DIAGNOSIS and MANAGEMENT of

ATOPIC DERMATITIS

Presented by :
Dzulkifli Sukri (C11111285)
Andi Ari Trisnawati (C11111322)
Hara Tri Yudhistiara (C11111186)

Advisor :
dr. Evelyn Aryani Pranowo

Supervisor :
dr. Asnawi Madjid, Sp.KK, MARS
Definition
■ Atopic dermatitis = eczema = itchy skin
■ Greek- meaning
◆ (ec-) over

◆ (-ze) out

◆ (-ma) boiling

■ Infants & small children (affects 1 in 7)

■ Atopic dermatitis of childhood may reappear at
different site later in life.
Cause
Cause
■ Inborn skin defect that tends to run in families, e.g. asthma
or hay fever
■ 85% with high serum IgE and + skin tests food & inhalant
Morphology
Distribution
■ In infants, the face is often affected first, then
the hands and feet; dry red patches may appear
all over the body.
■ In older children, the skin folds are most often
affected, especially the elbow creases and
behind the knees.
■ In adults, the face and hands are more likely to
be involved.
Distribution
Atopic Dermatitis
Child
Atopic
Dermatitis
Adults
 Associated features
■ The skin is usually dry, itchy & easily irritated by:
◆ soap

◆ detergents

◆ wool clothing

■ May worsen in hot weather & emotional stress.

■ May worsen with exposure to dust & cats.
Diagnosis

■ Clinical History
◆ Personal or family history of atopy (asthma, allergy,
atopic derm, contact urticaria)
◆ With or without pruritus

◆ Chronic relapsing dermatitis

■ Clinical Findings
◆ Typical morphology and distribution of lesion
 Differential Diagnosis

■ Seborrheic
dermatitis
Eritema and
yellow-orange scaling
anular
■ Psoriasis
Makula eritema
with thick scale
■ Allergic contact
dermatitis
mix of papular, vesicular, and
crusted lesions and loss of
sharp margination
Treatment
1. Reduce contact with irritants (soap substitutes)
2. Reduce exposure to allergens
3. Emollients
4. Topical Steroids
5. Antihistamines
6. Antibiotics
7. Other (herbals, soaps)
 1. Reduce contact with irritants
■ Avoid overheating: lukewarm baths,
100% cotton clothes, & keep bedding to
minimum
■ Avoid direct skin contact with rough
fibers, particularly wool, &
limit/eliminate detergents
■ Avoid dusty conditions & low humidity
■ Avoid cosmetics (make-ups, perfumes)
as all can irritate
■ Avoid soap- use soap substitute
■ Use gloves to handle chemicals and
detergents
2. Reduce exposure to allergens

■ Keep home, especially bedroom,

free of dust.
■ Allergic reactions include house
dust mite, molds, grass pollens &
animal dander.
■ Special diets will not help most
individuals b/c little evidence that
food is major culprit.
■ If food allergies exists, most likely
d/t dairy products, eggs, wheat, nuts,
shellfish, certain fruits or food
additives.
3. Emollients
■ Emollients soften the skin soft and reduce itching.
■ Moisture Trapping effectiveness
◆ Best: Oils (e.g. Petroleum Jelly)

◆ Moderate: Creams

◆ Least: Lotions

■ Apply emollients after bathing and times when the skin is

unusually dry (e.g. winter months).
Emollients: Oils
■ Consider using bath oil or mineral oil-based lotions in
lukewarm bath water
■ Add to tub 15 minutes into bath
■ Bath oil preparations:
◆ Alpha-Keri

◆ Aveeno bath

◆ Jeri-Bath

■ Colloidal oatmeal (Aveeno)

reduces itching
4. Topical Corticosteroids
■ Topical steroids very effective
■ Ointments for dry or lichenified skin
■ Creams for weeping skin or body folds
■ Lotions or scalp applications for hair-areas.
Corticosteroids
■ Hydrocortisone 1-2.5% applied to all skin.
■ Quite safe used even for months
■ Use intermittently thin areas- (eg-face & genitals)
■ Stronger potency topical steroids for
nonfacial/genital regions.
■ Avoid potent/ultrapotent topical steroid preparations
on face, armpits, groins & bottom.
Steroids for Young Children
■ Fluticasone proprionate cream 0.05%
■ Moderate- severe atopic derm > 3 months
■ Applied bid 3-4 weeks- mean 64% BSA
5. Antibiotics
■ Atopic eczema frequently secondarily
colonized with a bacteria (up to 30%).
■ Use oral antibiotics in recalcitrant or
widespread cases.
6. Antihistamines
■ Oral antihistamines can reduce urticaria &
itch
■ Non-sedating antihistamines less side effects
but more expensive
■ Sedative effect of hydroxyzine &
diphenhydramine helpful
7. Other
■ Psychological support
■ Alternative treatments
◆ Chinese herbal tea

♦ Variably effective-not very palatable

♦ Liver toxicity possible

 Tar

■ Coal tar or less messy preps (liquid carbonis

detergent 5-10%) in Eucerin or Aquaphor
◆ Chronic lichenified eczema patches

◆ Coal tar smells & stains clothes so apply

qhs using old clothes and old linens

◆ Coal tar can provoke a folliculitis.
 Soaps
■ Mild or Hypoallergenic
◆ Dove (unscented): Contains lotion
◆ Oil of Olay
◆ Cetaphil Skin Cleanser (non-soap)
◆ Neutrogena bar
◆ Pure Ivory soap is very drying/irritating
Thank you.