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DERMATITIS dr. Endi Novianto, SpKK
Departemen Ilmu Kesehatan Kulit & Kelamin FK Universitas Indonesia - RSCM
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Overview Definition Type of dermatitis
Clinical approach for dermatitis Management of dermatitis Quiz
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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
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Dermatitis Endogenous Exogenous Combination
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Endogenous dermatitis
Atopic dermatitis Neurodermatitis Seborrheic dermatitis Nummular dermatitis Prurigo nodularis Stasis dermatitis
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Exogenous dermatitis Allergic contact dermatitis
Irritant contact dermatitis Photo contact dermatitis Asteatotic dermatitis
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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
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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)
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Stadium Acute Sub acute Chronic
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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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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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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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Management of Dermatitis
Avoid precipitating factors and contactant Moisturizer Look for infection Topical treatment Systemic treatment
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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
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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
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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
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Maintenance treatment
Moisturizer Calcineurin inhibitor
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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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