2. Atopic dermatitis is a disease that began to arise at
the age of infants and children,
chronic and relapsing
characterized by itching of the skin.
inflammatory reaction
based on hereditary factors and environmental
factors,
the symptoms are chronic recurrent erythema,
papules, vesicles, crusting, and skuama.
2Prof DR Dr Ariyanto Harsono SpA(K)
6. Conventional Therapy
is not always safe
Topical steroid: cutaneous atrophy, striae, bruisability, telangiectasia
High-potency topical steroids can cause
systemic side effects in children.
6Prof DR Dr Ariyanto Harsono SpA(K)
11. Kriteria Hanifin and Rajka
Kriteria mayor (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
11Prof DR Dr Ariyanto Harsono SpA(K)
12. Kriteria Hanifin and Rajka
Kriteria mayor (minimal 3)
•Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial and extensor
Lichenification in babies and children
•Kronik
•History of family atopy
12Prof DR Dr Ariyanto Harsono SpA(K)
13. Kriteria Hanifin and Rajka
Kriteria mayor (minimal 3)
•Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial and extensor
Lichenification in babies and
children
•Kronik
•History of family atopy
13Prof DR Dr Ariyanto Harsono SpA(K)
14. Kriteria Hanifin and Rajka
Kriteria mayor (minimal 3)
•Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial and extensor Lichenification
in babies and children
•Kronik
•History of family atopy 14Prof DR Dr Ariyanto Harsono SpA(K)
15. Kriteria Hanifin and Rajka
Kriteria mayor (minimal 3)
•Pruritus
•Characteristic Distribution
and morphology of skin lesions
•Flexural Lichenification
•Facial and extensor in babies
and children
•Chronic
•History of family atopy
15Prof DR Dr Ariyanto Harsono SpA(K)
16. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
•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)
17. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
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
18. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
18Prof 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
19. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
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 (Stafilokokus/herpes)
•Tend to nonspesific dermatitis
•Nipple eczema
•Cheilitis
•Recurrent Conjunctivitis
20. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
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 (Staphylococcus/herpes)
•Tend to nonspesific dermatitis
•Nipple eczema
•Cheilitis
•Recurrent Conjunctivitis
21. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
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
22. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
22Prof 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
23. Kriteria Hanifin and Rajka
Kriteria minor (minimal 3)
•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
23Prof DR Dr Ariyanto Harsono SpA(K)
24. Kriteria Hanifin and Rajka
Kriteria minor
•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 24Prof DR Dr Ariyanto Harsono SpA(K)
25. Kriteria Hanifin and Rajka
Kriteria minor
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
26. Kriteria Hanifin and Rajka
Kriteria minor
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
27. Kriteria Hanifin and Rajka
Kriteria minor
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
28. Kriteria Hanifin and Rajka
Kriteria minor
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
29. Kriteria Hanifin and Rajka
Kriteria minor
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
30. Kriteria Hanifin and Rajka
Kriteria minor
30Prof 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
31. Kriteria Hanifin and Rajka
Kriteria minor
31Prof 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
32. Kriteria Hanifin and Rajka pada bayi
Kriteria mayor (minimal 2 mayor)
•History of family atopy
•Evidence of pruritic Dermatitis
•Dermatitis fasial, ekstensor, likenifikasi
Kriteria minor (minimal 1 minor)
•Xerosis/ichtyosis/hyperlinear palm
•Perifollicular accentuation
•Chronic scalp scalling
•Periauricular fissures
32Prof DR Dr Ariyanto Harsono SpA(K)
33. Kriteria Hanifin and Rajka pada bayi
Kriteria mayor (minimal 2 mayor)
•History of family atopy
•Evidence of pruritic Dermatitis
•Dermatitis fasial, ekstensor, lichenification
Kriteria minor (minimal 1 minor)
•Xerosis/ichtyosis/hyperlinear palm
•Perifollicular accentuation
•Chronic scalp scalling
•Periauricular fissures
33Prof DR Dr Ariyanto Harsono SpA(K)
34. Kriteria Hanifin and Rajka pada bayi
Kriteria mayor (minimal 2 mayor)
•History of family atopy
•Evidence of pruritic Dermatitis
•Dermatitis fasial, ekstensor, likenifikasi
Kriteria minor (minimal 1 minor)
•Xerosis/ichtyosis/hyperlinear palm
•Perifollicular accentuation
•Chronic scalp scalling
•Periauricular fissures
34Prof DR Dr Ariyanto Harsono SpA(K)
35. Kriteria Hanifin and Rajka pada bayi
Kriteria mayor (minimal 2 mayor)
•History of family atopy
•Evidence of pruritic Dermatitis
•Dermatitis fasial, ekstensor, likenifikasi
Kriteria minor (minimal 1 minor)
•Xerosis/ichtyosis/hyperlinear palm
•Perifollicular accentuation
•Chronic scalp scalling
•Periauricular fissures
35Prof DR Dr Ariyanto Harsono SpA(K)
36. Kriteria Hanifin pada anak
Kriteria mayor (minimal 3 mayor)
•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
Kriteria minor (minimal 1
minor)•Xerosis/ichtyosis/hyperlinear palm/keratosis pilaris
•IgE reactivity
•Chronic scalp scalling
•Perifollicular accentuation
•Periauricular fissures 36Prof DR Dr Ariyanto Harsono SpA(K)
37. Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Kepekaan infeksi kulit (Herpes/Strep/S aureus)
37Prof DR Dr Ariyanto Harsono SpA(K)
38. Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable of skin infetions (Herpes/Strep/S aureus)
38Prof DR Dr Ariyanto Harsono SpA(K)
39. Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable of skin infetions (Herpes/Strep/S aureus)
39Prof DR Dr Ariyanto Harsono SpA(K)
40. Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis
•Cheilitis
•Vulnerable of skin infetions (Herpes/Strep/staphilococcus)
40Prof DR Dr Ariyanto Harsono SpA(K)
41. 41Prof DR Dr Ariyanto Harsono SpA(K)
Seborrhoic dermatitis
44. Principle of Conventional Therapy
Eczema
Target for skin
care
Target for anti
inflammatory
44Prof DR Dr Ariyanto Harsono SpA(K)
45. 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
45Prof DR Dr Ariyanto Harsono SpA(K)
IVIG
46. Results: Anti-inflammatory activity
Stimutex-As + Saccharide Isomerate shows a significant anti-
inflammatory activity when compared with control.
The anti-inflammatory activity of Stimutex-As + Saccharide Isomerate
is equivalent to Dexamethasone, a moderately potent steroid.
*
46
47. Saccharide Isomerate: Moisture Retention
Efficacy
There were less moisture lost with saccharide isomerate
compared to urea and glycerin at all humidity levels.
Saccharide
Isomerate
47
48. • Saccharide isomerate regulates and retains
moisture in the skin at all humidity levels.
• The efficacy of saccharide isomerate has
been tested and proven to be superior to
urea and glycerin.
Prof DR Dr Ariyanto Harsono SpA(K)
49. Safety Profile
• There were no serious adverse events
reported except for 2 cases of erythema
which were treated with topical steroids.
49Prof DR Dr Ariyanto Harsono SpA(K)
50. Arachidonic Acid (ARA)
Phospholiphase A
Cyccloxygenase Lipoxygenase
Prostaglandine
TXA
Prostacyclin
Leukotriene A
Leukotriene B
Leukotriene C
γ-linoleic acid
HETE,5-HETE, PAF
50Prof DR Dr Ariyanto Harsono SpA(K)
51. Mechanism of IVIG blocking apoptosis via
Procaspase-8 pathway
Macrophage Keratinocyte
51Prof DR Dr Ariyanto Harsono
SpA(K)
Use of IVIG