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Prof DR Dr Ariyanto Harsono SpA(K)
1
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 reactionbased on hereditary factors and environmental
factors,the symptoms are chronic recurrent erythema,
papules, vesicles, crusting, and skuama.
2Prof DR Dr Ariyanto Harsono SpA(K)
Atopic Dermatitis:
Itch that erupts Not eruption that itches
3Prof DR Dr Ariyanto Harsono SpA(K)
4Prof DR Dr Ariyanto Harsono SpA(K)
EducationHidration
EmolientMoisturizerWet dressing
Allergen/irritants avoidanceAntihistamineTopical Steroid
5Prof DR Dr Ariyanto Harsono SpA(K)
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)
7Prof DR Dr Ariyanto Harsono SpA(K)
IgE
IL-4, IL-5IL-13
8Prof DR Dr Ariyanto Harsono SpA(K)
IgE
IL-4, IL-5IL-13
v
2
CD4+Th1 Cell
IFN-
CD8+Th1 Cell
DTH
Super antigen
9
Prof DR Dr Ariyanto Harsono SpA(K)
Spongious
InfiltrasiEosinofil
Udem
10Prof DR Dr Ariyanto Harsono SpA(K)
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)
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
•Riwayat atopi dan keluarga atopi
12Prof DR Dr Ariyanto Harsono SpA(K)
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 atopy13Prof DR Dr Ariyanto Harsono SpA(K)
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)
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 atopy15Prof DR Dr Ariyanto Harsono SpA(K)
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)
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
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
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
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
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
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
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)
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)
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
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
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
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
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
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
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
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)
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)
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)
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)
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)
Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis•Cheilitis•Kepekaan infeksi kulit (Herpes/Strep/S aureus)
37Prof DR Dr Ariyanto Harsono SpA(K)
Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis•Cheilitis•Vulnerable of skin infetions (Herpes/Strep/S aureus)
38Prof DR Dr Ariyanto Harsono SpA(K)
Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis•Cheilitis•Vulnerable of skin infetions (Herpes/Strep/S aureus)
39Prof DR Dr Ariyanto Harsono SpA(K)
Kriteria minor (minimal 1 minor)
•Hand/foot dermatitis•Cheilitis•Vulnerable of skin infetions (Herpes/Strep/staphilococcus)
40Prof DR Dr Ariyanto Harsono SpA(K)
41Prof DR Dr Ariyanto Harsono SpA(K)
Seborrhoic dermatitis
42Prof DR Dr Ariyanto Harsono SpA(K)
Pompholix
43Prof DR Dr Ariyanto Harsono SpA(K)
Principle of Conventional Therapy
Eczema
Target for skin care
Target for anti inflammatory
44Prof DR Dr Ariyanto Harsono SpA(K)
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
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
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
• 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)
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)
Arachidonic Acid (ARA)
Phospholiphase A
Cyccloxygenase Lipoxygenase
Prostaglandine
TXA
Prostacyclin
Leukotriene A
Leukotriene B
Leukotriene C
-linoleic acid
HETE,5-HETE, PAF50Prof DR Dr Ariyanto Harsono SpA(K)
Mechanism of IVIG blocking apoptosis via Procaspase-8 pathway
Macrophage Keratinocyte
51Prof DR Dr Ariyanto Harsono SpA(K)
Use of IVIG
Prof DR Dr Ariyanto Harsono SpA(K)
52
53Prof DR Dr Ariyanto Harsono SpA(K)
Thank you