masalah kulit pada bayi & anak - cikal · signs & symptoms of allergy: -vary from allergy...
TRANSCRIPT
Allergic reaction:
- Vary from mild to harmful
- The tendency to develop allergies
is often hereditary
Common Allergens:
- Airborne allergens:
house dust mites, pollen (from weeds, grass &
trees), molds, pets, cockroach
- Food allergens:
cow’s milk, eggs, seafood, peanut and tree nut,
soy, wheat
- Other allergens: insect stings, medicines, chemicals
Signs & Symptoms of Allergy:
- Vary from allergy to allergy and
child to child
- Skin rash, itchy eyes, itchy & runny
nose, sneezing, coughing, nasal
congestion, throat tightness,
difficulty breathing, and even shock
(faintness or passing out)
ALLERGIC SKIN CONDITION
- URTICARIA (HIVES)
- ALLERGIC CONTACT DERMATITIS
- ATOPIC ECZEMA (ATOPIC DERMATITIS)
- INSECT STING ALLERGY
- DRUG ALLERGY
… urticaria
- Red raised bumps or welts on the skin
- Can occur anywhere on the body
- ≤ 6 weeks: acute urticaria
≥ 6 weeks: chronic urticaria
- In some cases: accompanied by Angioedema (swelling in the deeper layers of the skin)
… urticaria
Common allergens:
food
medicines
climate changes
pets/animals
pollen
insect bites and stings
infections
stress
exposure to the sun
physical stimuli: pressure, cold, heat
… urticaria
- 15-25% of population: 1x urticaria
- Treatment:
mild: won’t require treatment
avoidance of the trigger
antihistamine
skin test
Allergic Contact Dermatitis
- Skin comes in direct contact
with an allergen
- For instance: nickel, tatoo ink,
cosmetics, diapers, etc
Atopic Eczema
(Atopic Dermatitis)
Eczema (dermatitis):
- a skin condition caused by
inflammation of the skin
- typically: itchy, red, dry, even
cracked
- can appear on any part of the body
- it’s not contagious
- it’s not allergy itself, but allergies can
trigger eczema
…atopic eczema (atopic dermatitis)
Atopic Dermatitis (AD):
- the most common of the many
types of eczema
- “Atopic”: describes condition that
occur when someone is overly sensitive to
allergens in their environment
asthma, allergic rhinitis, AD
- common skin condition
- 15-30% children, 10-20% adults
- incidence has increase 2-3 fold in the last
30 yrs, possibly due to environmental and
lifestyle changes
…atopic eczema (atopic dermatitis)
- AD in children:
47,6% in their first year
30% between ages 1-5
- The most children outgrow the
condition, more recent studies:
many continue to have relapses
as teenagers and adults.
…atopic eczema
The cause:
interaction between
- environment
- immune system
- skin barrier dysfunction
- genetic (heredity)
…atopic eczema (atopic dermatitis)
Genetic factor:
- Atopic history (asthma, AD, allergic rhinitis)
from both parents: 50-75 %
from one of the parents: 30-50%
- An infant who has parent or sibling with AD, asthma or RA has a 60-80% chance of developing AD
- 80% of children with AD develop asthma or
allergic rhinitis later in childhood
Role of Food Allergen in AD
Atopic dermatitis and food allergy are co-associated, but food allergy does not cause atopic dermatitis
Foods may trigger exacerbations of atopic dermatitis
Food allergy is more likely to play a role in atopic dermatitis in infants and young children with severe disease
Role of Food Allergen in AD
Foods should not be removed from the diet of a child with AD without determining a specific clinical outcome and a clear plan for reintroduction
Foods should be re-introduced within 3–4 weeks of removal from the diet if no clinical effect has been observed
An open food challenge is the most appropriate way to identify food as a trigger for problematic atopic dermatitis
SIGNS & SYMPTOMS of ATOPIC DERMATITIS
- The main symptoms: ITCHING
- The itching can be severe and persistent, especially at night.
Scratching the affected area causes a rash. The rash is red and patchy, and may be long-lasting (chronic) or come and go (recurring)
…atopic eczema (atopic dermatitis)
The usual location of the rash:
INFANT (ages 2 months – 2 years:
- face - neck
- scalp - arms
- leg - trunks
…atopic eczema (atopic dermatitis)
..the usual location of the rash:
CHILDREN (ages 2 – 12 years) :
- In areas that bend: inside of the elbows, back of the knee
- Wrist
- Neck
- Arms & legs
May appear for the first time or may be a continuitation of the infant phase
…atopic eczema (atopic dermatitis)
..the usual location of the rash:
ADOLESCENT & ADULTS:
- In areas that bend: inside of the elbows, back of the knee
- Neck
- Face
- Arms & legs
- Wrist
Adult-onset AD is rare, occurring in 9% to 14% of cases
Often improves as someone get older
…atopic eczema (atopic dermatitis)
Skin diseases that mimic Atopic Dermatitis:
- Seborrhoic eczema
- Miliaria (prickly heat)
Seborrhoic Eczema:
skin has yellowish, oily, scaly patches on the scalp, face, and sometimes other parts of the body.
…skin disease that mimic AD
Cradle cap
Miliaria (prickly heat) Miliaria is a rash that
develops in some people
when they sweat more
than usual. The rash is also
sometimes called a sweat
rash. It is not usually serious,
but it can be itchy and
uncomfortable.
Miliaria is due to blockage
of sweat ducts.
…skin disease that mimic AD
Skin conditions associated with AD:
Dry skin (xerosis): - due to skin barrier dysfunction
- lack of ceramide
- dry skin is sensitive, easily
irrtitated, and itchy
Keratosis Pilaris: - Rough bumps appear on the
skin, mainly on the back and
outer side of the upper arms.
- May also appear on the thighs
and buttocks
Skin conditions associated with AD:
Pityriasis alba: - Slightly scaly, round or oval, slightly
white patches on the skin.
- More apparent in summer / after
swimming
- Esp. in darker skinned children
- Incidence in AD children: 30-40%
Atopic pleat or Dennie-
Morgan fold: - Reported in 60-8-0% patients
- Extra line on the lower eyelid
- A distingusihing feature of AD or
caused by rubbing the eye
Skin conditions associated with AD:
Cheilitis: - Inflammation of the lips
- Cracks and scales on the lips
Hyperlinear palmar : - Many skin creases (lines) in the
palms
Skin conditions associated with AD:
Hand and Feet Eczema - Eczema that affect the palms and
the soles
- May develop tiny bubbles
(vesicles) which are intensely itchy
Periorbital eczema:
- Eczema around the eyes
- Commonly caused and
aggravated by rubbing and
scratching around the eyes
Skin conditions associated with AD:
Skin infection AD patients are more predisposed to develop skin
infection. They are susceptible
to bacterial, viral and fungal
infection
…atopic eczema
Treatment:
Avoiding dry skin
One study has show that emollients may reduce
the need for topical steroids by about 62%
- No single emollient shown to superior
- Not all of types emollients suit all people
- The best emollient is one which the patient prefers because then they will use it more frequently.
- Patients have a preference for one over the other based on lifestyle, cosmetic acceptability, personal choice, adverse reactions and cost
- Cost is a major issue. Wide range of prices.
Choosing the right emollient
Ceramide rich emollient more
effective in blocking TEWL.
Important to use ointments or thick
creams containing high lipid
content rather than watery ones.
Choosing the right emollient
Use very liberally Explain that you cannot “overdose” as
emollients do not contain any “active” drug
Adults should expect to use about 1 x
500 g tub each week a child 1 x 500 g every 2 weeks
Quantities of Emollient applied
Many times a day, 3 mins after
bathing
Avoid rubbing in (this causes irritation)
Use light downward strokes to apply
Should leave a thin film on skin surface
Method of application
…atopic eczema
…treatment:
- Avoiding irritants
- Avoid excessive scrubbing &
toweling
- Avoid possible allergens
- Controlling itching & scratching
- Avoid becoming overheated
Avoid:
- Sodium lauryl sulphate (SLS)
- Methylparaben & propylparaben
- Propylene glycol stearate
- Sulfur
- Povidon iodine
- Heksaklorofen
- klorheksidin
…atopic eczema (atopic dermatitis)
Medicines:
- Topical corticosteroids
- Calcineurin inhibitors
- Antihistamines
- Oral corticosteroids
- Cyclosporine
- Interferon
- Antibiotik / antiviral / antifungal if there
is secondary infection
…atopic eczema (atopic dermatitis)
Topical corticosteroids
- First line treatment
and very effective
- Using Finger Tip Unit (FTU)
1 FTU = 0,5 g of cream
For a 3-6 month old child
Entire face and neck – 1 FTU
An entire arm and hand – 1 FTU
An entire leg and foot – 1.5 FTUs
The entire front of chest and abdomen – 1
FTU
The entire back including buttocks – 1.5 FTUs
For a 1-2 year old child
Entire face and neck – 1.5 FTUs
An entire arm and hand – 1.5 FTUs
An entire leg and foot – 2 FTUs
The entire front of chest and abdomen – 2
FTUs
The entire back including buttocks – 3 FTUs
…atopic eczema (atopic dermatitis)
Calcineurin inhibitor: - Pimecrolimus (Elidel®) & Tacrolimus
(Protopic®)
- The US FDA : caution when prescribing
these medicines because of potential
cancer risk.
Only be used as directed, and only after
trying other treatment options, are not
approved for children younger than 2
years of age
…atopic eczema (atopic dermatitis)
Coal Tar:
- reduce itching
- should not be used on skin that is very
irritated
Antihistamines: - often used to treat itching and to help
patient sleep when severe night itching is a problem
…atopic eczema (atopic dermatitis)
Oral Corticosteroids:
- in severe cases
- when the rash cover large areas
Cyclosporine & Interferon:
- cytostatics
- only used if other treatment is not
succesful
Insect Sting Allergy
- Can cause serious and even deadly reaction
- Insects: honeybee, yellow jackets, hornets, wasp, fire ants
- Symptoms: wheezing, trouble breathing, coughing, hoarseness, throat tightness, stomachache, vomiting, diarrhea, itchy-water-or swollen eyes, hives, red spots, swelling, and loss of conciousness
Drug Allergy
Drug allergies are a group of symptoms caused by an allergic reaction to a drug (medication).
The most common drug allergens: Antibiotics:
Penicillin
Sulfa drugs
Tetracycline Analgesics:
Codeine
Non-steroidal anti-inflammatory drugs (NSAIDs)
Antiseizure: Phenytoin
Carbamazepine
…drug allergy
Drug allergy symptoms
Skin rash or hives
Itchy skin
Wheezing or other breathing problems
Swelling of body parts
Anaphylaxis, a life-threatening allergic reaction
Reactions can occur in any part of your body.
…drug allergy
What is anaphylaxis?
Anaphylaxis is a severe, life-threatening allergic reaction. This serious
reaction happens within seconds to minutes after taking the drug. Patient may experience:
Swelling of your body parts, with or without hives
Light headedness or dizziness
Sudden drop in your blood pressure, with or without loss of consciousnes
Shock, with damage to your internal organs
Anaphylaxis requires emergency treatment to prevent death and damage to your internal organs.
Treatment includes:
Drugs (oxygen, adrenalin, antihistamine)
Intravenous fluid
…drug allergy
Diagnosing Drug Allergy:
When did you take the drug
When did you stop the drug
When did you problem begin
What happened to you
How long did your problem last
What other prescription drugs did you take
What other non-prescription drugs
What health foods did you take
What herbs did you take
What minerals did you take
What are the exact names
What treatments did you get for the reaction
…drug allergy
Drug allergy treatment:
For a mild reaction you may only have to stop the drug.
For a more serious allergic drug reaction that is not life-threatening:
Antihistamine
to counteract the histamine released into
your body during the reaction
A non-steroidal anti-inflammatory drug or a
corticosteroid : to reduce inflammation
Treating Allergy
There is no real cure for allergies, but it is possible to relieve symptoms. The only real way to cope with them is to reduce or eliminate exposure to allergens. That means parents must educate their child early and often, not only about the allergy itself, but also about what reaction they will have if they consume or come into contact with the allergen.
Informing any and all caregivers (childcare personnel, teachers, extended family members, parents of your child’s friends, etc) abut your child allergy is equally important.
If reducing exposure to allergens isn’t possible or ineffective, medications may be prescribed, including antihistamines, corticosteroids, or epinephrine.