2. Dermatitis atopik adalah penyakit yang mulai
timbul pada usia bayi dan anak.
Ditandai dengan
Gejala utama gatal-gatal pada kulit.
kronis dan kambuh
reaksi inflamasi
berdasarkan faktor keturunan dan faktor
lingkungan,
eritema kronis berulang, papula, vesikel, krusta,
dan skuama.
2Prof DR Dr Ariyanto Harsono SpA(K)
5. 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
6. •Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial and extensor
Lichenification in babies and children
•Kronik
•History of family atopy
6Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
7. •Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial and extensor
Lichenification in babies and
children
•Kronik
•History of family atopy
7Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
8. •Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial dan ekstensor pada bayi
dan anak
•Kronik
•History of family atopy
8Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
9. 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 atopy
9Prof DR Dr Ariyanto Harsono SpA(K)
Hanifin and Rajka criteria
Major criteria (minimal 3)
10. 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)
11. 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)
12. •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)
13. •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)
14. •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)
15. •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)
16. •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)
17. 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. 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)
19. 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)
20. 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)
21. 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. 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)
23. 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)
24. •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)
25. 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
26. 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
27. 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
28. 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
29. 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
30. 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
31. 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
32. 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
33. 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
34. 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
35. 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
36. 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
37. 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)
38. 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)
39. 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)
40. 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)
41. 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)
42. Minor criteria(minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable to infection (Herpes/Strep/S aureus)
42Prof DR Dr Ariyanto Harsono SpA(K)
43. Minor criteria(minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable to skin infetions (Herpes/Strep/S aureus)
43Prof DR Dr Ariyanto Harsono SpA(K)
44. Minor criteria(minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable to skin infetions (Herpes/Strep/S aureus)
44Prof DR Dr Ariyanto Harsono SpA(K)
45. Minor criteria(minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable to skin infetions (Herpes/Strep/staphilococcus)
45Prof DR Dr Ariyanto Harsono SpA(K)
46. 46Prof DR Dr Ariyanto Harsono SpA(K)
Seborrhoic dermatitis
52. Emolient
Tidak sekedar membasahi, akan tetapi harus
bisa:
Menahan air
Antioksidan
Memperbaiki fungsi skin barrier
Melindungi fungsi skin barrier
Antipruritus
Antiinflamasi
Steroid sparring Prof DR Dr Ariyanto Harsono SpA(K) 52
54. • Gunakan topikal steroid potensi lemah
sampai sedang saja sebab steroid topikal
kekuatan kuat bisa menimbulkan efek
samping sistemik.
Prof DR Dr Ariyanto Harsono SpA(K) 54
55. Conventional Therapy
is not always safe
Topical steroid: cutaneous atrophy, striae, bruisability, telangiectasia
High-potency topical steroids can cause
systemic side effects in children.
55Prof DR Dr Ariyanto Harsono SpA(K)
56. PENGOBATAN
INKONVENSIONAL.
• Prinsipnya adalah pengobatan lanjutan bila
pengobatan konvensional gagal atau
mengalami efek samping yang serius.
• Emolient tetap digunakan di semua lini.
• Mulai digunakan Primecrolimus atau
Tacrolimus sebagai pengganti steroid
topikal. Lebih aman karena anti inflamasi
non steroid.
Prof DR Dr Ariyanto Harsono SpA(K) 56
57. 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
57Prof DR Dr Ariyanto Harsono SpA(K)
IVIG
58. Steroid oral dengan menggunakan
prednison 1 mg/ kg BB selama 5-7 hari,
tanpa tappering, atau steroid lain dengan
dosis analog, memberikan efek segera akan
tetapi hanya sementara. Sedapat mungkin
penggunaan steroid oral dihindari karena
terjadi withdrawal setelah dihentikan
Prof DR Dr Ariyanto Harsono SpA(K) 58
59. IVIG dengan dosis 500mg/ kgBB terbagi
dalam 3 hari. Diberikan secara infus
intravena dalam waktu 6-8 jam.
Prof DR Dr Ariyanto Harsono SpA(K) 59
60. Ciklosporin memberikan hasil pengobatan yang baik pada
kasus kasus yang gagal dengan steroid topikal maupun
oral. Penggunaannya terbatas karena efek samping berupa
nausea
hipertrichosis,
hipertensi,
parasthesia, dan
gangguan hati/ginjal.
Diberikan dengan dosis 2,5mg-4mg/kg/hari selama 6 minggu.
Preparat tablet 25mg/tablet atau 100mg/ml 50ml sirup.
Prof DR Dr Ariyanto Harsono SpA(K) 60
61. Data menunjukkan Azathioprin
memberikan hasil pengobatan yang baik.
Diberikan dengan dosis 1-3mg/kgBB.
Preparatnya tablet 50mg/tablet.
Prof DR Dr Ariyanto Harsono SpA(K) 61
62. Mycophenolate mofetil dengan dosis 500 mg 2X
perhari. Preparat: tablet 500mg/tablet.
Methotrexate dapat digunakan untuk sparing
effect kortikosteroid dengan dosis 3-10 mg
seminggu sekali. Preparatnya tablet 2,5 mg/tablet.
Sebaiknya disertai pemberian Folic acid.
Prof DR Dr Ariyanto Harsono SpA(K) 62
63. Kepustakaan
1. Harsono A. Atopic Dermatitis treatment:
from conventional to unconventional.
http://www.slideshare.net/ariyantoharsono/atopic
2. Nelson Textbook of Pedatrics.
Prof DR Dr Ariyanto Harsono SpA(K) 63