Idea Transcript
Dermatitis • Definisi: • Peradangan kulit (epidermis, dermis) sebagai respons terhadap pengaruh faktor eksogen dan atau faktor endogen. Menimbulkan kelainan polimorfik (eritema (eritema, edema, papul, vesikel, skuama, likenifikasi)
Etiologi Faktor eksogen: bahan kimia fi ik (SUV) fisik Faktor endogen: Dermatitis Atopik
Klinis Keluhan gatal Kelainan kulit bergantung pada stadium : eritema, eritema edema, edema vesikel/ bula, bula erosi erosi, • Akut eksudasi • Subakut: eritema ber ((-), ) eksudat keringÆ krusta • Kronis : lesi kering, skuama, papul, likenifikasi, erosi ekskoriasi erosi,
Tatanama/Klasifikasi • Belum seragam • Ada yg berdasarkan: etiologi ti l i (DK (DK, D D. M Medikamentosa) dik t ) morfologi (papulosa, eksfoliativa) bentuk (D. Nummularis) lokalisasi (D (D. intertrigenous)
DERMATITIS
Eczema
Atopic Dermatitis (Eczema / Atopic Eczema)
Contact Dermatitis
Non Atopic Dermatitis
Allergic Contact Dermatitis
Non Allergic Contact Dermatitis
DERMATITIS 1. Nonspecific Eczemaous Dermatitis 2. Atopic Dermatitis 3. Contact Dermatitis 4. 4 Seborrheic Dermatitis 5. Stasis Dermatitis 6 Lichen 6. Li h Simplex Si l Chronicus Ch i
Histological Dermatitis Histological: g Intercellular edema (spongiosis) inflammatoryy infiltrate in dermis - Acute dermatitis: erythema, edema, spongiosis causing vesicular - Subacute dermatitis: less spongiosis, juicy papules - Chronic dermatitis: thickened epidermis (lichenification)/acanthotic, slight spongiosis, scalling
The hallmarks of Eczematous D Dermatitis titi • 1 1. Marked pruritus • 2. Indistinct border • 3. 3 Epidermal E id l changes h b by vesicles, i l jjuicy i papules/lichenification • 4. Localized/ diffuse • 5. 5 Idiopathic/ cause by specific ethiology
Regional Dermatitis • • • • • • • • • •
Ear Eczema Eyelid dermatitis Breast Eczema H dE Hand EczemaÆ Æ Irritant I it t hand h d dermatitis d titi Vesicobullous Hand Eczema (Pompholyx, Dyshydrosis) Chronic vesicobullous hand eczema Hyperkeratotic Dermatitis of the palms Autosensitization Dermatitis Xerotic Eczema Nummular Eczema
Nummular eczema • Nummular dermatitis • Predominantly a disease of adulthood (5065 years) years), rare in infancy infancy, childhood • Man>Women • Characteristic: Oval patchesÆ with crusted papulovesicles Localisation: Trunk Extremities
Nummular Eczema • Also known as discoid eczema • A chronic disorder of unknown etiology • Papules and papulo vesicles cialescence to form nummular plazues with oozing, crust and scale • Commone sites: upper extremities, dorsal hands in women lower extremities in man • Pathology acute, subacute, chronic eczema
Etiology and Pathogenesis • • • • •
Pathog. Is unknown Pathog Family history atopy (-) H d ti off th Hydration the skin ki iis d decreased d Role of infection Role of invironmental allergen: HDM, Cand
Clinical Manifestation • Well demarcated demarcated, coin-shape coin shape plaques from coalescing papules and papulovesicles • Pinpoint oozing, crustedÆ entire surface • Plaque Pl 1 1-3 3 cm iin size i • Surrounding skin is normal/ xerotic • Pruritus • Central resolutionÆ annular form
Clinical Manifestation • Chronic plaque are dry dry, scaly and lichenified • Laboratory L b t test: t t patch t h test t t maybe b seful f l in i chronic recalcitrant– rule out superimposed i d CD
Dermatitis Numularis
Differential Diagnosis Acute vesico papular dermatitis: Contact dermatitis Infections: Dermatophyte Dermatophyte, HS virus virus, Varicella Zoster, Bacteria
Ch i vesico Chronic i papular l d dermatitis titi : Chronic CD, psoriasis, drug eruption, fungal infect
Therapy 1. Corticosteroid: - topically (under occlution) - injectable intralesional - sistemic 2. Calceneurin inhibitors: tacrolimus, pimecrolimus 3. Wide spread acute/ subacute eczematous: prednisone/ triamcinolone 40 mg/i m wet dressing/bath: acute dermatitis 4. Chronic: baths containing oilÆ moisturizers/emmolient 5. Itching: g hydroxyzine/ y y diphenhydramine p y
Atopic Dermatitis in Child
Lichen Simplex Chronicus • Also known as neurodermatitis circumcripta/ i i t / circumscribed i ib d neurodermatitis • Chronic, severely pruritic characterized by one or more lichenified plaquesÆ the skin is thickend • Most common sites: scalp, p, nape p of neck,, extensor aspects of extremities, ankles, • Anogenital region
Etiology and Pathogenesis • Induced by rubbing and scratching secondary to itch • Environmental factorsÆ inducing itch • ( heat, sweat, irritation) • Emotional/ psychological factors (depression, anxiety)
Clinical Finding • • • •
Severe itching (the hallmark of LSC)Æ Paroxysmal, continous/ sporadicÆ R bbi and Rubbing d scratching t hi Itch severity is worse with sweating, heat/ irritation from clothing/ psychological distress
Cutaneous Lesions • Repeating rubbing and scratchÆlichenified t hÆli h ifi d (thik (thikened d skin ki with ith accentuated skin marking) • Scally plaque with excoriations • Hyper yp and hypopigmentationÆ yp p g chronicity y • One plaque or more • Sites: scalp scalp, the nape of neck (women) ankles, extensor aspect o/t extremities, anogenital it l
Pathology LSC • Hyperkeratosis, hypergranulosis, psoriasisform epidermal hyperplasia hyperplasia, thickened papillary dermal collagen
Liken Simplek Kronikus/ N Neurodermatitis d titi
Therapy
Difficult T Tranquilizer ili and d anti ti d depressants t Topical steroid and intralesional steroid
Xerotic Eczema • Is the results of low humidity and dry skin • Clinis: dry fissure skinÆ trunk, extremities (lower leg)
Autosensitization/Id eruption • - generalized sub acute dermatitis • - ffeet/hands t/h d • - Hypersensitivity reaction to substance produced by the acute dermatitis
Dyshidrotic Eczema • -Characteristic: deep seated vesicles ( hi h resemble (which bl th the pearls l iin ttapioca i pudding) • -Palm, soles, side of fingers • -Bilaterally Bilaterally, symmetrically
CONTACT DERMATITIS An inflammatory reaction of the skin precipitated by an exogenous chemical
Contact Dermatitis 1. Irritant CD: produced by substance that has direct toxic effect on the skin 2. Allergic: trigger an immunologic g reactionÆ reactionÆ tissue inflammation
Pathogenesis • Irritant CD: nonspecific inflammatory reactions due toxic injury of the skin • Allergic CD: Cell mediated immunity/ type IV A. Sensitization phase B. Elicitation Phase Sensitization: hapten + proteinÆ LCsÆ Th1
type IV antigens
T
inflammatory mediators
lymphokines
activated macrophage
Irritants Subtances Æ direct toxic effect of the skin • Acids • Alkalis • Solvents • Detergents
Allergens Triggers immunologic reaction Ætissue inflammation • • • •
Metals Plants Rubber chemicals Medicines
Incidence: - Frequent problem - 50% occupational illness
History First determine: ACD/ICD • Strong irritantÆ several hours Æ skin damage • Weaker irritantsÆ multiple application & daysÆ dermatitis • Allergic Contact Dermatitis: – – – –
Requires 24-48 hours Often exposureÆ p Clinical disease Occasionally dermatitis (8-12 hours)Æ up to 4-7 hours Detailed history of occupation, hygiene habits, hobbies
The most common Sensitizers • • • • • •
Poison Ivyy Para phenylenediamine Nickel Rubber compounds Ethylenediamine Poison ivy: in the summer – Allergen: pentadecylcatechol (oleoresin of the plant)
PPD • Permanent coloring of hair • Cross reaction : Azo, aniline dye, Benzocaine procaine Benzocaine, procaine, Hydrochlorothiazine Sulfonamides When completely oxidized (fur coat), PPD not allergenic
Nickel • • • •
Most commonly in woman Ear piercing I allll metals In t l “Hypoallergenic” earring: one cannot be certain that they are free of nickel • Stainless steel: nickel bound so tightlyÆ g y ACD (-)
Rubber compound • ShoesÆ ACD on dorsa of the feet • Allergen: All M Mercaptobenzothiazole t b thi l Thiurams
Ethylenediamine Preservative in Mycolog cream, ointment (-) Dyes, insecticides, Rubber accelerators, Synthetic y waxes,, In aminophyllin Sensitive individual Ægeneralized eczematous dermatitis
Physical Examination • Acute/chronic • Depend upon the nature of the exposure patches/plaque, p q , angular g corner,, g geometric on Æp lines, sharp margin • Localization: Head& neck: cosmetics, hair dyes, permanent waves, shampoos Eyelid: eye cosmetic, cosmetic nail polish Photo allergic: produce by a photoreaction between SUV & allergen, allergen of the neck neck, arms
Physical Examination • The dorsum of the hands: industrial chemicals (irritants): petroleum, solvents • The dorsum of the feet: shoes (rubber (rubber, leather tanning agents) • Groins G i and db buttocks tt k iin iinfants: f t Di Diaper dermatitis: moisture and feces
Diagnosis • Patch test: The test material, in different vehicles (commonly white petrolatum) • Is applied pp to the skin under a metal disc,, called a Finn chamber g is used as • A test batteryy of 20-24 allergens standard allergens • The sheet is placed on the upper back, scaled with adhesive tape • The patch is removed after 48 hoursÆ read
Therapy • Prevention • Avoidance of irritant/allergenÆ change in life style y & occupation p • Protective clothing protective barrier creamÆ little • Occupational: protective, benefit • Substituted Subst tuted • Topical steroid • Antihistamine
Dermatitis Kontak Iritan
DKI pd tangan & ujungujung-ujung jari akibat asam
Dermatitis Kontak Alergi
DKA akibat kalung g nikel
DKA akibat semen
Fotoalergi (D (Dermatitis titi Berloque) B l )
Seborrheic Dermatitis/ Morbus Unna Unna • Definition: a chronic, superficial, inflammatory process affecting the hairy regions of the body • Etiology: unknown// Pityrosporum ovale Dandruff D d ff is i scaling li off th the scalp l without ith t inflammation • Incidence: a common problem problem, 2-5% adult 18-40 years, baby (cradle cap), children 6-10 6 10 years years, woman> man
Seborrheic Dermatitis • Predilection hairy region: scalp, scalp eyebrow • eyelid • Nasolabial creases creases, ears, chest
History • The occurrence of Seborrheic D Dermatitis titi parallels ll l th the iincreased d sebaceous gland activity occurring in i f t after infant, ft puberty, b t pruritus it
Physical examination • Predilection for the hairyy regions g where there are numerous sebaceous gland: scalp, eyebrows, eyelids, nasolabial creases, ears, chest intertriginous area: axilla chest, axilla, groin groin, buttocks buttocks, infra mammary folds • Bilateral and symmetrically • Most mild form, dandruff, fine whittis scaling without erythema. • Patch/plaque: indistinct margin, erythema, yellowish, greasy scaling, uncommon hair loss
Physical examination S.D • Mild form: dandruffÆ fine whitish scaling without erythema / Pityriasis sica • MildÆ Moderate: erythema, erythema yellowish greasy scaling
DD 1. A.D (infantile eczema) if iinfantÆ f tÆ Loc: L di diaper area & axillaÆ ill Æ diagnosis S.D If lesion: l i fforearms, shinsÆ hi Æ AD 2. Psoriasis: scalp, groin, other area papilosquamous patches & plaque 3 T 3. T. capitis: hair loss loss, urban black Biopsy : non diagnostic
Therapy S.D • Anti seborrheic shampoos (sulfur (sulfur, salicylic acid, selenium sulfide, zinc pyrithione) • ShampoosÆ must be rubbed in to the scalp 5-10 minutes • Inflam. I fl Seborrrheic: S b h i • topical steroid lot/gel Æ in hairy area; hydrocortisone creamÆ non hairy skin
STASIS DERMATITIS D fi ti Defination: An eczematous eruption of the lower legÆ legÆ secondary to peripheral venous disease
STASIS DERMATITIS y Venous incompetence Æ hydrostatic pressure, capillary damageÆ damageÆ extravasation of red blood cell & serumÆ serumÆ inflammatory eczematous process
Incidence
• Adults (middle age old age) • History: Chronic pruritic eruption precede by edema & swelling Patients with Stasis dermatitis have often had thrombophlebitis
Physical examination Varicose veinÆ are prominent 1. Edema g 2. Brown pigmentation 3. Petechiae 4. Sub acute and chronic dermatitis 5. Thickened skin, scaling and /or weeping 6. Any portion of the legÆ prominent site is above the medial malleolus
Therapy - Prevention of venous stasis and edema Æ use of supportive hose g should be restricted - Standing - Patients who are obeseÆ weight reduction - If this failsÆ bed rest with elevation of legs - Topical steroid - Wet compresses if there is oozing or crusting
History
- Patient may have history of emotional or psychiatric problem
Physical Examinations • Patients: anxious • Lichenified Li h ifi d plaque, l scratching t hi ((+))
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