ATOPIC DERMATITIS

Prof. DR. Dr. Ariyanto Harsono SpAK

1

2Prof DR Dr Ariyanto 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.

Dermatitis Atopika:

Itch that erupts Not eruption that itches

3Prof DR Dr Ariyanto Harsono SpA(K)

Conventional therapy

Is not always safe

cutaneous atrophy, striae, bruisability, telangiectasia

High-potency topical steroids can cause systemic effect in children

4Prof DR Dr Ariyanto Harsono SpA(K)

IgE

IL-4, IL-5IL-13

5Prof DR Dr Ariyanto Harsono SpA(K)

IgE

IL-4, IL-5IL-13

v

2

CD4+Th1 Cell

IFN-

CD8+Th1 Cell

DTH

Super antigen

6

Prof DR Dr Ariyanto Harsono SpA(K)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

Kriteria mayor (minimal 3)

•Pruritus

•Distribusi dan morfologi khas

•Flexural Lichenification

•Facial dan ekstensor pada bayi

dan anak

•Kronik

•Riwayat atopi dan keluarga atopi9Prof DR Dr Ariyanto Harsono SpA(K)

Kriteria Hanifin and Rajka

Kriteria mayor (minimal 3)

•Pruritus

•Distribusi dan morfologi khas

•Flexural Lichenification

•Facial dan ekstensor pada bayi

dan anak

•Kronik

•Riwayat atopi dan keluarga atopi10Prof DR Dr Ariyanto Harsono

SpA(K)

Kriteria Hanifin and Rajka

Kriteria mayor (minimal 3)

•Pruritus

•Distribusi dan morfologi khas

•Flexural Lichenification

•Facial dan ekstensor pada bayi

dan anak

•Kronik

•Riwayat atopi dan keluarga atopi11Prof DR Dr Ariyanto Harsono

SpA(K)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka

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)

Kriteria Hanifin and Rajka 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)

Kriteria Hanifin and Rajka 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)

Kriteria Hanifin and Rajka 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)

Kriteria Hanifin and Rajka 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)

Kriteria Hanifin pada anak

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)

Kriteria minor (minimal 1 minor)

•Hand/foot dermatitis•Cheilitis•Kepekaan infeksi kulit (Herpes/Strep/S aureus)

31Prof DR Dr Ariyanto Harsono SpA(K)

Kriteria minor (minimal 1 minor)

•Hand/foot dermatitis•Cheilitis•Kepekaan infeksi kulit (Herpes/Strep/S aureus)

32Prof DR Dr Ariyanto Harsono SpA(K)

Kriteria minor (minimal 1 minor)

•Hand/foot dermatitis•Cheilitis•Kepekaan infeksi kulit (Herpes/Strep/S aureus)

33Prof DR Dr Ariyanto Harsono SpA(K)

Kriteria minor (minimal 1 minor)

•Hand/foot dermatitis•Cheilitis•Kepekaan infeksi kulit (Herpes/Strep/staphilococcus)

34Prof DR Dr Ariyanto Harsono SpA(K)

Gradasi:1. Luas lesi: Fase Anak/Dewasa <9%……………..1 9-36%……………2 >36%……………..3 Fase infantil <18%………1 18-54%……..2 >54%………..32. Perjalanan Penyakit: remisi <3 bulan.tahun…….1 remisi >3 bulan/tahun……..2 kambuhan………………….33. 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)

Lini I:•Advis/informasi umum•Emolien/moisturizer•Steroid topikal•Antibiotik bila ada indikasi•Antihistamin

Lini II:•MRS•Wet dressing•Kontrol alergen•Konsultasi psikologLinoleic acid

Lini III:•Fototerapi•Steroid -sistemik•Imunosupresan•IFN •IVIG•Tacrolimus•Pimecrolimus 36Prof DR Dr Ariyanto Harsono

SpA(K)

Arachidonic Acid (ARA)

Phospholiphase A

Cyccloxygenase Lipoxygenase

Prostaglandine

TXA

Prostacyclin

Leukotriene A

Leukotriene B

Leukotriene C

-linoleic acid

HETE,5-HETE, PAF37Prof DR Dr Ariyanto Harsono

SpA(K)

Thank you

38Prof DR Dr Ariyanto Harsono SpA(K)