Download - Atopic Dermatitis Presentsi

8/12/2019 Atopic Dermatitis Presentsi

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Apriyanti Muhammad 1102080003

Hatija Muliana 1102080041Fhiqy Asjuwita 1102090005

Advisor : dr. Elfa Wirdani Fitri

Supervisor : dr.Hj.Sri Rimayani, Sp.KK

ATOPIC DERMATITIS


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Defenition

Atopic dermatitis is a chronicallyrelapsing skin disease that occurs most

commonly during early infancy and childhood. It

is frequently associated with abnormalities in

skin barrier function and allergen sensitization.


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Epidemiology

In USA, Europe, Japan, Australia prevalence

in children of 10%-20%, in adults isapproximately 1%-3%.

Female > male, ratio 1,3:1

A total of 45% of all cases of atopic dermatitis

begin within the first 6 months of life, 60%begin during the first year, and 85% begin

before 5 years of age.


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Etiologi

Atopic dermatitis is a highly pruritic inflammatory

skin disease that result from complex interactionsbetween genetic susceptibility genes resulting in a

defective skin barrier, defect in the innate immune

system and hightened immunologic responses to

allergen and microbial antigens.


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Patogenesis

Atopic dermatitis

Decrease skin

barrierImmunopathology

Citokin and

chemokinGenetics

Reduced

ceramide levels IgETh-2,IL-4,IL-

2,IL-10,IL-13,


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Diagnose

Clinical feature : Itching, Macular erythema, papules or

papulovesicles, eczematous areas with crusting,

lichenification and excoriation, dryness of the skin.

Atopic dermatitis can be devided into three stages ; Infantile (2 months to 2 years)

Children (2 10 years)

Adult

The diagnose is made when the patients has three or

more of the major criteria and three or more of the minor

criteria


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Minor criteria

(must also have three of the following)

Anterior subcapsular cataracts

darkening beneath the eyes

facial pallor

Itch when sweating

Intolerance to wool and lipid solvent.

Perifollicular accentuation

Food hypersensitivity

Course influenced by environmental

and/or emotional factors

immediate skin test reactivity

elevated serum IgE

early age onset

Cont..


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Infantile Atopic Dermatitis

Efflorescence :papulo-vesicles, exudate,

crusts

Predilection :

forehead,cheek, skalp, neck,

wrist, lower and

upper extremity.


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Efflorescence :

dryness, exudate, crusts,

papules, lichenification,

scaly skin, erosions

Predilection :

antecubital and poplitealfossae, fleksor wrist, eyelids,

around the neck, rare on the

face

Childhood Atopic

Dermatitis


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Adult Atopic

Dermatitis

Efflorescence

Plaque papular-eritematosa,scaly skin, lichenification

Predilection :

antecubital and poplitealfossae, neck, forehead,

around the eyes


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Differential Diagnose

Seborheic Dermatitis:

the eruption consists ofconfluent papules and

erythema with anorange hue and slight

scaling

Nummular Eczema:

A large asymmetricalplaque with vesicles,erosions, and crusts

Psoriasis:

The sparing in thecenter of the palm

and the sharpdelineation


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Cont..

Contact Dermatitis:

erythema, papulation,vesiculation, and crusting

Scabies:

Papules and burrows in typicallocation on the finger web


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Treatment1. Non Pharmacologic

2. Pharmacologic :

Topical Therapy

Skin Hydration : Urea Hydrofilic 10% +

Hydrocortison 1%, Emolient

Topical Corticosteroid : Hydrocortison 1-2,5%

(infant), Triamnosolon ( child & adult)

Tar preparation Topical Antihistamin : topical 5% Doxepin (1

week)


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Prognose

Periods of remission appear more frequently as

the patients grows older

Spontaneous resolution of Atopic Dermatitis hasbeen reported to occur after age 5 years in 40-

60% of patients affected during infancy,

particularly if their disease is mild.

30-50% will be develop into asma broncial and

hay fever


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Thank You