DERMATITIS

by :
Dr. Endang Sutedja, dr,
SpKK(K)

D E R M AT I T I S
Definition : skin inflammation (epidermodermitis)
subjective : itchy
objective : polymorph

CATCH BASKET TERM

* Eczema :
UNITARIS ( Europe ) :
Eczema & dermatitis synonim
DUALISTIS ( United State ) :
Eczema & dermatitis not synonim

Dermatitis consist of several stages :

I

Erythema - edematous

II

Vesico - bullous

III

Madidans (wet)

IV

Desquamation (crust & dry)

CLASSIFICATION :
1. Etiology
Exogen : contact dermatitis, dermatitis caused by drug
Endogen : atopic dermatitis, neurodermatitis, stasis dermatitis

2. Form :
numular dermatitis
3. Course of the disease :
Acute : several days - 1 week
Subacute
Chronic : 1,5 months or more

CONTACT DERMATITIS
caused by exogenous material
2 forms :
* Irritant contact dermatitis (ICD)
* Allergic contact dermatitis (ACD)
IRRITANT CONTACT DERMATITIS
Etiology
Onset
Subjective
Lesion
Contactant ( - )

: primary irritant contact

: first contact
: burning
: more severe than ACD, circumscribed,
oedema erythematous acute, blister
: heal rapidly

Irritant Contact Dermatitis

Divided based on the type of irritant :
* Strong irritant : strong acid and alkali agent
rapid and more severe dermatitis (toxic contact dermatitis)
* Weak irritant : soap, detergent, dye (hair dye, shoes polish)
chronic, etiologic agent depend on concentration and skin
thickness

Several Etiologies & Terms of Contact Dermatitis

Dermatitis Venenata

Insect and plants

secretion

House Wife Dermatitis

house wife

Occupational Dermatitis
Industrial Dermatitis

occupation
from factory

IRRITANT CONTACT
DERMATITIS

ALLERGIC CONTACT DERMATITIS

Etiology

: sensitizer

Onset

: repeatly contacts

Subject

: allergic patient

Subjective

: itchy

Lesion

: uncircumsribed

Contactant (-)

: exist / increase

ALLERGIC CONTACT DERMATITIS

* Occurred only at certain patient
* Hypersensitivity type IV
* Allergen :
* Metal : jewellery, watch, glasses
* Cosmetic
* Diagnosis :
History : burning / itchy after contact
Clinical manifestation :
* More toxic
* Localization depend on contact location
* Subjective : polymorph

ALLERGIC CONTACT DERMATITIS

Supporting examination:
PATCH TEST
* For allergic contact dermatitis patient
Suspected agent patch at volar or interscapular region
covered by impermeable material
* Read after 24 - 48 hours
* Criteria :
# Erythema
# Erythema + oedema
# Vesicle
# Confluent vesicles
# Necrosis

+
++
+++
++++
+++++

Patch test conditions

Skin lesion has already cleared
During occlusion do not exposure to water and sweating
3 days before : do not consume any drugs, esp antihistamin
and corticosteroid

TREATMENT OF CONTACT DERMATITIS

* Stop contact with causative agent
* Drugs :
*Topical depend on lesion :
Wet
dressing
Dry
corticosteroid ointment
Subacute
cream
*Systemic
antihistamine
if severe corticosteroid

PATCH TEST

PATCH TEST

PATCH TEST

PRICK TEST

23

ATOPIC DERMATITIS
* Atopic term from atopy
ATOPY :

a group of hereditary disease with hypersensitivity allergic

symptoms
* asthma
* hay fever
* allergic rhinitis
* hives
* drug/food allergic
* Only occurred at certain people

CRITERIAS OF ATOPIC DERMATITIS

Wise & Sulzberger ( 1923 ) :
Skin inflammation with atopy base in patient or family
who has symptoms, i.e erythema, oedema and scales
* Synonims :
Eczema flexurarum
Disseminated lichen chronicum simplex
Prurigo diasthetique

* Etiology : poorly understood, multifactorial

* Genetic
* Organ sensitivity
(level of itchy sensation > lower )
* Scratch/ trauma
* Allergen, air pollution, wool, fabrics
* Physical stress
* Temperature changes ( climates changes )
* Sweat retention
* etc.

D I AG N O S I S
* History : chronic recurrent (remission)
* Symptom : divide into 3 phases (Sulzberger)
based on age :
I.

Infantile ( 2 months - 2 years )

II.

Childhood phase ( 3 - 13 years )

III.

Adolescent + adulthood (> 13 years)

* Primary symptoms :
severe itching, caused by scratching skin lesions :
erythema, edema, vesicles, crusts, lichenification
sign of chronic skin disease caused by longtime scratching

PREDILECTION & CLINICAL APPEARENCE

I. INFANTILE
Face : both cheeks
Neck
oozing, erythema, oedema
Scalp
crusts, scales
II. CHILDHOOD PHASE
Skin fold :
Elbows
Knees
dry, erythema, papules,
Neck
lichenification
III. ADOLESCENCE / ADULTHOOD
Skin fold :
Elbows
Knees
dry, lichenification
Neck
diagnosis of atopic stigmata / atopic signs
patient/family

RAJKA ( 1975 )
Special criteria : subjective, clinical symptoms, laboratory

MAJOR CRITERIA
* Familiy history of atopic
* Combination : severe and persistant itchy + symptom
on the predilection site
* Elevated Ig E
* GI track atopic, ichthyosis, cataract
* Patients skin : dry, itchy sweating
* Remission chronic reccurent
* Skin test : (+) more than 1

MINOR CRITERIA :
* Onset : fast
* Alergy : food or drug
* Immunity to bacterial and viral infection
decrease of T cell function
* Food intolerance
* Influenced by : hot weather, emotion, infection
* Sensitive to wool, special fabrics
* Lab : eosinophilia

DIAGNOSIS
* Minimal 3 major or
* 2 major and several minors

HANIFIN ( 1976 )
I. * Itchy sensation
* Characteristic morphology & distribution
* Chronic course
II. * Patient and family history of atopy (+)
* Skin test (+)
* White dermatographism (+)
scratch on normal skin triple responds
i.e. white line, erythema, edema
atopic skin : white line, erythema, white line, because
of vasoconstriction
* Cataract

III. * Xerosis (dry skin)

* Ichthyosis
* Pityriasis alba
* Keratosis follicularis
* Elevated IgE
* Recurrent skin infection

DIAGNOSIS
* One of group I
> 2 of group II
* One of group I
> 4 of group III

SVENSONS CRITERIA ( 1985 )

I

Influenced by season
Xerosis
Influenced by stress
Itchy
Elevated Ig E ( N = 8 ) IU
Allergic rhinitis
History of rhinitis
Toxic irritation
Acrodermatitis in childhood
Atopic dermatitis in family

II. * Pale / redness on facial skin

* Knuckle dermatitis ( skin fold )
* Asthma
* Keratosis follicularis
* Food allergic
* Numular dermatitis
* Nipple eczema

* Pompholic ( papules on palm)

III. * Ichthyosis
* Dennie Morgans fold
(inferior palpebrae fold)

DIAGNOSIS : score 15
Group I

=3

Group II

=2

Group III

=1

TREATMENT OF ATOPIC DERMATITIS

Avoid allergen
Drugs :
Topical : depend on stage : infantile, childhood, adulthood
tar preparation as an antimitotic
Sistemic : antihistamine
corticosteroid ( severe )

ATOPIC DERMATITIS IN INFANT

ATOPIC DERMATITIS
IN CHILDHOOD

ATOPIC DERMATITIS IN ADULT

NEURODERMATITIS CIRCUMSCRIPTA
* Synonim : lichen simplex chronicus Vidal
* Usually related with physical, stress, anxiety disorder
* Predilection :
* Knuckle / lateral
* Anterior ankle
* Foot
* Lesion : hiperpigmentation, lichenifikation, circumscribed

TREATMENT
* Avoid : pshycologic disorder
* Drug :
* Topical : corticosteroid
* Systemic : antihistamine

NEURODERMATITIS

NUMULAR DERMATITIS
* Name : round lesion coin size
* Predilection :
* Extensor part of lower leg
* Shoulder and buttocks
* Recurrent chronic disease healed with hyperpigmented
macule
* Predisposing factors :
Infection :

- teeth
- ENT
- Internal disease : TB

NUMULAR DERMATITIS

STASIS DERMATITIS
* Synonim : circulatory dermatitis, major etiology :
circulation disorder
* Etiology : stasis at lower leg circulation, varices, pregnant
woman, often standing for long periode
* Clinical manifestation :
* Subjective : itchy
* Scratch painful ulcer occures
* Initial : edema at ankle region, evening after work

* Due to blockage hemosiderin outflows pigmentation

macule at 1/3 distal lower leg
* Chronic : wet/madidans dermatitis ulcer

DIAGNOSIS
* History : itchy, standing for long periode
* Predilection : dermatitis / ulcer

TREATMENT
The most important : recirculation
if severe consult to Dept. of Surgery

STATIS DERMATITIS