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

3Prof DR Dr Ariyanto Harsono SpA(K)

4Prof DR Dr Ariyanto Harsono SpA(K)

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

5Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

•Pruritus

•Characteristic Distribution

and morphology of skin lesions

•Flexural Lichenification

•Facial and extensor

Lichenification in babies and children

•Kronik

•History of family atopy

•Riwayat atopi dan keluarga atopi

6Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Major criteria (minimal 3)

•Pruritus

•Characteristic Distribution

and morphology of skin lesions

•Flexural Lichenification

•Facial and extensor

Lichenification in babies and

children

•Kronik

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

Hanifin and Rajka criteria

Major criteria (minimal 3)

•Pruritus

•Characteristic Distribution

and morphology of skin lesions

•Flexural Lichenification

•Facial dan ekstensor pada bayi

dan anak

•Kronik

•History of family atopy8Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Major criteria (minimal 3)

Kriteria Hanifin and Rajka

•Pruritus

•Characteristic Distribution

and morphology of skin lesions

•Flexural Lichenification

•Facial and extensor in babies

and children

•Chronic

•History of family atopy9Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Major criteria (minimal 3)

10Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

11Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•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

12

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•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

13

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•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

14Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•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

15Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•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

16Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Minor criteria (minimal 3)

17Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•Vulnerable of infections (Stafilokokus/herpes)

19Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

20Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

21Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

23Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria (minimal 3)

•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

24Prof DR Dr Ariyanto Harsono SpA(K)

Hanifin and Rajka criteria

Minor criteria (minimal 3)

Kriteria Hanifin and Rajka

25Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

26Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

27Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

28Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

29Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

•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)

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

•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)

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

32Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

33Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

34Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

Kriteria Hanifin and Rajka

35Prof DR Dr Ariyanto Harsono SpA(K)

•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

Hanifin and Rajka criteria

Minor criteria

Hanifin and Rajka criteria

Minor criteria

36Prof DR Dr Ariyanto Harsono SpA(K)

•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

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

37Prof DR Dr Ariyanto Harsono SpA(K)

Major criteria(minimal 2 major)

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

38Prof DR Dr Ariyanto Harsono SpA(K)

Major criteria(minimal 2 major)

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

39Prof DR Dr Ariyanto Harsono SpA(K)

Major criteria(minimal 2 major)

Hanifin and Rajka criteria for baby

Major criteria(minimal 2 major)

•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

40Prof DR Dr Ariyanto Harsono SpA(K)

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)

Minor criteria(minimal 1 minor)

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

42Prof DR Dr Ariyanto Harsono SpA(K)

Minor criteria(minimal 1 minor)

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

43Prof DR Dr Ariyanto Harsono SpA(K)

Minor criteria(minimal 1 minor)

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

44Prof DR Dr Ariyanto Harsono SpA(K)

Minor criteria(minimal 1 minor)

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

45Prof DR Dr Ariyanto Harsono SpA(K)

46Prof DR Dr Ariyanto Harsono SpA(K)

Seborrhoic dermatitis

47Prof DR Dr Ariyanto Harsono SpA(K)

Pompholix

48Prof DR Dr Ariyanto Harsono SpA(K)

Principle of Conventional Therapy

Eczema

Target for skin care

Target for anti inflammatory

49Prof DR Dr Ariyanto Harsono SpA(K)

EducationHidration

EmolientMoisturizerWet dressing

Allergen/irritants avoidanceAntihistamineTopical Steroid

50Prof DR Dr Ariyanto Harsono SpA(K)

Conventional Therapy is not always safe

Topical steroid: cutaneous atrophy, striae, bruisability, telangiectasia

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

51Prof DR Dr Ariyanto Harsono SpA(K)

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

52Prof DR Dr Ariyanto Harsono SpA(K)

IVIG

53Prof DR Dr Ariyanto Harsono SpA(K)

Thank you