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DERMATITIS dr. Endi Novianto, SpKK

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

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

3 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

4 Dermatitis Endogenous Exogenous Combination

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

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

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

8 Irritant Contact Dermatitis
Incidence rates: 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)

9 Stadium Acute Sub acute Chronic

10 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

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12 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

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14 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

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

23 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

24 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

25 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

26 Maintenance treatment
Moisturizer Calcineurin inhibitor

27 References Buku ajar ilmu penyakit kulit dan Kelamin FKUI
Fitzpatrick color atlas and synopsis of clinical dermatology Fitzpatrick dermatology in general medicine ogy/inflammatory.html


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