DERMATITIS

SMF/Bagian I.K Kulit & Kelamin

FK UNS/RSUD Dr.Moewardi Surakarta
 DERMATITIS
• Definisi
Inflamasi pd kompartemen dermo
epidermal, sbg reaksi dari
rangsang/injuri eksogen atau
endogen.

Inflamasi ini biasanya berdasarkan

reaksi alergi/respons imun.
Dermatitis Endogen Dermatitis Eksogen
Dermatitis Kontak
Dermatitis Atopik
Iritan

Dermatitis Kontak
Dermatitis Seboroik
Alergi

Dermatitis Numularis Dermatitis Fotosensitif

Pomfoliks Dermatophytid

Liken simpleks kronis

Dermatitis Asteatotik

Dermatitis
Gravitational

Juvenile plantar
dermatitis
DERMATITIS ATOPIK
 DEFINISI

adalah keadaan peradangan kulit kronis dan

residif, disertai gatal yang umumnya sering
terjadi selama masa bayi dan anak-anak,
sering berhubungan dengan peningkatan
kadar IgE dalam serum dan riwayat atopi
pada keluarga atau penderita (dermatitis atopi,
rhinitis alergika, asma bronkhiale, dan
konjungtivitis alergika)(Sularsito.S.A &
Djuanda, 2005)
STIGMATA ATOPI
Kata “atopi” pertama kali
diperkenalkan oleh Coca (1923)
Yaitu istilah yang dipakai untuk
sekelompok individu yang
mempunyai
riwayat kepekaan dalam
keluarganya, misalnya :
• Asma bronkial
• Rhinitis alergik
• Konjungtivitis alergik
• Dermatitis atopik
ETIOLOGI
• Interaksi berbagai faktor : genetik ,
imunologik , farmakologik ,
lingkungan, sawar kulit.

• 80 % penderita DA memiliki kadar

IgE dan eosinofil yang meningkat.

• Terdapat defisiensi imunologik,

karena fungsi sel – T menurun
 PEMICU

• Kulit yang kering

• Infeksi  kebanyakan oleh S.aureus
• Perbedaan iklim
• Alergi oleh inhalan (debu,serbuk bunga) ,
makanan tertentu, kimiawi (lotion, sabun,
detergen) dan autoalergen.
• Pakaian terlalu tebal , misal wool
• Stress
 Gambaran Klinis
• Umumnya kulit kering , pucat/kusam , kadar lipid epidermis
kurang.
• Pruritus >>, hilang timbul terutama malam hari  “eczema is
the itch that rashes”
• Krn garukan  kelainan polimorfi

Fase Fase Fase

Infantil Anak Dewasa
 Usia 3-10 thn
Usia 2 bln - 2 thn
Fossa Cubiti-Poplitea
Muka, leher>>,
Lesi kering
Lutut, madidans

Tipe Tipe
Infantil Anak

Dermatitis
Atopik

Tipe
Remaja-Dewasa
Usia 13-30 thn
Fossa Cubiti- Poplitea
Frontal periorbita
 KRITERIA DIAGNOSTIK (Hanifin & Rajka)
• Anamnesis MINOR:
• Gambaran klinis sesuai •Xerosis
umur •Infeksi kulit (khususnya oleh S.aureus
dan virus herpes simpleks)
• 3 kriteria mayor + minor •Dermatitis nonspesifik pada tangan atau
(menurut Hanifin-Rajka) kaki
•lktiosis/hipediniar palmads/keratosis
pilaris
MAYOR : •Pitiriasis alba
• Pruritus •Dermatitis di papila mamae
• Dermatitis di muka / ekstensor pd •White dermographism dan delayed
bayi-anak blanch response
• Dermatitis pd fleksura pd remaja- •Keilitis
dewasa •Lipatan infra orbital Dennie-Morgan
• Dermatitis kronis residif •Konjungtivitis berulang
• Riwayat atopi penderita - •Keratokonus
keluarga •Katarak subkapsular anterior
•Orbita menjadi gelap
 Muka pucat atau eritem
 Gatal bila berkeringat
 Intolerans terhadap wol atau pelarut lemak
 Aksentuasi perifolikular
 Hipersensitif terhadap makanan
 Perjalanan penyakit dipengaruhi oleh faktor lingkungan dan atau
emosi
 Tes kulit alergi tipe dadakan positif
 Kadar IgE di dalam serum meningkat
 Awitan pada usia dini1.
DIAGNOSA BANDING
• Dermatitis seboroik
• Dermatitis kontak alergi
• Dermatitis kontak iritan
• Dermatitis numularis
• Psoriasis
• Dermatofitosis
Dermatitis kontak alergi dermatitis atopik

Psoriasis

Dermatitis atopik
Dermatitis numularis Dermatitis seboroik

dermatofitosis
PEMERIKSAAN LABORATORIUM
• Darah : p↑ IgE serum, eosinofilia.
• White demographisme
• Percobaan asetilkolin
• Tes alergi pd kulit
• Kultur bakteri : koloni S.aureus di hidung dan lesi kulit
• PA kulit : berbagai tingkat akantosis, spongiosis, infiltrasi
dermis oleh limfosit, monosit,sel mast, dan eosinofil.
 40-60 %
Sembuh spontan
Pada usia > 5 thn

30-50%
20 % Tipe infantil
DA meghilang saat Remaja Bersama Asma Bronkial

65 % 84 %
DA gejala ↓ saat Remaja Kadang2 berlangsung hingga
Masa Remaja

Kronik residif
PROGNOSA Remisi pada masa anak dapat kambuh saat remaja –
dewasa
Dapat komplikasi dengan infeksi S.aureus dan HSV
PENANGANAN UMUM

• No rubbing, no Hindari
scratching ! Kontak
Iritan
• Cari faktor
pemicu dan Gunting Moist
kuku urizer
sebisa mungkin
dihindari Penanganan
• Warning : infeksi umum

sekunder oleh Sabun

S.aureus dan Sarung
Lunak
tangan
herpes simplex pH <<
 segera ke Kompres
dokter. dingin
MEDIKAMENTOSA
• Pengobatan Topikal
1. Hidrasi Kulit
diberikan pelembab misalnya krim hidofilik
urea 10%, asam laktat 5%, emolien
2. Kortikosteroid Topikal
3. Imunomodulator topikal
 Takrolimus (untuk anak usia 2-15 tahun 
0,03%; dewasa  0,03%, 0,1%)
 Pimekrolimus
4. Preparat Ter (Likuor Karbonis Detergen 5%-
10% atau crude coal tar 1%-5%)
5. Antihistamin
• Pengobatan Sistemik
1. Kortikosteroid (Sistemik : Prednison (30-60
mg/hari)
2. Antihistamin
 Sistemik  generasi I dan II
 Generasi I  difenhydramin Hcl,
klorfeniramin maleat, hidroxyzine
 Generasi II  loratadin
1. Antiinfeksi
2. Interferon
3. Imunomodulator
• siklosporin 2mg-5mg/kg/hari setelah gejala
hilang tap off
 PENGOBATAN SESUAI LESI

Penatalaksanaan
Dermatitis Atopik
AKUT KRONIS

Kompres Dingin
AntiPruritus
Krim Steroid
Salap Tar LCD
Balut Basah
Krim Steroid poten
Antibiotika
Balut Oklusif
Antiviral
Injeksi KIL
DERMATITIS NUMULARIS
DEFINISI DAN INSIDENSI
DEFINISI
• = discoid eczema
• Khas: lesi seperti uang logam/lonjong, batas tegas
INSIDENSI
• Anak-anak <<
• >> pada usia 55-65 tahun
• >
FAKTOR PENCETUS
• Penyebab pasti ??
• Diduga:
• infeksi stafilokokus  mekanisme hipersensitivitas
• Dermatitis atopik pada anak-anak
• Bahan, sabun, air, stres emosional, alkohol, obat–
obat topikal & sistemik
GAMBARAN KLINIS
• Stadium akut:
• Papula & vesikel bersatu  lesi khas: uang logam
berwarna merah dan diskret
• Lesi mengalami penyembuhan di tengah
• Eksudasi, edema, dan krusta
• Stadium lanjut: skuama dan likenifikasi.
• Predileksi:
• tungkai, lengan termasuk punggung tangan dan
tubuh
• >> anggota gerak bawah
PENATALAKSANAAN
• Kulit harus dalam keadaan hidrasi:
• Pelembab
• Hindari pemakaian bahan wol
• Pengobatan:
• Topikal:
• Kortikosteroid
• Takrolimus
• Pimekrolimus
• Sistemik:
• Antibiotik: bila ditemukan infeksi sekunder
• Antihistamin
PROGNOSIS
• Cenderung bertahan beberapa waktu  sembuh
• Rekuren
Also known as “Dyshidrotic eczema”
A form of eczema of the palm and
soles, oedema fluid accumulated
prominent vesicular eruption or
bullae:
The palms  Cheiropompholyx
The soles  Podopompholyx
>> young adults (<40 y) on both sexes
Aetiolgy : obscure, no exogenous cause
is found
Clinical picture
Intensely itch
No erythema but a sensation of heat
and prickling may precede attacks
Deep-seated vesicle confluent large
bullae
2 -3 weeks : subsides spontaneously &
resolution with desquamation
dryness, cracking & scaling
80% the palms & lateral aspect of finger
12% involvement of instep & sole
Acute phase : hand or feet soaked in sol
burrowi (aluminium acetat 10%) or sol rivanoli
1/2000 : 3-4 X daily, large bullae aspirated

Systemic and or topical antibiotics

When eruption << : soak stop zinc cream or

topical corticosteroids (subacute & chronic)

Oral corticosteroid
Also known as “Circumscribe
neurodermatitis”
A cutaneous response to reapeted
rubbing or scrubbing
>> adults with family history of
atopic disorders (as localized form
of AD)
Women more common than men
Well-defined hyperpigmented
lichenified lesion
Intensely itch  Itch-scratch-
inflammation cycle
Emotional factors is important
The common site of LSC:
• The nape
• Lower legs
• Scalp
• Upper thighs
• Vulva, scrotum,pubis
• Extensor fore arms
Potent topical corticosteroids under occclusion &
short period

Triamcinolone : intra dermal injection

Sedatian & anti pruritic

Scratching habit must be stopped

Antipruritic
Also known as :
Xerosis
Eczema craquele, Winter itch
Ecz. Associated with & possibly caused
by in skin surface lipid
Particularly on leg, arms & hand
predominantly in elderly during winter
months and clearing in the summer
Clinically :
Fine dry scaling and cracking
“Crazy paving” skin appearance
Cracks & fissures may be red &
inflammed
Greasy emollients preparation

Bath oil & an emollient cleanser daily

Mild topical corticosteroids, in urea base

or non-steroid cream (R/atopiclaire)

Also known as :
Stasis dermatitis,Hypostatic eczema
Varicose eczema
Due to venous stasis resulting from
varicose vein, secondary to venous
hypertension & deep vein thrombosis
Clinical features :
Inner aspect of lower legs
Dry skin, pruritic, edema,
Erythematous & purpuric with
accumulation of thick greasy scale
Thinning of skin & shiny
Hyperpigmented following healing
Elasticated support stocking or compression

bandage

Leg fully elevated for at least several hours each day

Bland, non-sensitising astringent

White soft paraffin

Mild potency topical corticosteroid

Systemic corticosteroid rarely indicated

 Juvenile Plantar Dermatosis
 Occurs primarily in children with an atopic diathesis
 Prepubertal children have thinner stratum corneum
of the plantar skin
 Worsens during the winter
 Humid environment in shoes leads to swelling and
maceration of the stratum corneum, which is then
less resistant to friction.
Juvenile Plantar Dermatosis

Plantar foot may be

tender, red, dry,
shiny; may have
cracks and fissures
Juvenile Plantar Dermatosis
 Observed more often since
impermeable materials like
plastic and rubber have
been used for sports
shoes

 Consider allergic contact

dermatitis, tinea pedis in
DDx

 Tx: Change shoes.

Apply emollients,
keratolytics.
• Skin damage after inflammatory
reaction due to contact with
irritant (usually chem.)
• 90% of industrial dermatitis
• Commonly cause by weaker
irritant : reapeted & cumulative
• Stronger irritant  acute toxic
contact dermatitis
• In infant & elderly incontinent
patients  napkin dermatitis
• In adults  both palmar, dorsum
of the hands and face exposed to
occupational irritant
Weak (‘relative’) irritants

Bleaches Soaps

Cleanser Solvents

Cutting Oils Weak acids

Detergents Weak alkalis

Enzymes, e.g in body secretions

and biological washing powders
• Identified irritant factors and reduced
• Barrier cream containing dimethicone
• Liberal use of emollients
• Mild topical cortocosteroids
• Topical anticandidal for 2nd Candida albicans
infection in napkin dermatitis
• A delayed-type hypersensitivity
reaction of the skin following
topical exposure to antigen
• Sensitization may be after a
short periode of contact or many
years of regular exposure
• The clinical patterns : erythema
and edema follows the site of
contact
• >> flexures, the eyelids & hands
• << The young & very old 
because of  CMI
• Patch testing  the
cornerstone of diagnosis
• Appropriated antigens
produce positive reaction
after 48-96 hours of
application (under occlusion)
• Not performed during a
periode of severe acute
eczema  “Angry Back”
syndrome
Substance (Common source)

Antibiotics, e.g. penicillins, neomycin, sulphonamides

Antihistamines, e.g. diphenhydramine, promethazine
Antiseptics, e.g. thimerosal, hexachlorophene
Balsam of Peru (polishes and cosmetics)
Chromate (cement, leather, mathces)
Cobalt (cement)
Colophony (sticking plaster)
Dyes, e.g. p-phenylenediamine (hair colourings, clothing, shoes)
Lanolin (ointments, cosmetics)
Local anaesthetics, e.g. benzocain (pain- and pruritus- relieving cream)

Nickel (jewelers, zips, fastenings)

Plants, e.g. Rhus (poison ivy, poison oak), primula, chrysanthemums
Preservatives, e.g. p-hydroxybenzoic acids (ointments, creams)
Rubber preservative chemical (gloves, shoes, elastic, tyres)
• Avoid precipitating antigens
• Cool bathing & compresses in very acute cases
• Bland emollients of low sensitizing potential
• Topical corticosteroids or non-steroid corticosteroid
(atopiclaire)
• Oral corticosteroids
• Certain substrats (drug or
chemical) transformed into
sensitizer after exposed to UV
• Following topical or systemic
administration of certain
photosensitizing agents
• Clinical features similar with
ACD
• Generally affecting sites
exposed to sunlight
Substance (Photosensitizing agents)

Aftershave lotion, perfumes & cosmetics (musk ambrette, 6-

methylcoumarin, psoralens)
Animal foodstuffs (quinoxaline-n-dioxide)
Coal tar
Cutting oils
Drugsa , e.g. antiarrhythmics, antibacterials, antifungals, antidepressant,
antidiabetics, diuretics, NSAIDS, tranquilizers
Dyes
Furocoumarins, e.g. 8-methoxypsoralen
Sunscreens, e.g. p-aminobenzoic acid (PABA), PABA esters,
benzophenones, dibenzolymethanes, cinnamates

a Includes drugs applied topically or administered systemically

Abbreviation : NSAIDS = Non-Steroidal Anti-Inflammatory Drugs
Avoidance of exposure to sunlight

Removal of the precipitating photosensitizer

High-protection, non-irritating sun screen

Topical corticosteroids

Oral corticosteroids
Synonyms :
Autosensitisation or ‘id’ dermatitis
• A secondary eczematous
reaction, as a reaction to a
dermatophyte infection elsewhere
in the skin, in hypersensitive
individual
Clinical Feature:
• Characterized by the sudden
symmetrical eruption of tiny
vesicles on distant site, e.g the
sides of fingers or feet
The aim of treatment is to identify and treat the
precipitating cause

Secondary lesions are treated as for pompholyx