Penanganan Dermatitis Atopik

Penanganan Dermatitis Atopik

Prof Ariyanto Harsono MD PhD SpA(K)

Atopic dermatitis is a disease that begin to arise at the age of infants and children

characterized by itching of the skin. chronic and relapsing inflammatory reaction based on hereditary factors and environmental

factors, the symptoms are chronic recurrent erythema,

papules, vesicles, crusting, and skuama.

2Prof DR Dr Ariyanto Harsono SpA(K)

Atopic Dermatitis:

Itch that erupts Not eruption that itches



Major criteria (minimal 3)

•Pruritus

•Characteristic Distribution and morphology of skin lesions

•Flexural Lichenification

•Facial and extensor Lichenification in babies and children

•Chronic

•History of family atopy


Hanifin and Rajka criteria

•Pruritus

•Characteristic Distribution

and morphology of skin lesions


•Facial and extensor

Lichenification in babies and children

•Kronik

•History of family atopy

•Riwayat atopi dan keluarga atopi




•Pruritus




•Facial and extensor

Lichenification in babies and

children

•Kronik

•History of family atopy7Prof DR Dr Ariyanto Harsono SpA(K)



•Pruritus




•Facial dan ekstensor pada bayi

dan anak

•Kronik




Kriteria Hanifin and Rajka

•Pruritus




•Facial and extensor in babies

and children

•Chronic





•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


Minor criteria (minimal 3)






12




13



















18

•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive

•High IgE levels•Early Onset of age•Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis



•Vulnerable of infections (Stafilokokus/herpes)


•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











22

•Ichtyosis , palmar hyperlinearity, keratosis pilaris•Xerosis•Skin Test positive•High IgE levels•Early Onset of age•Vulnerable of infections •Tend to nonspesific dermatitis•Nipple eczema•Cheilitis•Recurrent Conjunctivitis







•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 conjunctivitis






•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


Minor criteria





Minor criteria




Minor criteria




Minor criteria




Minor criteria


•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 30Prof DR Dr Ariyanto Harsono SpA(K)


Minor criteria


•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 31Prof DR Dr Ariyanto Harsono SpA(K)


Minor criteria





Minor criteria





Minor criteria





Minor criteria





Minor criteria


Minor criteria



Hanifin and Rajka criteria for baby

Kriteria mayor (minimal 2 mayor)

•History of family atopy•Evidence of pruritic Dermatitis•Dermatitis fasial, ekstensor, lichenification

Minor criteria (minimal 1 minor)

•Xerosis/ichtyosis/hyperlinear palm•Perifollicular accentuation•Chronic scalp scalling•Periauricular fissures


Major criteria(minimal 2 major)











Minor criteria(minimal 1 minor)










Hanifin criteria for children

Major criteria (minimal 3 major)

•Pruritus•Characteristic Distribution and morphology of skin lesions•Dermatitis fasial, ekstensor selama bayi dan awal usia anak•Flexural lichenification dan linearity by adolescence•Chronic Dermatitis

Minor criteria(minimal 1 minor)•Xerosis/ichtyosis/hyperlinear palm/keratosis pilaris•IgE reactivity•Chronic scalp scalling•Perifollicular accentuation•Periauricular fissures 41Prof DR Dr Ariyanto Harsono SpA(K)


•Hand/foot dermatitis•Cheilitis•Vulnerable to infection (Herpes/Strep/S aureus)



•Hand/foot dermatitis•Cheilitis•Vulnerable to skin infetions (Herpes/Strep/S aureus)



•Hand/foot dermatitis•Cheilitis•Vulnerable to skin infetions (Herpes/Strep/S aureus)



•Hand/foot dermatitis•Cheilitis•Vulnerable to skin infetions (Herpes/Strep/staphilococcus)



Seborrhoic dermatitis


Pompholix


Principle of Conventional Therapy

Eczema

Target for skin care

Target for anti inflammatory


EducationHidration

EmolientMoisturizerWet dressing

Allergen/irritants avoidanceAntihistamineTopical Steroid


Conventional Therapy is not always safe

Topical steroid: cutaneous atrophy, striae, bruisability, telangiectasia

High-potency topical steroids can cause systemic side effects in children.


Mild Moderate Severe

Mild to Moderate Potency Topical Steroids

Pimecrolimus

Tacrolimus

Oral Steroids

Cyclosporine, mycophenolate

Light treatment

New Treatment Strategy in AD

Emolient

Dry skin

Itching and/or early sign of inflammation

Flare


IVIG


Thank you