When conventional therapy fails to treat atopic dermatitis
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When conventional therapy fails to treat atopic dermatitis
- 1. Prof DR Dr Ariyanto Harsono SpA(K) 1
- 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)
- 3. Atopic Dermatitis: Itch that erupts Not eruption that itches 3Prof DR Dr Ariyanto Harsono SpA(K)
- 4. 4Prof DR Dr Ariyanto Harsono SpA(K)
- 5. Education Hidration Emolient Moisturizer Wet dressing Allergen/irritants avoidance Antihistamine Topical Steroid 5Prof 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)
- 7. 7Prof DR Dr Ariyanto Harsono SpA(K)
- 8. IgE IL-4, IL-5 IL-13 8Prof DR Dr Ariyanto Harsono SpA(K)
- 9. IgE IL-4, IL-5 IL-13 v 2 CD4+Th1 Cell IFN-γ CD8+Th1 Cell DTH Super antigen 9 Prof DR Dr Ariyanto Harsono SpA(K)
- 10. Spongious Infiltrasi Eosinofil Udem 10Prof 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
- 42. 42Prof DR Dr Ariyanto Harsono SpA(K) Pompholix
- 43. 43Prof DR Dr Ariyanto Harsono SpA(K)
- 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
- 52. Prof DR Dr Ariyanto Harsono SpA(K) 52
- 53. 53Prof DR Dr Ariyanto Harsono SpA(K) Thank you