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Atypical mycobacterial infection mimicking carbuncle in an elderly patient: A case report Barros, Terlinda; Legiawati, Lili; Yusharyahya, Shannaz Nadia; Sularsito, Sri Adi; Wihadi, Imelda
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 1
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Background: Atypical mycobacterium infection occurs under certain skin conditions, namely the disruption of skin integrity and mucous membranes accompanied by the reduction of cellular immunity. However, atypical mycobacterial infection in elderly patients is rarely reported. Case: A 64 years old male patient, complained of red lumps on the upper-backfor a month, accompanied by mild fever and minimal pain. Three months before, the patient had accupuncture on the neck and upper back. Physical examination showed multiple miliar to lenticular sized papules and pustules on an erythematous-violaceus base with hard and immobile palpable nodes and infiltrate. After clinical and laboratory workup, the patient was diagnosed withcarbuncle with Candida spp colonization. The treatment consisted of systemicantibiotics and topical antifungals. There was no clinical improvement after 3 weeks. Histopathology and laboratory results suggested atypical mycobacterium infection. Discussion: Atypical mycobacterium infection should be considered in elderly patients with skin and soft tissue infections that show no clinical improvement tostandard therapy.
Atopic dermatitis in the elderly Irawan, Yudo; Rihatmadja, Rahadi; Legiawati, Lili; Yusharyahya, Shannaz Nadia; Sularsito, Sri Adi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
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Atopic dermatitis (AD) is a recurrent skin inflammation accompanied by itching. The incidence of AD is increasing worldwide. AD, which persists until elderly or with an onset during elderly, is known as senile AD. It has different prevalence and clinical features from other AD stages. Senile atopic dermatitis affects males more than females, which is different from other stages of AD. Skin manifestation of senile AD is similar with the adult stage of Hanifin-Rajka criteria, but can be atypical. The typical feature of senile AD is eczematous dermatitis around a free-lesion fossa. Other common clinical manifestations are erythroderma and non- specific chronic dermatitis. In the management of senile AD, changes related to aging process should be considered. Management of senile AD is complex, involves combined pharmacological treatment consists of topical and systemic agents, and non pharmacological aspects. Appropriate treatment considering effectiveness and safety will improve the quality of life of patients with senile AD.
Atypical mycobacterial infection resembles sporotrichosis in elderly patient Fauziah, Siti Nurani; Legiawati, Lili; Sularsito, Sri Adi; Yusharyahya, Shannaz Nadia; Rihatmadja, Rahadi; Sirait, Sondang P.; Huda, Fifi Mifta; Widyasari, Indah
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
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Atypical mycobacterial (AM) infection is caused by Mycobacterium species other than M.tuberculosis. AM skin infection has clinical manifestations that resemble M. tuberculosis infection and deep fungal infection. Laboratory workup is necessary to confirm the diagnosis. An 83-year old female came with a painful lump and swelling on her right lower extremity since three months before admission. Physical examination revealed a plaque consisting, of multiple erythematous and hyperpigmented papules and nodules, diffuse erythematous lesion, and shallow ulcers partially covered with pus and crust. Histopathological features showed tuberculoid granuloma. Direct test and periodic acid-Schiff (PAS) staining of the skin biopsy found no fungal element nor acid-fast bacilli (AFB). Culture and polymerase chain reaction (PCR)of M. tuberculosis were negative. The working diagnosis was atypical mycobacterial infection and treatment with 450 mg rifampicin and 100 mg minocycline daily were administered accordingly. In two months observation following the treatment, the pain was no longer exist, the ulcers were completely healed, and some nodules were in the process of healing Among other Mycobacterium spp, M.marinum is the most common cause of AM infrections. Clinical manifestation of M. marinum infection may present as solitary or multiple nodules on the hands, feet, elbows and knees with sporotrichoid spreading patern. The diagnosis of AM was established based on clinical and laboratory examination. The diagnosis was also confirmed by good clinical response to minocycline and rifampicin.
Venous Ulcer Santoso, Irene Dorthy; Nilasari, Hanny; Yusharyahya, Shannaz Nadia
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 2, No. 2
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Leg ulcers one common problem in the adult population to geriatric with a prevalence about 1-2%. The pattern of life which tends to be sedentary, less activity, obesity, increased the incidence of leg ulcers. The duration of healing and recurrence occurs in majority of patients contributed the decline in quality of life for patients with venous ulcers. Diagnosis, latest treatment and prevention are essential to discuss.
Vaginal microbiota in menopause Martinus, Martinus; Wibawa, Larisa Paramitha; Effendi, Evita Halim; Yusharyahya, Shannaz Nadia; Nilasari, Hanny; Indriatmi, Wresti
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 3
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The human vagina together with its resident, microbiota, comprise a dynamic ecosystem. Normal microbiota is dominated by Lactobacillus species, and pathogen microbiota such as Gardnerella species and Bacteroides species can occur due to decrease in Lactobacillus domination. Lactobacillus plays an essential role in keeping normal vaginal microbiota in balance. Vaginal microbiota adapts to pH change and hormonal value. Changes in the vaginal microbiota over a woman’s lifespan will influence the colonization of pathogenic microbes. They include changes in child, puberty, reproductive state, menopause, and postmenopause. Estrogen levels change will affect the colonization of pathogenic microbium, leading to genitourinary syndrome of menopause. Vulvovaginal atrophy is often found in postmenopausal women, and dominated by L. iners, Anaerococcus sp, Peptoniphilus sp, Prevotella sp, and Streptococcus sp. The normal vaginal microbiota’s imbalance in menopause will cause diseases such as bacterial vaginosis, and recurrent vulvovaginal candidiasis due to hormonal therapies. Changes in the vaginal microbiota due to bacterial vaginosis are characterized by decrease in H2O2-producing Lactobacillus. They are also caused by the increase in numbers and concentration of Gardnerella vaginalis, Mycoplasma hominis, and other anaerob species such as Peptostreptococci, Prevotella spp, and Mobiluncus spp.
Case series of primary psychiatric skin disorders with multi-disciplinary approach Lusiana, Lusiana; Prayogo, Rizky Lendi; Yusharyahya, Shannaz Nadia; Sitohang, Irma Bernadette S.; Bramono, Kusmarinah
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 4, No. 2
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Background: The incidence of psychodermatologic diseases, a group of skin abnormalities associated with psychosomatic factor, are increasing recently. About 20-40% patients with skin symptoms have concurrent psychiatric problems which are often difficult to diagnose and treat. The new classification of primary psychiatric skin disorders are delusional disorders, obsessive-compulsive and related disorders, and factitious disorders. This classification could be used for effective treatment in each patient which involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Illustration: The first case was a 39-year-old unmarried female, with anemia and dermatitis artefacta occurred as wound due to blade cuts. Patient was with schizoaffective depressive type and was not under regular treatment. The second case was a 61-year-old male referred with unresolved prurigo nodularis for the past 30 years. After in-depth assessment, there were delusional parasitosis and neurotic excoriations disorders. The third patient was a 50-year-old female admitted with recurrent ulcer on her face. She was aware that the lesions were intentionally manipulated by her own fingers when she was depressed. Discussion: All patients were classified as primary psychiatric skin disorders with varied skin manifestations. Symptoms usually occurred when the patient was in the depression state or low compliance for the psychotropic drugs. Patients generally had poor insight and refused to be associated with psychiatric factors. Dermato-venereologists are expected to conduct early detection and treat this disease. Conclusion: It is important to approach psychocutaneous disease in multi-disciplinary manner, especially with the psychiatrist.
The importance of multidisciplinary approach in management of pressure injury in elderly with multiple comorbidities Kusumawardhani, Dina; Yusharyahya, Shannaz Nadia; Legiawati, Lili; Astriningrum, Rinadewi; Adistri, Kara
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 7, No. 2
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Background: Pressure injury (PI) can occur as a result of prolonged bed rest in immobilized patients. The healing process is often slow if the wounds are not managed comprehensively, particularly in elderly patients or patients with neurological disorder, diabetes mellitus, and malnutrition. Proper treatment can improve the healing process. Case illustration: A 66-year-old female with multiple comorbidities presented with PI on the left lower back, as well as the sacral and right gluteal regions. She was diagnosed with grade 3 and unstageable PI, and was treated using a multidisciplinary approach. Her wounds were treated with a combination of hydrogels and polyurethane foam dressings. Discussion: Managing comorbidities, optimizing local wound care, regular repositioning in special mattress, and improving nutritional status are necessary to accelerate healing in cases of PI. There was an increase in the wound granulation and epithelialization, as well as a decrease in the ulcer size and exudates after 16 weeks of treatment. A considerable amount of time is needed to treat grade 3 and unstageable PI in an immobile elderly patient with multiple comorbidities. Conclusion: Multidisciplinary collaboration among healthcare workers is essential for the treatment of PI in elderly populations.
The effects of vitamin D on chronic wounds Priyanto, Mufqi Handaru; Miranda, Eliza; Yusharyahya, Shannaz Nadia; Legiawati, Lili; Novianto, Endi; Bramono, Kusmarinah; Krisanti, Roro Inge Ade
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 8, No. 1
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Background: Wounds that fail to proceed through the normal healing process are referred to as chronic wounds, also known as ulcers. Chronic wounds have immeasurable biological, psychological, social, and economic effects, bringing tremendous challenges for patients, doctors, healthcare providers, and healthcare systems. Discussion: This condition is associated with a variety of comorbidities and complex etiologies. The global incidence of chronic wounds is expected to increase with longer life expectancy. Thus, a holistic approach is necessary, such as proper wound management, proper control of comorbidities, and provision of adequate nutrition, including vitamin D supplementation. Vitamin D is an essential pro-hormone for cell differentiation, proliferation, and growth. It affects the skin’s immune response, and is therefore thought to promote wound healing and tissue repair. Many studies have been published on the association between low vitamin D levels and chronic wounds. However, whether or not vitamin D supplementation directly contributes to wound healing still needs to be elucidated. Conclusion: Despite the many reports on vitamin D as an adjuvant treatment for chronic wounds, further large-scale clinical studies are needed to cement the role of vitamin D as an effective standard therapy for chronic wound healing.
PERAN SUPLEMENTASI VITAMIN D PADA TATA LAKSANA SARKOIDOSIS KUTIS Mutiara Ramadhiani; Yudo Irawan; Shannaz Nadia Yusharyahya; Lili Legiawati
Media Dermato-Venereologica Indonesiana Vol 50 No 1 (2023): Media Dermato-Venereologica Indonesiana
Publisher : Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33820/mdvi.v49i4.311

Abstract

Sarkoidosis merupakan kelainan inflamasi multisistem yang ditandai dengan terbentuknya granuloma dan terjadi pada berbagai organ, terutama paru dan kulit. Granuloma berisi sel imun berupa makrofag yang juga berperan dalam metabolisme vitamin D. Makrofag pada granuloma sarkoidosis terbukti mampu memproduksi 1,25-dihidroksi vitamin D (kalsitriol) di luar ginjal yang berasal dari prekusor 25-hidroksi vitamin D (calcifediol). Selain itu, metabolisme 1,25-dihidroksi vitamin D di makrofag tidak memiliki mekanisme umpan balik yang efektif dalam menjaga keseimbangan kadar vitamin D di tubuh. Penurunan ini dapat mengganggu keseimbangan kadar kalsium pada pasien sarkoidosis. Pemberian suplementasi vitamin D dianggap sebagai terapi adjuvan dalam tata laksana sarkoidosis, namun diketahui dapat menyebabkan hiperkalsemia. Perubahan kadar vitamin D pada sarkoidosis tidak selalu menjadi indikasi pemberian suplementasi vitamin D, diperlukan pemeriksaan laboratorium yang tepat sebelum memberikan suplementasi vitamin D guna mengurangi risiko terjadinya hiperkalsemia pada sarkoidosis. Pemberian suplementasi vitamin D dalam dosis rendah diperbolekan bagi pasien sarkoidosis yang tidak disertai kondisi hiperkalsemia, namun perlu dilakukan pemeriksaan kadar vitamin D dan kalsium secara rutin.
KASUS RECESSIVE DYSTROPHIC EPIDERMOLYSIS BULLOSA-MITIS YANG TERDIAGNOSIS PADA SAAT LANJUT USIA Inadia Putri Chairista; Shannaz Nadia Yusharyahya; Lili Legiawati; Rahadi Rihatmadja; Rinadewi Astriningrum
Media Dermato-Venereologica Indonesiana Vol 50 No 1 (2023): Media Dermato-Venereologica Indonesiana
Publisher : Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33820/mdvi.v50i1.402

Abstract

Introduction: Recessive dystrophic epidermolysis bullosa (RDEB) is a rare bullous disease caused by mutations in the COL7A1 gene encoding anchoring fibril collagen that maintains skin integrity. Case: Male, 67-year-old, presented with blisters and wound on various parts of the body, worsening in the recent year. They had been known to easily appear after trauma since. Vesicles-bullae, erosions-excoriations, milia, and atrophic scars were found on the axillae, groins, and limbs, as well as hyperkeratosis and anonychia of the hands and. Histopathological examination showed subepidermal cleft, milia and fibrosis, without immunoglobulin deposits on immunofluorescence. Discussion: Contrary to classical RDEB, blisters in mitis variant do not always cause impairment. The pronounced symptoms in advanced age might be mistaken for epidermolysis bullosa acquisita. Negative immunoglobulin deposition is the diagnostic key, confirming that blister does not result from an autoimmune process, but rather, from trauma to the abnormal skin, more so by flattening of the rete ridges in the elderly. In the absence of definitive therapy, treatment is symptomatic. Conclusion: The diagnosis RDEB-mitis might be missed in geriatric. Correct diagnosis has implication on management because not only does RDEB-mitis require no immunosuppressant, measures to minimize blister formation is more important to save patient from complication.