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Imunopathogenesis Dermatitis Atopic : A Research at Hasan Sadikin General Hospital, Bandung (Imunopatogenesis Dermatitis Atopik : Penelitian di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung)

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The actiology of atopic dermatitis (AD) is still controversial and IgE mediated immediate type allergy is probably not the only mechanism involved in the pathogenesis of this chronic skin disease. In search of other possible mechanism of the pathogenesis, this study was conducted. Seventy seven patients included to the research and 55 clinically diagnosed as AD, while 22 patients with various other non atopic dermatosis (NAD) referred as control group. Helminth infection and other atopic manifestation were excluded. Routine blood, feces and urine examination were done. Serum IgE (IgE-Total) concentration measured by ELISA, and spesific serum IgE to house dust mite allergen (HDM) (IgE -spesific) by Phadezym Rast method. The Patch Test and the Seratch Test on different volar site of under arms of the subject were done. IgE on the Langerhans cells (LC) was detected by Peroxidase-Anti-Peroxidase method. Immune responses to the HDM allergen were detected by prick test and patch test with the similar alergen on the volar site of the forearm. Clinical severity grading based on Rajka and langeland criteria. The IgE assay's showed that the total IgE concentration in the sera of AD patients was not significantly different with the control group (p more than 0.005). Concentration of total IgE in the sera higher than 200 IU of AD patients were found on 19/55 (34.5 percent) while among the NAD patients 11/22 (50 percent). Thirty one out of 55 (56.3 percent) AD patients showed positive HDM specific reactivity of serum IgE while 4 out of 22 NAD patients (control group) showed positive HDM specific reactivity (p=0.005). The scratch test result showed that 40 out of 55 AD patients (72.7 percent) and 3 out of 22 NAD patients (13.8 percent) had positive reactivity againts HDM allergen (p less than 0.001). While the patch tests result showed a positive reactivity againts HDM allergen in 29.1 percent AD patients but not in control group (p=0.0037). The immunohistological observation of the biopsies showed lesional skin which cells positive reactivity with anti IgE anti bodies in 40 out of 55 AD patients (72.7 percent) and 10 out of 22 NAD patients (45.5 percent) in the epidermal site (p=0.0235). Conclusions AD manifestations result not only from an IgE mediated immediate reaction but other mechanisms play also a role. According to the immune respose to HDM allergen, AD must be classified as three patterns ie : pure humoral, pure cellular and mixed humoral and cellular mechanism and the rest consist of the group of non immunologic responder. In connection with this results, AD must be referred to the immunologic group, since they were the only group that fit the they were the only group that fit the terminology of skin inflamation (Dermatitis) and Atopic condition.

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Majalah Kedokteran Bandung,27(1)1995:9-15

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: ., 1995

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dermatitis, atopic

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