Journal-ATOPIC DERMATITIS.ppt

8/20/2019 Journal-ATOPIC DERMATITIS.ppt

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BY

FARIZ HILMAN

PROFESSIONAL MENTOR:

DR. BOWO WAHYUDI, SP.KK

ATOPIC DERMATITIS

Hywel C. Williams, Ph.D.

From the Center of Evidence-Based Dermatology,Qeen!s "edical Center, #niversity of $ottingham, $ottingham, #nited %ingdom.

&ddress re'rint re(ests to Professor Williams at the Center of EvidenceBasedDermatology,

Qeen!s "edical Center,#niversity of $ottingham, $ottingham $)* +#H, #nited %ingdom, or at hywel.

williamsnottingham.ac. .

$ Engl "ed +//0120+3+245-+5.Copyright © 2005 Massachusetts Medical Society.

mailto:[email protected]:[email protected]:[email protected]


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Clinical Pro6lem

&to'ic dermatitis 7or ato'ic ec8ema9 is an itchy,inflammatory sin condition with a 'redilection for

the sin fle:res.characteri8ed 6y 'oorly defined erythema with

edema, vesicles, and wee'ing in the acte stage andsin thicening 7lichenification9 in the chronic stage.


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Acute At!"cDe#$at"t"s:

;ntense erythemaand vesicles.

C%#&"c At!"cDe#$at"t"s:


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Prevalence

;nternational =tdy of &sthma and &llergies inChildhood3

the 'revalence of sym'toms of ato'ic dermatitis in

children si: or seven years of age dring a one-year'eriod varied.

=tdies sggest that ato'ic dermatitis im'oses a higheconomic 6rden


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Cases

=everal genes have 6een identified that may e:'lainsome cases.

&llergens 3 hose-dst mites and foods may 6e

im'ortant in some cases$onallergic factors 3 rogh clothing, Staphylococcus

aureus infections, e:'osre to micro6es dringinfancy, e:cessive heat, and e:'osre to irritants that

disr't the fnction of the sin 6arrier may also 6eim'ortant.


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Diagnostic Criteria

Difficlt to define its varia6le mor'hology anddistri6tion and its intermittent natre.

>here is no o6?ective marer>he 'resence or a6sence of slee' distr6ance, the

nm6er and location of involved sites, and the clinicalcorse are the indicators of severity that 'ro6a6ly'rovide the 6est 6asis for maing decisions a6ottreatment.

=in 'ric and @adioalergosor6ent >est for food andenvironment allergen asses the disease!s contri6tion


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>reatment

a. >o'ical %ortiosteroid- A/ in good res'onse +:day more effective

- ;t de'ends on severity

- =E 3 thinning sin, striae, telangietasia at face, glacoma7rarely9

6. Emolien

- Cring the dry sin 7:erosis9.

- increase the res'onse to drgs.


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c. >o'ical Calcinerin ;nhi6itor

- to'ical >acrolims /,4the effect as good as'otent to'ical corticosteroid

- to'ical Pimecrolims lower effect- to'ical Calcinerin not casing thinning thesin

- =ide effect3 feel lie 6rnt


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d. ther to'ical agent

- Coal cream 6etter than hydrocortison 4 after5 wees se

- >o'ical Cromoglycate effectively 'roven- it. B4+ and gel licorice

e. ral &ntihistamin - Cetiri8ine not give a 6etterim'rovement


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f. &nti6iotic

- Flo:acillin contine in 5 wees

- Com6ination Corticosteroid &nti6iotic not

give a good effectg. #

- =hort term sefl

- =ide effects itchy, feel 6rnt,

arsinogeni.

h. ;mnos'ressant


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&reas of #ncertainty

@andomi8ed trials are lacing to assess the 6enefitsof many sim'le interventions, sch as emollients andother non'harmacologic a''roaches.

>he 6enefits of rotine allergy testing re(ireclarification. "oreover, it is nclear whether earlyaggressive thera'y in children with ato'ic dermatitis

alters the natral history of the disease.


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Conclsions

Patients and families who are descri6ed in the vignette, often have concerns a6ot to'icalcorticosteroids that can 6e alleviated 6y a''ro'riateedcation.

Patients and families shold 6e taght a6ot thecorse of ato'ic dermatitis1 that is, that a singlecase and cre are nliely, althogh good control is

nearly always 'ossi6le.


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For the girl in the vignette, this ?ornal recommendsonce-daily a''lication of a 'otent to'icalcorticosteroid to the lim6s and trn for 4/ days

6efore schedling a second visit to evalate 'rogress.

&lthogh data to s''ort the se of emollients arelimited, this ?ornal wold attem't to maintainremission 6y li6eral se of emollients only, with

recorse to five-day corses of 'otent or moderate-strength to'ical corticosteroids for flares.

Journal-ATOPIC DERMATITIS.ppt

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