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Atopic dermatitis
This document discusses atopic dermatitis (AD), also known as eczema. It provides information on the characteristics and criteria for diagnosing AD according to Hanifin and Rajka. AD typically begins in infancy or childhood as a chronic, relapsing inflammatory skin condition caused by hereditary and environmental factors. Symptoms include redness, papules, vesicles, crusting, scaling and intense itching. Conventional therapies can cause side effects, so alternative treatments are discussed including wet wrapping, controlling allergens, psychological consultation, gamma-linolenic acid, phototherapy, immunosuppressants and IFN gamma. The document also outlines the arachidonic acid pathway and its role in AD pathogenesis.
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Atopic dermatitis
- 1. ATOPIC DERMATITIS Prof. DR.Dr. Ariyanto Harsono SpAK 1
- 2. 2Prof DR DrAriyanto Harsono SpA(K) • Atopic dermatitis is a disease that began to arise at the age of infants and children, are chronic and relapsing. • inflammatory reaction • based on hereditary and environmental factors, • the symptoms are erythema, papules, vesicles, crusting, squama • intense pruritus.
- 3. Dermatitis Atopika: Itch thaterupts Not eruption that itches 3Prof DR Dr Ariyanto Harsono SpA(K)
- 4. Conventional therapy Is notalways safe cutaneous atrophy, striae, bruisability, telangiectasia High-potency topical steroids can cause systemic effect in children 4Prof DR Dr Ariyanto Harsono SpA(K)
- 5. IgE IL-4, IL-5 IL-13 5Prof DRDr Ariyanto Harsono SpA(K)
- 6. IgE IL-4, IL-5 IL-13 v 2 CD4+Th1 Cell IFN-γ CD8+Th1Cell DTH Super antigen 6 Prof DR Dr Ariyanto Harsono SpA(K)
- 7. Kriteria Hanifin andRajka Kriteria mayor (minimal 3) •Pruritus •Kharacteristic distribution and morphoology •Flexural Lichenification •Facial and ekstensor in baby •Chronic •Atopic history in the family 7Prof DR Dr Ariyanto Harsono SpA(K)
- 8. Kriteria Hanifin andRajka Kriteria mayor (minimal 3) •Pruritus •Distribusi dan morfologi khas •Flexural Lichenification •Facial and ekstensor babies •Chronic •Atopic history in the family 8Prof DR Dr Ariyanto Harsono SpA(K)
- 9. Kriteria Hanifin andRajka Kriteria mayor (minimal 3) •Pruritus •Distribusi dan morfologi khas •Flexural Lichenification •Facial dan ekstensor pada bayi dan anak •Kronik •Riwayat atopi dan keluarga atopi 9Prof DR Dr Ariyanto Harsono SpA(K)
- 10. Kriteria Hanifin andRajka Kriteria mayor (minimal 3) •Pruritus •Distribusi dan morfologi khas •Flexural Lichenification •Facial dan ekstensor pada bayi dan anak •Kronik •Riwayat atopi dan keluarga atopi 10Prof DR Dr Ariyanto Harsono SpA(K)
- 11. Kriteria Hanifin andRajka Kriteria mayor (minimal 3) •Pruritus •Distribusi dan morfologi khas •Flexural Lichenification •Facial dan ekstensor pada bayi dan anak •Kronik •Riwayat atopi dan keluarga atopi 11Prof DR Dr Ariyanto Harsono SpA(K)
- 12. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 12Prof DR Dr Ariyanto Harsono SpA(K)
- 13. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 13Prof DR Dr Ariyanto Harsono SpA(K)
- 14. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 14Prof DR Dr Ariyanto Harsono SpA(K)
- 15. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 15Prof DR Dr Ariyanto Harsono SpA(K)
- 16. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 16Prof DR Dr Ariyanto Harsono SpA(K)
- 17. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 17Prof DR Dr Ariyanto Harsono SpA(K)
- 18. Kriteria Hanifin andRajka Kriteria 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 •Konjungtivitis kambuhan 18Prof DR Dr Ariyanto Harsono SpA(K)
- 19. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 19Prof DR Dr Ariyanto Harsono SpA(K)
- 20. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 20Prof DR Dr Ariyanto Harsono SpA(K)
- 21. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 21Prof DR Dr Ariyanto Harsono SpA(K)
- 22. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 22Prof DR Dr Ariyanto Harsono SpA(K)
- 23. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 23Prof DR Dr Ariyanto Harsono SpA(K)
- 24. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 24Prof DR Dr Ariyanto Harsono SpA(K)
- 25. Kriteria Hanifin andRajka Kriteria minor •Dennie Morgan infraorbital fold •Keratoconus •Katarak subkapsular anterior •Orbital darkening •Facial pallor/eritem •Pityriasis alba •Gatal bila berkeringat •Intoleransi thd wol/lipid solvent •Perifollicular accentuation •Intoleransi makanan •Pengaruh lingkungan dan emosi •White dermatographism 25Prof DR Dr Ariyanto Harsono SpA(K)
- 26. Kriteria Hanifin andRajka pada bayi Kriteria mayor (minimal 2 mayor) •Riwayat keluarga atopi •Evidence of pruritic Dermatitis •Dermatitis fasial, ekstensor, likenifikasi Kriteria minor (minimal 1 minor) •Xerosis/ichtyosis/hyperlinear palm •Perifollicular accentuation •Chronic scalp scalling •Periauricular fissures 26Prof DR Dr Ariyanto Harsono SpA(K)
- 27. Kriteria Hanifin andRajka pada bayi Kriteria mayor (minimal 2 mayor) •Riwayat keluarga atopi •Evidence of pruritic Dermatitis •Dermatitis fasial, ekstensor, likenifikasi Kriteria minor (minimal 1 minor) •Xerosis/ichtyosis/hyperlinear palm •Perifollicular accentuation •Chronic scalp scalling •Periauricular fissures 27Prof DR Dr Ariyanto Harsono SpA(K)
- 28. Kriteria Hanifin andRajka pada bayi Kriteria mayor (minimal 2 mayor) •Riwayat keluarga atopi •Evidence of pruritic Dermatitis •Dermatitis fasial, ekstensor, likenifikasi Kriteria minor (minimal 1 minor) •Xerosis/ichtyosis/hyperlinear palm •Perifollicular accentuation •Chronic scalp scalling •Periauricular fissures 28Prof DR Dr Ariyanto Harsono SpA(K)
- 29. Kriteria Hanifin andRajka pada bayi Kriteria mayor (minimal 2 mayor) •Riwayat keluarga atopi •Evidence of pruritic Dermatitis •Dermatitis fasial, ekstensor, likenifikasi Kriteria minor (minimal 1 minor) •Xerosis/ichtyosis/hyperlinear palm •Perifollicular accentuation •Chronic scalp scalling •Periauricular fissures 29Prof DR Dr Ariyanto Harsono SpA(K)
- 30. Kriteria Hanifin padaanak Kriteria mayor (minimal 3 mayor) •Pruritus •Distribusi dan morfologi tipikal •Dermatitis fasial, ekstensor selama bayi dan awal usia anak •Flexural lichenification dan linearity by adolescence •Dermatitis kronik Kriteria minor (minimal 1 minor)•Xerosis/ichtyosis/hyperlinear palm/keratosis pilaris •IgE reactivity •Chronic scalp scalling •Perifollicular accentuation •Periauricular fissures 30Prof DR Dr Ariyanto Harsono SpA(K)
- 31. Kriteria minor (minimal1 minor) •Hand/foot dermatitis •Cheilitis •Kepekaan infeksi kulit (Herpes/Strep/S aureus) 31Prof DR Dr Ariyanto Harsono SpA(K)
- 32. Kriteria minor (minimal1 minor) •Hand/foot dermatitis •Cheilitis •Kepekaan infeksi kulit (Herpes/Strep/S aureus) 32Prof DR Dr Ariyanto Harsono SpA(K)
- 33. Kriteria minor (minimal1 minor) •Hand/foot dermatitis •Cheilitis •Kepekaan infeksi kulit (Herpes/Strep/S aureus) 33Prof DR Dr Ariyanto Harsono SpA(K)
- 34. Kriteria minor (minimal1 minor) •Hand/foot dermatitis •Cheilitis •Kepekaan infeksi kulit (Herpes/Strep/staphilococcus) 34Prof DR Dr Ariyanto Harsono SpA(K)
- 35. Gradasi:1. Luas lesi:Fase Anak/Dewasa <9%……………..1 9-36%……………2 >36%……………..3 Fase infantil <18%………1 18-54%……..2 >54%………..3 2. Perjalanan Penyakit: remisi <3 bulan.tahun…….1 remisi >3 bulan/tahun……..2 kambuhan………………….3 3. Intensitas: gatal ringan, gangguan tidur+…..1 gatal sedang, gangguan tidur+…..2 gatal berat, gangguan tidur+……3 Skor: 3-4: ringan 5-7: sedang 8-9: berat 35Prof DR Dr Ariyanto Harsono SpA(K)
- 36. Lini I: •Advis/informasi umum •Emolien/moisturizer •Steroidtopikal •Antibiotik bila ada indikasi •Antihistamin Lini II: •MRS •Wet dressing •Kontrol alergen •Konsultasi psikolog ∀γLinoleic acid Lini III: •Fototerapi •Steroid -sistemik •Imunosupresan •IFN γ •IVIG •Tacrolimus •Pimecrolimus 36Prof DR Dr Ariyanto Harsono SpA(K)
- 37. Arachidonic Acid (ARA) PhospholiphaseA Cyccloxygenase Lipoxygenase Prostaglandine TXA Prostacyclin Leukotriene A Leukotriene B Leukotriene C γ-linoleic acid HETE,5-HETE, PAF 37Prof DR Dr Ariyanto Harsono SpA(K)
- 38. Thank you 38Prof DRDr Ariyanto Harsono SpA(K)