DERMATOLOGY

ALLERGIC SKIN
DISEASES
BY :
E.SUTEDJA,DR,Sp.kk

ALLERGIC SKIN DISEASES

ALLERGY

ALLOS

+ ERGOS

DEVIATION IN BODY IMMUNE REACTION

(HYPERSENSITIVITY)
COOMB & GEL
TYPE I IMMEDIATE (RAPID)
ANAPHYLAXIS
II CYTOTOXIC
III ANTIGEN-ANTIBODY COMPLEX
IV DELAYED TYPE (CELL-MEDIATED)

ALLERGEN : FOOD
INHALANT
DRUGS

PSYCHOLOGICAL
DISEASES :
URTICARIA
DRUG ERUPTION
CONTACT DERMATITIS
ATOPIC DERMATITIS

URTICARIA
DEFINITON :
A VASCULAR REACTION IN THE SKIN RESULTS FROM A VARIETY OF
CAUSES THAT IS CHARACTERIZED BY :
LOCALIZED EDEMA RAPIDLY DISAPPEARED- GRADUALLY
FAINT /RED COLOR
RISE FROM THE SURFACE
SENSATION OF ITCHING/BITE/PRICKED
ANGIOEDEMA DEEP SKIN LAYER
LOOSE CONNECTIVE TISSUE
SUB-MUCOSA/SUB-CUTIS
(RESPIRATORY,GASTRO- INTESTINAL,
CARDIOVASCULAR TRACTS)

ETIOLOGY : 80% UNKNOWN

DRUGS : PENCILLIN & DERIVATIVES
SULPHONAMIDES
ANALGESICS/ANTIPYRETICS
DIURETICS
OPIATES
CONTRAST
TRANQUILIZERS
ANTICONVULSANTS
FOODS : SEA FISHES
LEGUMES
COCOA
EGGS

INSECT BITES (VENOME)

PHOTOSENSITIZER : GRISEOFULVINE
SULPHONAMID
COSMETICS
INHALANT : POLLEN
FUNGAL SPORES
DUST
ANIMAL FURS
CONTACTANTS
PHYSICAL TRAUMA
INFECTIONS
INFESTATION
PSYCHE
SYSTEMIC DISEASES

CLASSIFICATION :
ACUTE
: < 6 WEEKS
4 WEEKS (DAILY)
CHRONIC : > 6WEEKS
4 WEEKS (DAILY)
MORPHOLOGY : PAPULAR
GUTTATA
GIRATA
EXTENT :

LOCALIZED
GENERALIZED
ANGIOEDEMA

MECHANISM : IMMUNOLOGICAL
NON-IMMUNOLOGICAL
PATHOGENESIS :

SYMPTOMS :

CAPILLARY VASODILATATION/ERYTHEMA
INCREASED CAPILLARY PERMEABILITY
RELEASING OF MEDIATORS
IMMUNOLOGICAL/NON-IMMUNOLOGICAL

ITCHING, SENSE OF BURNED , PRICKED,

ERYTHEMATOUS & EDEMATOUS

SUPPORTIVE TESTS :
1. ROUTINE BLOOD, URINE, FAECES
2. TEETH
LOCAL INFECTIONS
3. IgE, EOSINOPHIL
4. PRICK TEST
INHALANTS, FOODS, FUNGUS
5. ELIMINATION TEST
ELIMINATING
ATTEMPTED ONE BY ONE
6. ICE TEST

THERAPY :

IDEAL

Urticaria :
-salycylate
-antipruritus
Wet
Dry

compress
corticosteroid

AVOID THE CAUSES

ANTIHISTAMINE (H1)
CORTICOSTEROID

ERYTHEMA MULTIFORME
Erupsi :
- Sudden & recurent
- Skin/mucosa
- Pupil-like
- Severe
S/constitution; vesceral lesion
TYPE :

Macula erythema
Vesicobullosa

Macula erythema :

- Sudden
- Symmetrical : dorsal manus
hand palms extensor
extremities
Symptoms : incise the center of target lesion
vesicle, erythematous, purplish faint
concentrical circle red circle
Vesicobullosa type :
Macula; papule;urtical;vesicobullosa in the mucosa
Therapy : corticosteroid 3 x 10 mg

DRUG ERUPTION
Incidence
Drug/substance

Port of entry :
- Gastro-intestinal tract
- Respiratory tract
- IV;ID;IM
- Topical

Increased
Establish diagnosis
Prophylaxis
Treatment

Drug reaction

all reaction in the body induced by

drugs
- toxicity
- overdosis
- intolerance
- allergy, etc.

Diagnosis :
1. Accurate anamnesis :
Given medication
Acute onset
Itching/sub-febrile
2. Cutaneous abnormalities :
Distribution :
diffuse & symmetry
Single drug-induced abnormalities,
Multiple drug-induced abnormalities

a few hours

similar
disorders

FORMS :
Urticaria
Erythema
morbilliform
Dermatitis
Purpura
Exanthema fixtum (Fixed Drug Eruption)
- Hyperpigmentation :
permanent/transient
- Relaps
- Similar sites
Predilection
labia (lips); penis
Erythema nodosum
Erythroderma

STEVENS-JOHNSONS
SYNDROME
Definition :
Syndromes

Skin
Orificial and ocular mucosa
Varied general state: mild --- severe
erythema multiforme mayor

Synonym :
Etiology :
Systemic drug-induced allergy
Infection
Neoplasm
Pathogenesis :
type III and IV

DIAGNOSIS :
Mild
severe
coma

decreased consciousness

soporous

TRIAD :
-Skin disorder
-Orificial mucous disorder
-Opthalmic disorder
Skin : erythema , papules, vesicles, bullae, erosion, purpura
Mucosa :
Mouth : 100%
Genitalia : 50%
Anus/nose : 4 - 8 %

Eye Disorder :
80% conjuctivitis catarrhalis
Corneal ulcer
Iritis, Iridocyclitis
Complication :
Bronchopneumonia
Loss of body fluid
shock
Eye
blindness, lacrimation

THERAPY :
-Care,General state, Infuse
-Corticosteroid
life saving
-4-6 x 5 mg/day
critical period (3days)
-Get decreased to be 5mg/day
per day
1x5 mg
-Antibiotics (carefully)
PROGNOSIS :
Take action immediately,and appropriately good prognosis
Death
5 15 %

TEN
More severe than Steven-Johnsons syndrome
Epidermolysis
Mucosa
Synonym : Lyells syndrome
Etiology : similar with Steven-Johnsons
Syndromes : severe
death
fluid electrolyte imbalance
Prodromal :
Severe illness
High fever
Soporo comatous
Skin : erythema generalisata

vesicle

bulla purpura

With the mucosa of :

Oral/lips
Erosion/excoriation
Crust
Patological anatomy : Epidermolysis
Nikolsky sign (+)
Therapy : similar to Steven-Johnson syndrome
Prognosis :
50 7% worse
Infection is better than drugs
Death 28.6%
Steven-Johnson syndrome 1 %