KULIAH REGULER

DERMATITIS – ECZEMA
2013
DERMATITIS –ECZEMA

Dr. Retno Indar W, Msi, SpKK

Bagian/SMF Ilmu Kesehatan
Kulit & Kelamin FK UNDIP
 DERMATITIS -Eczema
 A common type of inflamation of skin
( epidermo- dermatitis ) which is not caused by micro-
organism. Itching is the most symptom

 Some types appear to be due to as yet unidentified

constitutional abnormalities, while others are more
obviously the result of some external set of circumstance

 Constitutional : eg Atopic dermatitis

 External : eg Contact dermatitis

Eflorescense of Dermatitis-Eczema
Erythem

Papule

Vesicle

Pustule
“Oozing”

Crust

Squama
 Several types of Derm- ecz

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

A.D  may divided into three stages,

namely :
• Infantile ( 2 months – 2 years)
• Childhood ( 2 years – 10 years)
• Adult
 Infantile
 Usually begins as an itchy erythema of cheeks followed
by development of vesicle, rupture and produce moist
crusted areas

 The eruptions may rapidly extend to other parts of the

body, chiefly the scalp, the neck, the forehead, the wrist
and the extremities

 The buttocks and diaper area are often involved

 The eruption may become generalized with erythroderma

Infantil AD
 Childhood AD
 The lesion to be less exudative, drier, and more papular

 The classic locations are the antecubital, and the popliteal

spaces, the wrist, eyelids, and the face and in collarette about
the neck

 The other area, however, are frequently affected

 Itching

 There is a decrease in the frequency of sensitization to egg,

wheat and milk, but an increase in sensitization to nonigested
substances, particulary wool, cat hair, dog hair, and pollens
Childhood AD
 Adolescent and Adult AD
 Usually the eruption involves the antecubital and popliteal
fossae, the front and sides of the neck, the forehead and
the are about the eyes
 Hands dermatitis occurs more frequently in atopic
individuals, and eczematous lessions of the dorsum are
usual
 Pruritus : paroxysm, nocturnal, triggered by acute emotional
stress
 Trigger factors : rough clothing, wool irritation, foods or
tension.
Adolescent and Adult AD
 Associated features

 Cutaneous stigmata : Dennie-Morgan fold, Keratosis pilaris,

and Hertoghe’s sign
 Vascular stigmata : White dermographism
 Personality traits : Nervous tension
 Ophthamologic abnormalities : cataracts, keratoconus.
 Susceptibility to infection :
S.aureus, generalized Herpes simplex or vaccinia virus
infections to produce Kaposi’s varicelliform eruption

 Immunology : elevated serum IgE, decreased T-supressor

cells, decreased chemotaxis and activations of PMN
leucocyte.
 Diagnosis
Hanifin & Rajka , Svenson, SCORAD criterias

Hanifin & Rajka criteria :

Major criteria
1. Pruritus
2. Typical morphology and distribution
3. Tendency toward chronics or chronically relapsing dermatitis
4. Personal or family history of atopic diseases (asthma, allergic
rhinitis, AD)
Minor criteria :
1. Xerosis / ichthyosis/ hyperlinear palms
2. Pityriasis alba
3. Keratosis pilaris
4. Facial pallor / infraorbital darkening
5. Elevated serum IgE
6. Keratoconus
7. Tendency to non spesific hand eczema
8. Tendency to repeat cutaneous infections
 Differential diagnosis

• Nummular Dermatitis
• Seborrhoic Dermatitis
• Contact Dermatitis
• Psoriasis
• Scabies
 General management

1. In infancy and childhood

a. It should be avoided :
 External irritation
 Sudden change of temperature, excessive
bathing, insufficient cleanless especially in the
diaper region, local infections

b. Food elimination ( with special attention)

b. Antihistamin systemically

c. Olive oil on absorbent cotton may used with

gentle patting for cleansing to avoide rubbing the
affected patrs. Particular attention should be given
the genitals and buttocks and the diapers should
be changed

d. Weak topical corticosteroid.

2. In adults :
a. The emosional stress should be controlled
b. Avoid extremes cold and heat
c. Hydrated xerotic skin
d. Antihistamin
e. Topical steroid ( be ware of the potentiallity)
f. Antiobiotics ( if nedded)
 Contact Dermatitis (CD)

 An exogenous dermatitis which develops as a reaction

of the skin to contact with a foreign substance / an
environmental agent, either a primary irritant ( Irritant
CD) or an allergen (allergic CD)
 It may be affected by exposure to UV-light, resulting
into two variant reaction : Photoallergic & Phototoxic
CD
 Allergic Contact Dermatitis (ACD)
 Occur in predisposed individual
 Sensitization occurs within a week after contact with a
substance (allergen), but there are no visible skin changes
 Subsequent contact with allergen, even in small amounts,
causes an dermatitis
 Once established, sensitivity may persists for months,
years, or even a lifetime
 Irritant Contact Dermatitis

 Occure in any individual provided the chemical irritant

is applied in a potent enough concentration for a
sufficient length of time

 Inflamation of the skin develops at the site of contact

 There is non allergic mechanism involved, the damage

result from direct chemical action
 Irritants:
strong irritant  severe inflamation at the first
contact
Weak irritants:  less toxic substances which require
repeated or prolinged conatact to
cause inflamation (detergent,
organic solvents, excessive
exposure to water)
 Incidence:
 The incidence of cases of ICD (each type)
depending mainly on the degree of exposure and
the causative agent
 In patients with atopic dermatitis there is a
relatively high incidence of ICD
Sign

Allergic dermatitis
Based on erythematous skin there are : edema,
papules, vesicles and occasionally bullae. Patches are
single / multiple, and of various size and shape. Strong
irritant  burns, ulcer and necrosis
Patch Test
 Treatment
 Preventive :
Once the causative agent has been identified, further
contact should be avoided
 Topical therapy :
in acute state : wet dressing : Burowi solution 1/20 –1/40,
Permanganate 1/10.000, followed by topical steroid.
in chronic state : moderate topical steroid
 Systemic therapy :
Antihistamin (severe pruritus) and steroid (severe /
ex tensive eruption
Contact Dermatitis
 Seborrhoic Dermatitis

Two distinct subset of patients :

* The Infantile form *
 Characterized by large yellowish scale mainly on the scalp,
face, axilla and napkin rash
 May cause confusion with Infantile Atopic Dermatitis
 No link between the infantile and adult form
 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
 many cases seen in obese, female patients have a degree of
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 edges
Examples :
 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