dr.

Archianda Arsad, SpKK

Department of Dermato-Venereology
Medical Faculty, North Sumatera University

Atopic dermatitis (AD) = Atopic eczema

o A chronically relapsing skin disease
o Occurs most commonly during early
infancy and childhood
o Frequently associate with elevated
serum IgE levels
o A personal/family history of atopy(+)

 Prevalence 3x than 1960s

Industrialized countries > agricultural countries
Female : male = 1,3:1
AD, associated with :
- small family size
- increased income and education
- migration rural urban
- use of antibiotic

Hereditary
(genetic)

Food & aero

allergens

Cellular
immunity
defect

Allergy (hypersensitivity)

Irritan
Infection
Climate

ATOPIC DERMATITIS
Xerosis
Decrease
skin barrier
Psychological effect

 Strong maternal influence

Chromosome 5q31-33, contains a clustered
family of functionally related cytokine genes :
- IL-3, IL-4, IL-5, IL-13
expressed
- GM-CSF
by Th2 cell
- Differences in transcriptional activity of the
IL-4 gene influence AD predisposition
- A significant association between a specific
polymorphism in the mast cell chymase gene
and AD

Key cells in AD skin :

Langerhans cells
Lymphocyte cells
Eosinophils
Mast cells

 Increased synthesis of IgE

Increased specific IgE to multiple
allergens, including foods, aeroallergens,
microorganism, bacterial toxins,
autoallergens
Increased expression of of CD23 (affinity
IgE receptor) on B cells and monocytes
Increased basophil histamine release

 Impaired delayed-type hypersensitivity

response
Eosinophilia
Increased secretion of IL-4, IL-5 dan IL-13 by
Th2 cells
Decreased secretion of IFN- by Th1 cells
Increased soluble IL-2 receptor levels
Elevated levels of monocyte CAMPphosphodiesterase with increased IL-10 and
prostaglandin E2

Epidermal lipid
Epidermal lipid
TEWL
TEWL
Skin capacitance
Skin capacitance

Soap &
detergen

Decrease
Decreaseskin
skinbarrier
barrierfunction
function

Allergen
Allergenabsorption
absorption
Microbial
Microbialcolonization
colonization
Treshold
Tresholdofofpruritus
pruritus

 Food infant and children :milk and

eggs
adult : seafood and nuts
Aeroallergens : dust mites, animal
danders, molds, pollens.
Temperature & humidity
Intense perspiration
Emotional stress

 Diagnostic criteria of AD : various

The UK working partys : proposed
alternative system, the criteria of Hanifin &
Rajka (1994)
Diagnose of AD:
-Three or more of the major criteria
-Three or more of the minor criteria

 Pruritus
Typical morphology & distribution
Involvement during infancy & early
childhood flexural
Flexural dermatitis in adult
Chronic or chronically relapsing dermatitis
Personal or family history of atopy

Xerosis
Skin infection
Hand/foot dermatitis
Ichthyosis/palmar hyperlinearity/keratosis
pilaris
Pityriasis alba
Nipple eczema
White dermatografism & delayed blanched
response

Cheilitis
Infra orbital fold
Anterior subcapsular cataracts
Orbital darkening
Facial pallor
Itchiness when sweating

 Perifollicular accentuation
Food hypersensitivity
Duration of AD influenced by environment
and psychis factors
Immediate skin test reactivity
Elevated serum IgE
Early age of AD

Hyperlinearity of
palmaris

Dennie Morgan folds

1.
2.
3.
4.
5.
6.
7.
8.
9.

Seborrhoic dermatitis
Contact dermatitis
Numular dermatitis
Scabies
Ichthyosis
Psoriasis
Dermatitis herpetiformis
Sezary syndrome
Leterrer-Siwe disease

In infant
1. Wiskott-Aldrich syndrome
2. Hyper- IgE syndrome

 Education
Appropriate skin hydration & use of
emollient skin barrier repair measure
Avoidance of irritants
Identification & treatment of complication
bacterial, viral of fungal infection
Treatment of psychosocial aspect of disease
Antipruritic intervention

1. Topical therapy
2. Systemic therapy

1. Cutaneus hydration
2. Topical glucocorticoid
3. Topical calcineurine inhibitor
(tacrolimus & pimocrolimus)
1. Tar preparation
2. Topical anti histamine : not
recommended except : doxepine cream
5%

1.
2.
3.
4.
5.
6.

Systemic glucocorticoid
Anti histamine
Infection agent
Interferon
Cyclosporine
Phototherapy (UVB, UVA+UVB, PUVA)

1.
2.
3.
4.
5.
6.

Many factor correlate with AD difficult to

predict prognosis
The predictive factors correlate with a poor
prognosis of AD :
Widespread AD in childhood
Associated allergenic rhinitis & asthma
Family history of AD in parents or sibling
Early age at onset of AD
Being an only children
Very high serum IgE levels

 30-35% infatile AD asthma / hay fever

Often develop non specific irritant hand
dermatitis