Dermatitis Dermatitis Dermatitis Dermatitis • Definisi: Definisi: • Peradangan kulit (epidermis, dermis) sebagai respons terhadap pengaruh faktor sebagai respons terhadap pengaruh faktor eksogen dan atau faktor endogen. Menimbulkan kelainan polimorfik (eritema Menimbulkan kelainan polimorfik (eritema, edema, papul, vesikel, skuama, likenifikasi) likenifikasi)
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Definisi: • Peradangan kulit (epidermis, dermis) sebagai ...ocw.usu.ac.id/.../dms146_slide_dermatitis.pdf · Dermatitis NumularisDermatitis Numularis. Differential DiagnosisDifferential
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DermatitisDermatitisDermatitisDermatitis
• Definisi:Definisi:• Peradangan kulit (epidermis, dermis)
sebagai respons terhadap pengaruh faktorsebagai respons terhadap pengaruh faktor eksogen dan atau faktor endogen. Menimbulkan kelainan polimorfik (eritemaMenimbulkan kelainan polimorfik (eritema, edema, papul, vesikel, skuama, likenifikasi)likenifikasi)
EtiologiEtiologiEtiologiEtiologi
Faktor eksogen: bahan kimiafi ik (SUV)fisik (SUV)
Faktor endogen: Dermatitis Atopik
KlinisKlinisKlinisKlinis
Keluhan gatalKeluhan gatalKelainan kulit bergantung pada stadium• Akut : eritema edema vesikel/ bula erosiAkut : eritema, edema, vesikel/ bula, erosi,
ti l i (DK D M dik t )etiologi (DK, D. Medikamentosa)morfologi (papulosa, eksfoliativa)bentuk (D. Nummularis)lokalisasi (D intertrigenous)lokalisasi (D. intertrigenous)
DERMATITIS
Eczema Contact Dermatitis
Non AllergicContactAllergic ContactNon AtopicAtopic Dermatitis
DermatitisDermatitisDermatitisDermatitis2. Atopic Dermatitis2. Atopic Dermatitis3. Contact Dermatitis3. Contact Dermatitis4 Seborrheic Dermatitis4 Seborrheic Dermatitis4. Seborrheic Dermatitis4. Seborrheic Dermatitis5. Stasis Dermatitis5. Stasis Dermatitis6 Li h Si l Ch i6 Li h Si l Ch i6. Lichen Simplex Chronicus6. Lichen Simplex Chronicus
H d E I it t h d d titi• Hand Eczema Irritant hand dermatitis• Vesicobullous Hand Eczema (Pompholyx, Dyshydrosis)• Chronic vesicobullous hand eczemaChronic vesicobullous hand eczema• Hyperkeratotic Dermatitis of the palms• Autosensitization Dermatitis• Xerotic Eczema• Nummular Eczema
• Nummular dermatitisNummular dermatitis• Predominantly a disease of adulthood (50-
65 years) rare in infancy childhood65 years), rare in infancy, childhood• Man>Women• Characteristic: Oval patches with
crusted papulovesiclesLocalisation: Trunk
ExtremitiesExtremities
Nummular EczemaNummular EczemaNummular EczemaNummular Eczema• Also known as discoid eczema• A chronic disorder of unknown etiology• Papules and papulo vesicles cialescencePapules and papulo vesicles cialescence
to form nummular plazues with oozing, crust and scalecrust and scale
• Commone sites: upper extremities, dorsal hands in women lower extremities in manhands in women lower extremities in man
• Pathology acute, subacute, chronic eczema
Etiology and PathogenesisEtiology and PathogenesisEtiology and PathogenesisEtiology and Pathogenesis
• Pathog Is unknownPathog. Is unknown• Family history atopy (-)
H d ti f th ki i d d• Hydration of the skin is decreased• Role of infection• Role of invironmental allergen: HDM,
• Chronic plaque are dry scaly and• Chronic plaque are dry, scaly and lichenifiedL b t t t t h t t b f l i• Laboratory test: patch test maybe seful in chronic recalcitrant– rule out
• Severe itching (the hallmark of LSC)Severe itching (the hallmark of LSC)• Paroxysmal, continous/ sporadic
R bbi d t hi• Rubbing and scratching• Itch severity is worse with sweating, heat/
irritation from clothing/ psychological distress
Cutaneous LesionsCutaneous LesionsCutaneous LesionsCutaneous Lesions• Repeating rubbing and
t h li h ifi d (thik d ki ithscratch lichenified (thikened skin with accentuated skin marking)
• Scally plaque with excoriations• Hyper and hypopigmentation chronicityyp yp p g y• One plaque or more• Sites: scalp the nape of neck (women)• Sites: scalp, the nape of neck (women)
ankles, extensor aspect o/t extremities, it lanogenital
• -Characteristic: deep seated vesicles ( hi h bl th l i t i(which resemble the pearls in tapioca pudding)
• -Palm, soles, side of fingers• -Bilaterally symmetricallyBilaterally, symmetrically
CONTACT DERMATITISCONTACT DERMATITIS
An inflammatory reaction ofAn inflammatory reaction ofAn inflammatory reaction of An inflammatory reaction of the skin precipitated by an the skin precipitated by an
exogenous chemicalexogenous chemical
Contact DermatitisContact Dermatitis1.1. Irritant CD: produced by Irritant CD: produced by
substance that has direct toxic substance that has direct toxic effect on the skineffect on the skin
2.2. Allergic: trigger an Allergic: trigger an immunologic reactionimmunologic reaction tissue tissue gginflammationinflammation
PathogenesisPathogenesisPathogenesisPathogenesis
• Irritant CD: nonspecific inflammatoryIrritant CD: nonspecific inflammatory reactions due toxic injury of the skin
• Allergic CD: Cell mediated immunity/• Allergic CD: Cell mediated immunity/ type IV
A. Sensitization phaseB. Elicitation Phase
Sensitization: hapten + protein LCs Th1
type IV
antigens
T
inflammatorymediators lymphokines
activated macrophage
IrritantsIrritantsIrritantsIrritants
Subtances direct toxic effect of the skin• AcidsAcids• Alkalis• Solvents• Solvents• Detergents
– Requires 24-48 hours– Often exposure Clinical diseasep– Occasionally dermatitis (8-12 hours) up to 4-7 hours– Detailed history of occupation, hygiene habits, hobbies
The most common SensitizersThe most common Sensitizers
• Poison Ivyy• Para phenylenediamine• Nickel• Rubber compounds• EthylenediamineEthylenediamine• Poison ivy: in the summer
– Allergen: pentadecylcatechol (oleoresin of the plant)Allergen: pentadecylcatechol (oleoresin of the plant)
• Acute/chronic• Depend upon the nature of the exposure
patches/plaque, angular corner, geometric on p p q , g , glines, sharp margin
• Localization: Head& neck: cosmetics, hair dyes, permanent waves, shampoosEyelid: eye cosmetic nail polishEyelid: eye cosmetic, nail polishPhoto allergic: produce by a photoreaction between SUV & allergen of the neck armsbetween SUV & allergen, of the neck, arms
• The dorsum of the hands: industrialThe dorsum of the hands: industrial chemicals (irritants): petroleum, solvents
• The dorsum of the feet: shoes (rubber• The dorsum of the feet: shoes (rubber, leather tanning agents)G i d b tt k i i f t Di• Groins and buttocks in infants: Diaper dermatitis: moisture and feces
DiagnosisDiagnosisDiagnosisDiagnosis
• Patch test: The test material, in different vehiclesPatch test: The test material, in different vehicles (commonly white petrolatum)
• Is applied to the skin under a metal disc, called a pp ,Finn chamber
• A test battery of 20-24 allergens is used as y gstandard allergens
• The sheet is placed on the upper back, scaled with adhesive tape
• The patch is removed after 48 hours read
TherapyTherapyTherapyTherapy
• PreventionPrevention• Avoidance of irritant/allergen change in life
• Definition: a chronic, superficial, inflammatory process affecting the hairy regions of the body
/• Etiology: unknown/ Pityrosporum ovale
D d ff i li f th l ith tDandruff is scaling of the scalp without inflammation
• Incidence: a common problem 2-5%• Incidence: a common problem, 2-5%adult 18-40 years, baby (cradle cap), children 6-10 years woman> manchildren 6 10 years, woman> man
• The occurrence of SeborrheicD titi ll l th i dDermatitis parallels the increased sebaceous gland activity occurring in i f t ft b t itinfant, after puberty, pruritus
• Predilection for the hairy regions where there y gare numerous sebaceous gland: scalp, eyebrows, eyelids, nasolabial creases, ears, chest intertriginous area: axilla groin buttockschest, intertriginous area: axilla, groin, buttocks, infra mammary folds
• Bilateral and symmetricallyBilateral and symmetrically• Most mild form, dandruff, fine whittis scaling
without erythema.• Patch/plaque: indistinct margin, erythema,
An eczematous eruption of the An eczematous eruption of the lower leglower leg secondary to peripheralsecondary to peripherallower leglower leg secondary to peripheral secondary to peripheral venous diseasevenous disease
• History: Chronicpruritic eruptionpruritic eruptionprecede by edema & swelling
Patients with Stasis dermatitis have oftenPatients with Stasis dermatitis have often had thrombophlebitis
Physical examinationPhysical examination
Varicose vein are prominent1. Edema2. Brown pigmentationg3. Petechiae4. Sub acute and chronic dermatitis5. Thickened skin, scaling and /or weeping6. Any portion of the leg prominent site is6. Any portion of the leg prominent site is
above the medial malleolus
TherapyTherapyTherapyTherapy
- Prevention of venous stasis and edemaPrevention of venous stasis and edema use of supportive hose
- Standing should be restrictedg- Patients who are obese weight reduction- If this fails bed rest with elevation of legsIf this fails bed rest with elevation of legs- Topical steroid- Wet compresses if there is oozing or- Wet compresses if there is oozing or
crusting
HistoryHistory
-- Patient may have history of emotional or Patient may have history of emotional or psychiatric problempsychiatric problem