Sumber: Katzungs Basic and Clinical Pharmacology 9th Ed.

Sumber: Jorizzo and Raphini: Dermatology. 2003. Elsevier.

Jenis reseptor histamine:

1. H1 endothel, smooth muscle 2. H2 gastric mucose, cardiac muscle, brain 3. H3 pre-synaptic area (brain, mesenteric plexus)

Pembagian singkat antihistamine:

1. H1 receptor antagonist a. First generation (sedating) i. Chlorpheniramine ii. Hydroxyzine

b. Second generation (less sedating) i. Loratadine ii. Cetrizine c. Third generation (almost no sedating effect) i. Desloratadine ii. fexofenadine 2. H2 receptor antagonist a. Cimetidine b. Ranitidine c. Famotidine

Tabel perbedaan DKI vs DKA

Kriteria Kelompok yang beresiko

Bahan penyebab Konsentrasi bahan penyebab Mekanisme Awitan Gejala Morfologi Batas lesi Histopatologi

DKI Semua orang, terutama mereka yang terkena paparan berulang atau berhubungan dengan pekerjaan Air, sabun, pelarut, deterjen, asam, basa, cairan tubuh Biasanya tinggi, dosedependent Nonimunologis, kerusakan jaringan secara langsung Menit hingga jam Rasa panas dan pedih Eritema, edema, deskuamasi

DKA Orang yang sudah tersensitisasi dan memiliki predisposisi genetik Racun tumbuhan, logam, kosmetik, obat, karet, resin Bisa rendah

Imunologis, reaksi hipersensitivitas tipe lambat Jam hingga hari Gatal Eritema, edema, vesikel, papul, likenifikasi Biasanya tegas, terbatas pada Kadang berbatas tegas area yang terpapar Spongiosis dengan infiltrasi Spongiosis dengan infiltrasi neutrofil limfosit.

Pemeriksaan Penunjang DKI

Investigations Irritant contact dermatitis is essentially a clinical diagnosis based on knowledge of the nature and conditions of an individuals exposure in the context of their dermatitis. A complicating allergic contact dermatitis always needs to be excluded by patch testing but patch tests do not aid in the diagnosis. Investigations are most frequently used in the context of scientific studies but may also predict an individuals susceptibility. None can be reliably used clinically on a large scale. Quantifying the irritant response Although visual appraisal of skin erythema and surface changes is still widely used to assess irritant reactions, a number of non-invasive techniques have been developed in recent years which permit objective evaluation of key changes to the skin. The optimal method to be used varies with the nature of the irritant [1]. Erythema. Among the most overt clinical features of irritant reactions is erythema, which may be quantified using a number of different approaches. Laser Doppler flowmetry (LDF) provides a measure of superficial blood flow by transmitting monochromatic light from a heliumneon laser through optical fibres to the skin surface. The light is Doppler-shifted by moving blood cells in the upper dermis, remaining unchanged in the surrounding stationary tissue. By means of a differential signal detector and signal processing arrangement, the back-scattered or reflected light is interpreted. The final output, which is linearly related to the product of the number of blood cells and their average velocity in the measured volume, is expressed in relative and dimensionless units. Studies by a number of investigators have shown that LDF generally correlates well with visually assessed erythema, and is capable of discriminating between negative and weakly positive irritant reactions [2,3]. Alternative methods for objectively quantifying erythema rely upon the generalized increase in red blood cells resulting from both increased blood flow and blood vessel dilatation. Those which are based upon remittance spectroscopy emit red and green light from a tungsten halogen lamp or LED source. Oxyhaemoglobin in the blood vessels absorbs a proportion of the green light, and largely reflects the red light. Changes in the quantity of oxyhaemoglobin significantly alter the amount of green light absorbed, but have very little influence on the red light. An erythema index can therefore be calculated from the ratio between the reflected green and red light, such that the greater the erythema, the higher the value of the erythema index [4]. Erythema may also be quantified using tristimulus colorimeters, virtually all of which employ a system for colour definition known as the Commission Internationale de lEclairage (CIE) L*a*b* colour system. This provides a three-dimensional coordinate system where L* represents an axis for brightness, a* represents a green red axis and b* represents a yellowblue axis [5,6]. Transepidermal water loss. In addition to inducing erythema, irritants commonly affect barrier function, leading to alterations in TEWL. Measuring instruments employ open chambers, through which, when applied to the surface of the skin, water vapour evaporates, creating a water-pressure gradient from which the evaporative TEWL, expressed in g/m2/h, is calculated [7]. Many variables influence TEWL measurements. Some relate to the environment and to instrument operation, necessitating a careful adherence to good laboratory practice, as outlined in a report from the Standardization Group of the

European Society of Contact Dermatitis [8]. Others relate directly to the individual; age and anatomical site are among the most important variables. Measurements of TEWL have proved valuable in predicting susceptibility to skin irritation, assessing the protective effects of barrier creams, and evaluating the irritancy potential of different chemicals [912]. Hydration. Changes in the hydration state of the skin also commonly occur in irritant contact dermatitis, and, again, this parameter may be objectively measured. Several different devices are available, based on differing biophysical approaches. Using the principle of capacitance, hydration of the stratum corneum can be measured to a depth of approximately 0.1 mm. In contrast, skin conductance has also been used as a measure of hydration. Studies suggest that capacitance may be more effective in the assessment of dry skin, whereas conductance is better suited for studies of water accumulation in the stratum corneum [13]. A third method uses the principle of impedance-based capacitance to assess hydration levels. Skin thickness. Although not extensively applied, highfrequency ultrasound has also proved valuable for the assessment of another aspect of the irritant response, namely changes in skin thickness [14]. Sumber: Rooks Textbook of Dermatology. 4 vol set. p813-814. 2004.