DERMATITIS dr. Endi Novianto, SpKK Departemen Ilmu Kesehatan Kulit & Kelamin FK Universitas Indonesia - RSCM

Overview Definition Type of dermatitis Clinical approach for dermatitis Management of dermatitis Quiz

Definition Inflammation of the skin (epidermis & dermis) as a response to exogenous or endogenous factors Clinical sign: polymorphic/ oligomorphic efflorescence (erythema, edema, papule, vesicles, scale, lichenification) Subjective: itchy Synonym: eczema

Dermatitis Endogenous Exogenous Combination

Endogenous dermatitis Atopic dermatitis Neurodermatitis Seborrheic dermatitis Nummular dermatitis Prurigo nodularis Stasis dermatitis

Exogenous dermatitis Allergic contact dermatitis Irritant contact dermatitis Photo contact dermatitis Asteatotic dermatitis

Allergic Contact Dermatitis Prevalence: 2.7-13.6 cases per 1000 population Metal, protein, latex Itchy Localized lesion: erythematous papules, edema, vesicles, bula Type IV Hypersensitivity (immunologic) Patch test

Irritant Contact Dermatitis Incidence rates: 4.5-46.9 per 10,000 workers Common in wet workers (salon, pencuci, tenaga kesehatan) Solvents, acid, alkali Pain, itchy Distinct border localized lesion: erythema, vesicle, bulae, erosion, excoriation, scales Tissue injury (non immunologic)

Stadium Acute Sub acute Chronic

Acute dermatitis Erythema, edema, erosion, excoriation, oozing, vesicles or bulla Epidermis : spongiosis, vesicle, bulla, intracellular edema, exocytosis Dermis: vasodilatation, edema, inflammatory cells infiltrate (mononuclear or eosinophil) Example: atopic dermatitis infant phase, nummular eczema, acute irritan contact dermatitis

Sub acute dermatitis Erythema, edema, crust Epidermis : spongiosis, vesicles, mild acanthosis, crust, focal para keratosis, exocytosis Dermis: edema, vasodilatation, inflammatory cells infiltrate, increase of fibroblast Example : atopic dermatitis child phase

Chronic dermatitis Dry, scales, hyperpigmentation, papule, lichenification, erosion, excoriation Epidermis: acanthosis, hyperkeratosis, para keratosis, elongation of rete ridges, mild spongiosis, mild exocytosis, melanin pigment in basal cells Dermis: papilomatosis, thickening of blood vessels, mononuclear cells infiltrate, increasing of fibroblast and collagen Example : atopic dermatitis adolescence or adult phase, neurodermatitis, chronic irritant contact dermatitis, prurigo nodularis

Management of Dermatitis Avoid precipitating factors and contactant Moisturizer Look for infection Topical treatment Systemic treatment

Treatment of acute dermatitis Wet dressing: sol as salisilicum 1%O , PK 1:10.000, NaCl 0,9%, Mild potency topical corticosteroid cream (Hydrocortison acetate 1-2 ½ %, desonide) Severe inflammation : systemic corticosteroid Infection : topical fucidic acid or systemic antibiotic

Treatment of subacute dermatitis Wet dressing: sol as salisilicum 1%O , PK 1:10.000, NaCl 0,9%, Mild-medium potency topical corticosteroid cream (Hydrocortison butirat, desonide, mometasone furoat) Severe inflammation : systemic corticosteroid Infection : topical fucidic acid or systemic antibiotic

Treatment of chronic dermatitis Medium-high potency topical corticosteroid ointment (desoxymetsone, triamcinolon acetonide, clobetasol propionat) Recalcitrance: systemic corticosteroid, UVA/ NBUVB Infection : topical fucidic acid or systemic antibiotic

Maintenance treatment Moisturizer Calcineurin inhibitor

References Buku ajar ilmu penyakit kulit dan Kelamin FKUI Fitzpatrick color atlas and synopsis of clinical dermatology Fitzpatrick dermatology in general medicine http://dermnetnz.org/doctors/dermatopathol ogy/inflammatory.html