Dms146 Slide Dermatitis

8/13/2019 Dms146 Slide Dermatitis

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Peradangan kulit (epidermis, dermis)

eksogen dan atau faktor endogen. ,

edema, papul, vesikel, skuama,


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Faktor eksogen: bahan kimia

s

Faktor endogen: Dermatitis Atopik


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Kelainan kulit bergantung pada stadium

, , , ,

eksudasi

- ,

Kronis : lesi kering, skuama, papul, likenifikasi,

,


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Ada yg berdasarkan:

et o og , . e amentosa

morfologi (papulosa, eksfoliativa)bentuk (D. Nummularis)

.


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DERMATITIS

Eczema Contact Dermatitis

Non AllergicAllergic ContactNon Atopic

Atopic Dermatitis

DermatitisDermatitisDermatitisAtopic Eczema)


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DERMATITISDERMATITIS1. Nonspecific Eczemaous1. Nonspecific Eczemaous

2. Atopic Dermatitis2. Atopic Dermatitis

3. Contact Dermatitis3. Contact Dermatitis

..5. Stasis Dermatitis5. Stasis Dermatitis

. c en mp ex ron cus. c en mp ex ron cus


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Histolo ical:

Intercellular edema (spongiosis)inflammator 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


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The hallmarks of EczematousThe hallmarks of Eczematous

erma serma s

.

2. Indistinct border

. p erma c anges y ves c es, u cy

papules/lichenification 4. Localized/ diffuse

.


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Ear Eczema

Eyelid dermatitis Breast Eczema

an czema rr an an erma s

Vesicobullous Hand Eczema (Pompholyx, Dyshydrosis)

Chronic vesicobullous hand eczema

Hyperkeratotic Dermatitis of the palms

Autosensitization Dermatitis

Xerotic Eczema Nummular Eczema


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Predominantly a disease of adulthood (50-

, ,

Man>Women Characteristic: Oval patches with

crusted papulovesicles

Localisation: Trunk


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Also known as discoid eczema

A chronic disorder of unknown etiology

to form nummular plazues with oozing,

Commone sites: upper extremities, dorsal

Pathology acute, subacute, chronic

eczema


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.

Family history atopy (-)

y rat on o t e s n s ecrease

Role of infection Role of invironmental allergen: HDM,

Cand


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-,

from coalescing papules and

Pinpoint oozing, crusted

entire surface aque - cm n s ze

Surrounding skin is normal/ xerotic

Pruritus


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,

lichenified

a ora ory es : pa c es may e se u n

chronic recalcitrant rule outsuper mpose


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Contact dermatitis

, ,

Varicella Zoster, Bacteria

ron c ves co papu ar erma s:

Chronic CD, psoriasis, drug eruption,

fungal infect


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1. Corticosteroid:

- topically (under occlution)

- injectable intralesional

-

2. Calceneurin inhibitors: tacrolimus,

pimecrolimus3. Wide spread acute/ subacute eczematous:

prednisone/ triamcinolone 40 mg/i m

4. Chronic: baths containing oil moisturizers/emmolient

5. Itchin : h drox zine/ di henh dramine


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Atopic Dermatitis in ChildAtopic Dermatitis in Child


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Also known as neurodermatitis

c rcumcr p a c rcumscr e

neurodermatitis

Chronic, severely pruritic characterized by

one or more lichenified plaques the skinis thickend

Most common sites: scal , na e of neck,

extensor aspects of extremities, ankles,


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secondary to itch

( heat, sweat, irritation) Emotional/ psychological factors

(depression, anxiety)


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Paroxysmal, continous/ sporadic

u ng an scratc ng

Itch severity is worse with sweating, heat/irritation from clothing/ psychological

distress


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Repeating rubbing and

scra c c en e ene s n w

accentuated skin marking)

Scally plaque with excoriations

H er and h o i mentation chronicit One plaque or more

,ankles, extensor aspect o/t extremities,

anogen a


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Hyperkeratosis, hypergranulosis,,

thickened papillary dermal collagen


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Liken Simplek Kronikus/Liken Simplek Kronikus/

euro erma seuro erma s


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TherapyTherapy

Difficult

ranqu zer an ant epressants

Topical steroid and intralesional steroid


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Is the results of low humidity and dry skin

Clinis: dry fissure skin trunk, extremities(lower leg)


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- generalized sub acute dermatitis

- eet an s

- Hypersensitivity reaction to substanceproduced by the acute dermatitis


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-Characteristic: deep seated vesicles

w c resem e t e pear s n tap oca

pudding) -Palm, soles, side of fingers

- ,


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CONTACT DERMATITISCONTACT DERMATITIS

the skin precipitated by anthe skin precipitated by anexogenous chemicalexogenous chemical


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Contact DermatitisContact Dermatitis

1.1. Irritant CD: produced byIrritant CD: produced by

substance that has direct toxicsubstance that has direct toxic

effect on the skineffect on the skin2.2. Allergic: trigger anAllergic: trigger an

immunolo ic reactionimmunolo ic reaction tissuetissue

inflammationinflammation


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reactions due toxic injury of the skin

type IVA. Sensitization phase

B. Elicitation Phase

Sensitization: hapten + protein LCs Th1


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type IV

antigens

T

inflammatory

mediatorslymphokines

activated macrophage


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Subtances direct toxic effect of the skin

Alkalis

Detergents


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inflammation

Metals Plants

Medicines


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Incidence:Incidence:

-- Frequent problemFrequent problem

-- 50% occupational illness50% occupational illness


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Strong irritant several hours skin damage

dermatitis

Requires 24-48 hours

Often exposure Clinical disease

Occasionally dermatitis (8-12 hours) up to 4-7 hours

Detailed history of occupation, hygiene habits, hobbies


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The most common SensitizersThe most common Sensitizers

Poison Ivy

Para phenylenediamine Nickel

Rubber compounds

Poison ivy: in the summer

Aller en: entadec lcatechol oleoresin of the lant


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PPDPPD

Permanent coloring of hair

Cross reaction : Azo, aniline dye,

, ,

Hydrochlorothiazine

SulfonamidesWhen completely oxidized (fur coat), PPD not allergenic


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Ear piercing

n a meta s

Hypoallergenic earring: one cannot becertain that they are free of nickel

Stainless steel: nickel bound so ti htl

ACD (-)


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ShoesACD on dorsa of the feet

ergen: ercapto enzot azo e

Thiurams


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Preservative in Mycolog cream, ointment (-)

Dyes, insecticides,

Rubber accelerators,

S nthetic waxesIn aminophyllin

eczematous dermatitis


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Acute/chronic

Depend upon the nature of the exposure atches/ la ue, an ular corner, eometric onlines, sharp margin

Localization:Head& neck: cosmetics, hair dyes, permanentwaves, shampoos

,

Photo allergic: produce by a photoreaction, ,


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chemicals (irritants): petroleum, solvents ,

leather tanning agents)

ro ns an u oc s n n an s: aper

dermatitis: moisture and feces


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,

(commonly white petrolatum) Is a lied to the skin under a metal disc called a

Finn chamber

A test batter of 20-24 aller ens is used asstandard allergens

The sheet is placed on the upper back, scaled

with adhesive tape The patch is removed after 48 hours read


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Avoidance of irritant/allergen change in lifest le & occu ation

Protective clothing

,benefit

Substituted

Topical steroid


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Dermatitis Kontak IritanDermatitis Kontak Iritan

DKI pd tangan & ujungDKI pd tangan & ujung--ujung jari akibat asamujung jari akibat asam


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DKA akibat kalun nikelDKA akibat kalun nikel DKA akibat semenDKA akibat semen

FotoalergiFotoalergi


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FotoalergiFotoalergi

erma s er oqueerma s er oque

Seborrheic Dermatitis/ MorbusSeborrheic Dermatitis/ Morbus


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Seborrheic Dermatitis/ MorbusSeborrheic Dermatitis/ Morbus

nnanna Definition: a chronic, superficial, inflammatory

process affecting the hairy regions of the body

Etiology: unknown/ Pityrosporum ovale

an ru s sca ng o e sca p w ouinflammation

- ,

adult 18-40 years, baby (cradle cap),

- > ,


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Seborrheic DermatitisSeborrheic Dermatitis Predilection hairy

,

eyelid ,

ears, chest


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The occurrence of Seborrheicermat t s para e s t e ncrease

sebaceous gland activity occurring in

n an , a er pu er y, prur us


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Predilection for the hair re ions where there

are numerous sebaceous gland: scalp,eyebrows, eyelids, nasolabial creases, ears,

, , , ,infra mammary folds

Most mild form, dandruff, fine whittis scaling

without erythema.

Patch/plaque: indistinct margin, erythema,yellowish, greasy scaling, uncommon hair loss


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without erythema / Pityriasis sica ,

greasy scaling


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1. A.D (infantile eczema)

n an oc: aper area ax a

diagnosis S.D es on: orearms, s ns

2. Psoriasis: scalp, groin, other area

plaque

. . ,

Biopsy : non diagnostic


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,

acid, selenium sulfide, zinc pyrithione)

scalp 5-10 minutes

n am. e orrr e c:

topical steroid lot/gel in hairy area;

hydrocortisone cream non hairy skin


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e na on:e na on:

An eczematous eruption of theAn eczematous eruption of the

venous diseasevenous disease

STASIS DERMATITISSTASIS DERMATITIS


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STASIS DERMATITISSTASIS DERMATITIS

pressure, capillary damagepressure, capillary damage extravasation ofextravasation ofeczematous processeczematous process

I idI id


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IncidenceIncidence

Adults (middle age old age)

History: Chronic

precede by edema & swelling

had thrombophlebitis

Physical examinationPhysical examination


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Physical examinationPhysical examination

Varicose vein are prominent1. Edema

2. Brown pigmentation

3. Petechiae

4. Sub acute and chronic dermatitis5. Thickened skin, scaling and /or weeping

above the medial malleolus

ThTh


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TheraThera

- use of supportive hose

- Standin should be restricted

- Patients who are obese weight reduction- - Topical steroid

-

crusting


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Patients: anxious c en e p aque, scratc ng +


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THANK YOU FOR LISTENINGTHANK YOU FOR LISTENING


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Dms146 Slide Dermatitis

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