol gel

Clobetasol topical
solution

Clobex/Clobetasol
Website

Diflorasone 0.05% Generics Adults: Diflorasone cream

Psorcon (cream and Apply a thin film
ointment) 1 to 4 times a day. Diflorasone ointment

Flurandrenolide 4 Cordran (tape) Apply every 12

mcg/sq cm hours.

Halobetasol propionate Generic Adults: Generic halobetasol

0.05% Ultravate Thin layer cream
(cream, ointment)- 1 to 2 times a day
+ for a 2-week Halobetasol ointment
treatment.

Anti-itch Doxepin 5% Cream Zonalon Adults:

(anti-pruritus) Generic Apply a thin film
4 times a day at 3
to 4 hour intervals
for up to 8 days.

Immunomodulatory Pimecrolimus 1% Elidel Cream For short term and

Skin Medications intermittent long-
term treatment of
atopic dermatitis.
 Age 2 and above,
apply twice daily.

Tacrolimus 0.03% Protopic Ointment Apply to affected Protopic Website

Tacrolimus 0.1% 0.03% (children skin twice daily.
age 2 to 15) Stop 1 week after
0.1% (for age 16 the signs and
and older) symptoms of
atopic dermatitis
clear up.

Age 2 and older.

Mild-moderate
Other Crisaborole Eucrisa Webstie
Eucrisa Atopic Dermatitis
>=2 y/o apply 2
times per day