When conventional therapy fails to treat atopic dermatitis
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When conventional therapy fails to treat atopic dermatitis

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When conventional therapy fails to treat atopic dermatitis When conventional therapy fails to treat atopic dermatitis Presentation Transcript

  • Prof DR Dr Ariyanto HarsonoSpA(K)1
  • Atopic dermatitis is a disease that began to arise atthe age of infants and children,chronic and relapsingcharacterized by itching of the skin.inflammatory reactionbased on hereditary factors and environmentalfactors,the symptoms are chronic recurrent erythema,papules, vesicles, crusting, and skuama.2Prof DR Dr Ariyanto Harsono SpA(K)
  • Atopic Dermatitis:Itch that eruptsNot eruption that itches3Prof DR Dr Ariyanto Harsono SpA(K)
  • 4Prof DR Dr Ariyanto Harsono SpA(K)
  • EducationHidrationEmolientMoisturizerWet dressingAllergen/irritants avoidanceAntihistamineTopical Steroid5Prof DR Dr Ariyanto Harsono SpA(K)
  • Conventional Therapyis not always safeTopical steroid: cutaneous atrophy, striae, bruisability, telangiectasiaHigh-potency topical steroids can causesystemic side effects in children.6Prof DR Dr Ariyanto Harsono SpA(K)
  • 7Prof DR Dr Ariyanto Harsono SpA(K)
  • IgEIL-4, IL-5IL-138Prof DR Dr Ariyanto Harsono SpA(K)
  • IgEIL-4, IL-5IL-13v2CD4+Th1 CellIFN-γCD8+Th1 CellDTHSuper antigen9Prof DR Dr Ariyanto Harsono SpA(K)
  • SpongiousInfiltrasiEosinofilUdem10Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria mayor (minimal 3)•Pruritus•Characteristic Distribution and morphology of skin lesions•Flexural Lichenification•Facial and extensor Lichenification in babies and children•Chronic•History of family atopy11Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria mayor (minimal 3)•Pruritus•Characteristic Distributionand morphology of skin lesions•Flexural Lichenification•Facial and extensorLichenification in babies and children•Kronik•History of family atopy12Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria mayor (minimal 3)•Pruritus•Characteristic Distributionand morphology of skin lesions•Flexural Lichenification•Facial and extensorLichenification in babies andchildren•Kronik•History of family atopy13Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria mayor (minimal 3)•Pruritus•Characteristic Distributionand morphology of skin lesions•Flexural Lichenification•Facial and extensor Lichenificationin babies and children•Kronik•History of family atopy 14Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria mayor (minimal 3)•Pruritus•Characteristic Distributionand morphology of skin lesions•Flexural Lichenification•Facial and extensor in babiesand children•Chronic•History of family atopy15Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Stafilokokus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis16Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)17Prof DR Dr Ariyanto Harsono SpA(K)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Stafilokokus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)18Prof DR Dr Ariyanto Harsono SpA(K)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Stafilokokus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)19Prof DR Dr Ariyanto Harsono SpA(K)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Stafilokokus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)20Prof DR Dr Ariyanto Harsono SpA(K)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Staphylococcus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)21Prof DR Dr Ariyanto Harsono SpA(K)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Stafilokokus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)22Prof DR Dr Ariyanto Harsono SpA(K)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections (Stafilokokus/herpes)•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis
  • Kriteria Hanifin and RajkaKriteria minor (minimal 3)•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Tes kulit positif•Peningkatan IgE serum•Onset usia muda•Mudah infeksi kulit (Stafilokokus/herpes)•Kecenderungan nonspesific dermatitis•Nipple eczema•Cheilitis•Reccurent conjunctivitis23Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria minor•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism 24Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and RajkaKriteria minor25Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and RajkaKriteria minor26Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and RajkaKriteria minor27Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and RajkaKriteria minor28Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and RajkaKriteria minor29Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and RajkaKriteria minor30Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and RajkaKriteria minor31Prof DR Dr Ariyanto Harsono SpA(K)•Dennie Morgan infraorbital fold•Keratoconus•Anterior subcapsular cataract•Orbital darkening•Facial pallor/erythem•Pityriasis alba•Itch when sweating•Wool intolerant /lipid solvent•Perifollicular accentuation•Food Intolerant•Emotional and environmental influence•White dermatographism
  • Kriteria Hanifin and Rajka pada bayiKriteria mayor (minimal 2 mayor)•History of family atopy•Evidence of pruritic Dermatitis•Dermatitis fasial, ekstensor, likenifikasiKriteria minor (minimal 1 minor)•Xerosis/ichtyosis/hyperlinear palm•Perifollicular accentuation•Chronic scalp scalling•Periauricular fissures32Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and Rajka pada bayiKriteria mayor (minimal 2 mayor)•History of family atopy•Evidence of pruritic Dermatitis•Dermatitis fasial, ekstensor, lichenificationKriteria minor (minimal 1 minor)•Xerosis/ichtyosis/hyperlinear palm•Perifollicular accentuation•Chronic scalp scalling•Periauricular fissures33Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and Rajka pada bayiKriteria mayor (minimal 2 mayor)•History of family atopy•Evidence of pruritic Dermatitis•Dermatitis fasial, ekstensor, likenifikasiKriteria minor (minimal 1 minor)•Xerosis/ichtyosis/hyperlinear palm•Perifollicular accentuation•Chronic scalp scalling•Periauricular fissures34Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin and Rajka pada bayiKriteria mayor (minimal 2 mayor)•History of family atopy•Evidence of pruritic Dermatitis•Dermatitis fasial, ekstensor, likenifikasiKriteria minor (minimal 1 minor)•Xerosis/ichtyosis/hyperlinear palm•Perifollicular accentuation•Chronic scalp scalling•Periauricular fissures35Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria Hanifin pada anakKriteria mayor (minimal 3 mayor)•Pruritus•Characteristic Distribution and morphology of skin lesions•Dermatitis fasial, ekstensor selama bayi dan awal usia anak•Flexural lichenification dan linearity by adolescence•Chronic DermatitisKriteria minor (minimal 1minor)•Xerosis/ichtyosis/hyperlinear palm/keratosis pilaris•IgE reactivity•Chronic scalp scalling•Perifollicular accentuation•Periauricular fissures 36Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria minor (minimal 1 minor)•Hand/foot dermatitis•Cheilitis•Kepekaan infeksi kulit (Herpes/Strep/S aureus)37Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria minor (minimal 1 minor)•Hand/foot dermatitis•Cheilitis•Vulnerable of skin infetions (Herpes/Strep/S aureus)38Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria minor (minimal 1 minor)•Hand/foot dermatitis•Cheilitis•Vulnerable of skin infetions (Herpes/Strep/S aureus)39Prof DR Dr Ariyanto Harsono SpA(K)
  • Kriteria minor (minimal 1 minor)•Hand/foot dermatitis•Cheilitis•Vulnerable of skin infetions (Herpes/Strep/staphilococcus)40Prof DR Dr Ariyanto Harsono SpA(K)
  • 41Prof DR Dr Ariyanto Harsono SpA(K)Seborrhoic dermatitis
  • 42Prof DR Dr Ariyanto Harsono SpA(K)Pompholix
  • 43Prof DR Dr Ariyanto Harsono SpA(K)
  • Principle of Conventional TherapyEczemaTarget for skincareTarget for antiinflammatory44Prof DR Dr Ariyanto Harsono SpA(K)
  • Mild Moderate SevereMild to Moderate Potency Topical SteroidsPimecrolimusTacrolimusOral SteroidsCyclosporine, mycophenolateLight treatmentNew Treatment Strategy in ADEmolientDryskinItching and/or early sign ofinflammationFlare45Prof DR Dr Ariyanto Harsono SpA(K)IVIG
  • Results: Anti-inflammatory activityStimutex-As + Saccharide Isomerate shows a significant anti-inflammatory activity when compared with control.The anti-inflammatory activity of Stimutex-As + Saccharide Isomerateis equivalent to Dexamethasone, a moderately potent steroid.*46
  • Saccharide Isomerate: Moisture RetentionEfficacyThere were less moisture lost with saccharide isomeratecompared to urea and glycerin at all humidity levels.SaccharideIsomerate47
  • • Saccharide isomerate regulates and retainsmoisture in the skin at all humidity levels.• The efficacy of saccharide isomerate hasbeen tested and proven to be superior tourea and glycerin.Prof DR Dr Ariyanto Harsono SpA(K)
  • Safety Profile• There were no serious adverse eventsreported except for 2 cases of erythemawhich were treated with topical steroids.49Prof DR Dr Ariyanto Harsono SpA(K)
  • Arachidonic Acid (ARA)Phospholiphase ACyccloxygenase LipoxygenaseProstaglandineTXAProstacyclinLeukotriene ALeukotriene BLeukotriene Cγ-linoleic acidHETE,5-HETE, PAF50Prof DR Dr Ariyanto Harsono SpA(K)
  • Mechanism of IVIG blocking apoptosis viaProcaspase-8 pathwayMacrophage Keratinocyte51Prof DR Dr Ariyanto HarsonoSpA(K)Use of IVIG
  • Prof DR Dr Ariyanto HarsonoSpA(K)52
  • 53Prof DR Dr Ariyanto HarsonoSpA(K)Thank you