DERMATITIS

by :DR.E.Sutedja,dr,SpKK(K)

DERMATITIS
A skin inflammation
(epidermodermitis) that
gives subjective complain
of itching and objective
symptoms of
polymorphous skin lesion

CATCH BASKET TERM

Two opinions about eczema and

dermatitis :

UNITARIST (European) :
Eczema and Dermatitis synonimous

DUALIST (American) :
Eczema and Dermatitis differrent
Recently widely accepted

DERMATITIS

stadia :

I. ERYTHEMAOEDEMATOUS
II.

VESICO-BULLOUS

III. MADIDANS (wet)

IV. DESQUAMATIVUM
(crusts and dry)

CLASSIFICATIONS :
Etiology :
- Exogen : contact dermatitis
dermatitis medicamentosa
- Endogen : atopic dermatitis
neurodermatitis
stasis dermatitis

The form of skin lesion :

Nummular dermatitis

Course of the disease :

Acute : few days 1 week

Sub-acute
Chronic : 1.5 months or more

CONTACT DERMATITIS
dermatitis that occurs by contact
with exogenous
substance/materials

2 types :

IRRITANT CONTACT DERMATITIS

(TOXIC)
ALLERGIC CONTACT DERMATITIS

IRRITANT CONTACT
DERMATITIS
Etiology
: primary irritant contact
Initiation : the first exposure
Complain : burning/stinging
Lesion
: more severe, sharp border,
acute erythema, oedema,
bullae
Contactant (-) : rapid recovery

ETIOLOGY AND TERMS OF

CONTACT DERMATITIS

Dermatitis Venenata

housewives

Occupational Dermatitis:

insect secretions, plant sap

Housewife Dermatitis :

job

Industrial Dermatitis :

factory

ALLERGIC CONTACT
DERMATITIS

Etiology
: sensitizer
Initiation : repeated exposure
Patient
: allergic persons
Complain : itching
Lesion
: obscured border
Contactant (-)/eliminated :
steady/more severe

ALLERGIC CONTACT
DERMATITIS

certain peoples
Type-IV Hypersensitivity Reaction
allergens : metals : jewelry, watch, eyeglasses
cosmetics
history of itching/burning after exposure to
allergen
clinical symptoms :
more severe : toxic contact dermatitis
the location depends on contact-sites
polymorphous skin lesion

PATCH TEST :

person with allergic contact dermatitis

suspected materials the volar /
interscapular area impermeable cover
read within 24-48 hours
Criterias :
erythema
erythema + oedema
vesicle
confluent vesicles
necrosis

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

PRE-REQUISITES FOR
THE PATCH TEST :

The skin disorder has recovered

During the test avoid
water/sweat
3 days prior to the test :
no drugs allowed
(antihistamin,corticosteroid)

TREATMENT OF CONTACT
DERMATITIS

eliminating the cause

medicamentosa :
topical : based on the skin lesion

Wet : compress
Dry : corticosteroid ointment
Sub-acute : cream

systemic : antihistamine,
severe :
corticosteroid

ATOPIC
DERMATITIS
There is an atopy

A group of hereditary disorders with clinical

manifestations as allergic-hypersensitivity :
Asthma
Hay fever
Allergic rhinitis
Urticaria
Foods/drugs allergy
Occurs in certain peoples

ATOPIC DERMATITIS
Wise and Sulzberger
(1923)
A skin inflammatory disorder based

on atopy, in patients and their

families, with clinical manifestations
as erythema, oedema, and squama
synonyms :
eczema flexurarum
lichen chronicum simplex
disseminata
prurigo diasthetique

ETIOLOGY :
UNKNOWN, MULTIFACTORIAL

Genetic
Organ-sensitive (lower itchingthreshold)
Scratching/trauma
Allergen,dust,wool,substance
Psychological stress
Thermal alteration (climate changes)
Sweat retention
etc.

DIAGNOSIS

chronic residif (remision)

Sulzberger : 3 phases :
infantile (2 months - 2 years)
childhood (3 - 13 years)
adolescence + adult (>13 years)
MAIN SYMPTOMS :

severe itching, scratches, skin

erythema, oedema, vesicles, crusts,
lichenification

ATOPIC DERMATITIS
1.

INFANTILE
face : both sides of cheeks
neck : oozing,erythema,oedema
head : crust,squama

2.

CHILDHOOD
in the fold of:

Elbow

Knee dry,erythema,papules,lichenification

Neck

3.

ADOLESCENCE/ADULT
in the fold of:

Elbow

Knee dry, lichenification

Neck

RAJKA (1975)

Etiology & pathology : multifactorial

hereditary
immunology
non-immunology
specific criteria :
complains
clinical manifestations
laboratory findings

MAJOR CRITERIA

family history of atopy

severe & persistent itching at the
predilection sites
increased IgE
atopic gastrointestinal tract,
ichthyosis, cataract
dry skin, itching when sweating
chronic residif-remission
more than one positive-skin test

MINOR CRITERIA

Rapid onset
Drugs/foods allergy
Decreased host defense against
bacterial/viral
infection reducing T-cell functions
Food intolerance
Influenced by heat, emotion, infection
Sensitive to wool, certain clothes
Lab : eosinophilia

DIAGNOSIS :

At least 3 major criterias

2 major and several minor criterias

HANIFIN (1976)
I

II

- Itching sensation
- Specific distribution and morphology
- Chronic course of disease
- Atopy in patient or family
- Positive skin test
- White dermatographism (+)
- Cataract

White dermatographism :
Scratching lines on normal skin triple reponses
(white lines, erythema, oedema)
Atopy : white lines, erythema,then re-whitening
(vasoconstriction)

III

Xerosis
Ichthyosis
Pytiriasis alba
Keratosis follicularis
Increased IgE
Recurrent skin infections

DIAGNOSIS :

One of group I
Two or more of group II,
One of group I
Four or more of group III

SVENSON CRITERIA (1985)

I

The course of the disease

influenced by season
Xerosis (dry skin)
Influenced by psychological
stress
Itching
Increased IgE (N=80 IU)
Rhinitis allergic
Toxic irritation
Acrodermatitis in childhood
Atopic dermatitis in the family

II.

III.

Pale / reddish face

Knuckle dermatitis (body
folds)
Asthma
Keratosis follicularis
Food allergy
Nummular dermatitis
Nipple eczema
Pompholyx (papules on
hands)
Ichthyosis
Dennie-Morgan fold (inferior

DIAGNOSIS

: values

15

Group I
= 3
Group II = 2
Group III = 1

TREATMENT OF AD :
Avoiding allergen
Medicamentosa :
Topical : ~ stadium, age
Tar preparation:
antimitotic,
thinning
Systemic : antihistamine
corticosteroid (severe)

NEURODERMATITIS
CIRCUMSCRIPTA

= lichen simplex chronicus Vidal

psychological disturbances, stress,
anxiety
dorsal lateral neck
anterior ankle
foot
hyperpigmentation, lichenification,
sharp border

NEURODERMATITIS
CIRCUMSCRIPTA

THERAPY :
Avoiding psychological
disturbances
Medicamentosa :
- Topical : corticosteroid
- Systemic : antihistamine

NUMMULAR
DERMATITIS

the round-shape coin-like lesion

Predilection :
extensor part of the lower legs,
shoulders and sacrum
Chronic residif
Healed with hyperpigmented
macules

NUMMULAR
DERMATITIS
Predisposition factors :
Infections:
Dental infections
Ear, Nose, Throat infections
Internal diseases : pulmonary TBC

STASIS DERMATITIS
Synonim : dermatitis circulatorius, caused
mainly
by circulatory disorders
Etiology : stasis in blood flow of the lower
legs,
varices, pregnant women,
prolonged
standing

STASIS DERMATITIS

Clinical features :

Subjective : itching
Scratching ulcers painful
Initiated with ankle-oedema
in the afternoon after working

STASIS DERMATITIS
Congestion hemosiderin

out from the vessels hyperpigmented

one third part distally of the lower legs
Subsequently dermatitis
frequently wet
followed by ulcerations

STASIS DERMATITIS
ANAMNESIS :
itching, prolonged standing

CLINICAL FEATURES :
dermatitis / ulcers

TREATMENT : circulation recovery

severe the surgery department

THANK YOU