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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Jurnal Sehat Indonesia (JUSINDO) Journal of General Procedural Dermatology and Venereology Indonesia Cermin Dunia Kedokteran
Githa Rahmayunita
Department Of Dermatology & Venereology, Faculty Of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Hospital, Jakarta, Indonesia
Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Veterinary

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Ultraviolet phototherapy for treatment of various dermatoses Irwan Saputra Batubara; Larisa Paramitha Wibawa; Erdina Pusponegoro; Windy Keumala Budianti; Githa Rahmayunita; Shannaz Nadia Yusharyahya
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 53, No 4 (2021)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005304202107

Abstract

Ultraviolet (UV) radiation has been applied to treat many chronic skin diseases. Based on the wavelength, UV radiation consists of three types, namely ultraviolet C (UVC), ultraviolet B (UVB), and ultraviolet A (UVA). The types of UV that are widely used in dermatology are narrowband ultraviolet B (NB-UVB), broadband ultraviolet B (BB-UVB), UVA1, and psoralen combined with UVA (PUVA). The interaction between UV and the skin determines the effectiveness of phototherapy. The biological effects of UV are used in the management of inflammatory skin diseases, malignancies, and various rare dermatoses. Apart from these benefits, UV increases the risk of photoaging and skin cancer. Therefore, further researches are necessary to enhance the effectiveness and safety of phototherapy. This literature review discusses the role of phototherapy in various dermatoses other than psoriasis and vitiligo.
BLENDED LEARNING AS A METHOD FOR IMPROVING STUDENTS’ ACHIEVEMENT IN DERMATOTHERAPY: A PRELIMINARY STUDY Sri Linuwih Menaldi; Hanny Nilasari; Githa Rahmayunita; Siti Farida; Nanda L. Prasetya
Jurnal Pendidikan Kedokteran Indonesia: The Indonesian Journal of Medical Education Vol 9, No 3 (2020): November
Publisher : Asosiasi Institusi Pendidikan Kedokteran Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jpki.55485

Abstract

Background: Dermatotherapy is an important topic in Dermatology and Venereology module. The time allocated for dermatotherapy topic is limited, so that the development of learning method is needed to achieve the learning objectives. Blended learning is a combination of e-learning and face to face lecture session. This method is often used when there is less time available for lecturing and limited number of teachers. This learning method is expected to be more effective and efficient for the students and also the teachers. This study was conducted to examine the effectiveness of blended learning method used in dermatotherapy topic, and to identify the obstacle of using this method. Methods: This study is a cross sectional study, using quantitative and qualitative approach, involving 22 fifth-year medical students of Faculty of Medicine Universitas Indonesia who enrolled in dermatology and venereology module. We collected data from questionnaire, pre and post-test, and feedback from the students. Comparison of pre-test and post-test results were analysed using paired T test, and followed by bivariate test of students’ characteristic, gadget usage and e-learning activities associated with the increased post-test score.Results: An increased in post-test score was found to be statistically significant (p<0.05). Approximately 95,4% of students passed the final exam on the dermatotherapy subject. Bivariate analysis revealed that the number of gadgets owned, digital usage and e- learning activities did not have a significant effect on the post-test score. Based on the students’ feedback, blended learning had a positive impact on helping their learning process; however, the materials of e-learning must be interactive, informative and comprehensive. Face-to-face lecture is still an important component in learning hence it is irreplaceable. Conclusion: Blended learning is an effective method of learning and should be considered if there is limitation of lecture time and number of teachers available. By using this method, medical students are more flexible in their study and it can be adjusted to their own learning style hence heling them understand better. Further development and improvement are needed for this method as to achieve the learning objectives.  Keywords: blended learning, dermatotherapy, medical students
Multiple juvenile xanthogranuloma: A rare case of having clinical appearance mimicking molluscum contagiosum or syringoma Nugraha, Heru; Rosandi, Ridha; Nainggolan, Evelyn; Rahmayunita, Githa; Agustin, Triana; Rihatmadja, Rahadi; Boediardja, Siti Aisah
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 1
Publisher : UI Scholars Hub

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Abstract

Introduction: Juvenile xanthogranuloma (JXG) is an uncommon benign cutaneous fibrohistiocytic, self-healing, class II non-Langerhan’s cell histiocytosis (NLCH). JXG accounts for 80-90% of cases of NLCH. It occurs most commonly on the head and neck of infants and young children and resolves spontaneously. Case: A one year-old boy presented with asymptomatic, multiple yellowish, shiny, and firm nodules with telangiectasia on the surface, measuring around 1 centimeter in diameter, on the face, the trunk, the arms, and lower extremities. The first lesion appeared on the face 8 months prior to consultation then spread gradually to other areas. He was referred from another hospital and was diagnosed as molluscum contagiosum (MC) with differential diagnosis of syringoma. Enucleation had been performed but failed to produce the molluscum bodies. Initial histopathological examination provided the diagnosis of syringoma. The second histopathological examination showed dermal inflammatory cells consisting of eosinophils, lymphocytes, and histiocytes with marked foam cells and giant cells. Eccrine sweat glands were normal. Some lesions decreased in size at subsequent follow-ups; observation was advised until 3-6 years. Discussion: JXG should be suspected in cases with multiple yellowish nodules appearing in the first year of life. MC usually presents with whitish papules, whereas syringoma is more rarely appeared, presenting with yellow-to-brownish papules. Histopathological examination can easily differentiate the suspected diagnoses; however, selection of lesion, timing and complete clinical information was crucial in reaching the final diagnosis. In this case there was a good clinicopathological correlation that the diagnosis of JXG was made with certainty. There was no eye and other organ abnormalities.
Occupational skin cancer and precancerous lesions Raissa, Fifinela; Rahmayunita, Githa; Menaldi, Sri Linuwih; Soemarko, Dewi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 3
Publisher : UI Scholars Hub

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Abstract

Occupational skin cancer and precancerous lesions are skin disorders caused by exposure to chemical carcinogens such as polycyclic hydrocarbons and arsenic, or radiation, such as ultraviolet light and ionizing light in the workplace. Annual increase in skin cancer incidence is believed to be related to various factors such as frequent intense sunlight exposure (i.e. at work, recreational activities, and sun-tanning habit), ozone depletion, an increase in number of geriatric population, and an increase of public awareness in skin cancer. The most common occupational skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Examples of occupational precancerous lesion of the skin are actinic keratosis and Bowen’s disease. Particular diagnostic criteria to diagnose occupational diseases has been developed. Early detection of occupational skin cancer and precancerous lesion is necessary. An effective prevention program consists of primary prevention such as prevention of hazardous material exposure, secondary prevention such as early detection of disease for early intervention, and tertiary prevention such as minimizing long-term impact of the disease.
Profile of vitiligo patients and distribution of narrowband-UVB therapy at dr. Cipto Mangunkusumo General Hospital Suseno, Lis Surachmiati; Sukma, Putu Martha Gerynda; Rihatmadja, Rahadi; Agustin, Triana; Rahmayunita, Githa; Novianto, Endi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Abstract

Background: Vitiligo is a disease marked by depigmented macules. Prevalence of vitiligo varies between 0.1- 2.3% worldwide. The objectives of this study are to identify the socio-demographic profile of vitiligo patients and distribution of narrowband-UVB given as a treatment modality. However, in Indonesia, including at dr. Cipto Mangunkusumo General Hospital, there has not been any study on the profile of vitiligo patients. Therefore, a preliminary study on the patients’ profile would be very useful for healthcare providers in calculating the need for narrowband-UVB equipment and evaluation of its current use. Methods: A retrospective descriptive study, using secondary data obtained from dr. Cipto Mangunkusumo General Hospital medical records during the period of 2015-2017. Results: There were 255 vitiligo patients enrolled. Females were greater in number (55.3%). Most patients were distributed evenly in all age groups, highest number of patients were the 21-30 years age group (18.8%). Most patients received elementary school–high school education (56.9%), worked as private employees (36.9%), resided in Jakarta (47.8%). The common diagnosis were unspecified vitiligo (53.3%). Onset of symptoms were mostly around 2 months prior to diagnosis (38.8%) and most of the patients received other treatments other than narrowband-UVB (N=180, 70.6%). Conclusion: The number of vitiligo cases decreased each year with the average vitiligo cases of 85 cases per year and mostly women whereas the number of unspecified vitiligo were quite high. Therefore, more attention is needed from the physicians to treat the patient starting from the establishment of vitiligo to the decision treating with narrowband-UVB.
Diagnostic procedures in pediatric dermatology Widodo, Arini Astasari; Rahmayunita, Githa; Agustin, Triana; Astriningrum, Rinadewi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Abstract

Diagnostic procedures in pediatric dermatology are different and significantly more challenging than those in adult patients, especially on how to approach the patients. We need to acknowledge that pediatric patients have unique anatomical, physiological, and psychological aspects. Compared to adults, children have smaller procedure area, are less cooperative, and more difficult to understand. For these reasons, we should perform diagnostic procedures on children cautiously. Having extensive knowledge in this field can facilitate us to carry out an ethical, efficient, targeted procedure with less risk. This article reviewed the most appropriate, most comfortable, and least invasive diagnostic procedures for children. Some of the most commonly performed pediatric dermatology procedures highlighted in this article are potassium hydroxide examination, Gram staining examination, acid fast bacilli examination, skin test for allergies, and skin biopsy for children. We also discuss the process of obtaining a written informed consent from the parents who were involved in decision making process and play a crucial role in assisting physicians to calm their children during the diagnostic procedures.
Langerhans cell histiocytosis: Diagnosis and Management Lusiana, Lusiana; Sjakti, Hikari Ambara; Rahmayunita, Githa; Jacoeb, Tjut Nurul Alam; Krisanti, Inge Ade
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 4, No. 1
Publisher : UI Scholars Hub

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Abstract

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal clonal proliferation of Langerhans dendritic cells. The incidence of LCH is 1 to 3 cases per 1 million children worldwide, and occurs most frequently in children of 1–4 years of age. The etiopathogenesis of LCH, whether it is neoplastic or reactive, is still controversial. Langerhans cell histiocytosis has a wide spectrum of clinical features, and dermatological abnormalities usually occur early. The most frequent lesions are elevated yellowish-red translucent papules about 1–2 mm in diameter and generally located in seborrheic areas. The most recent classification (the Histiocyte Society study 2017) categorized LCH into four groups; a single system with involvement of unifocal or multifocal organs, lung LCH, and multi-system LCH with either low- or high-risk multiorgan involvement. The definitive diagnosis of LCH are typical morphology along with Birbeck granules and/or positive results on CD1a antigen stain on cells found on lesions. Treatment of LCH is multimodal, determined based on age, extent of lesion, organ involvement, and organ location.
The use of systemic medications in pediatric dermatoses: A review Narla, Shanthi; Rahmayunita, Githa; Astriningrum, Rinadewi; Shwayder, Tor; Yosi, Ariyati; Lim, Henry W.
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 4, No. 1
Publisher : UI Scholars Hub

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Abstract

Research has begun to illustrate a favorable efficacy and side-effect profile for many systemic agents used in pediatric dermatological conditions (i.e. atopic dermatitis, psoriasis, scleroderma, alopecia areata, chronic spontaneous urticaria, autoimmune blistering disorders, and hidradenitis suppurativa) despite not having extensive randomized clinical trials. The purpose of this article is to summarize the available data on the treatment regiments, safety, and efficacy of systemic immunosuppressants, including the newer biologics, focusing on the most up-to-date systematic reviews or randomized clinical trials. The review demonstrates that many of the present studies lack data on long-term efficacy and consist of small patient populations. Further research into the long-term safety of these systemic medications is of vital importance especially due to the chronic nature of most pediatric dermatological conditions that require the use of systemic agents.
The management of seborrheic dermatitis 2020 Widaty, Sandra; Bramono, Kusmarinah; Listiawan, Muhammad Yulianto; Yosi, Ariyati; Miranda, Eliza; Rahmayunita, Githa; Brahmanti, Herwinda; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
Publisher : UI Scholars Hub

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Abstract

Background: Seborrheic dermatitis (SD) is a chronic relapsing dermatitis manifesting in the seborrheic area, affecting infants or adults. In Indonesia, the prevalence of SD is 0.99–5.8% of all dermatology cases from 2013 to 2015. SD has been known to be a prominent manifestation among HIV patients, but there is an increasing trend in the general population. Therefore, in 2017, the Indonesian Society for Dermatology and Venereology proposed a consensus for the management of SD in Indonesia based on the discussion from 12 dermatological centers. Concurrent with the development of new drugs, this study aims to evaluate and develop a guideline for the treatment of seborrheic dermatitis in Indonesia to update the previous guidelines in 2017. Methods: Systematic review was based on evidence-based methods, and scientific evidences were acquired through systematic search. Evidence analysis was in accordance with the level of evidence. The available evidences were evaluated, and conclusion was based on the grade of recommendation. Critical appraisal was conducted by experts in dermatology and venereology. Results: Severity of SD can be determined by using the Seborrheic Dermatitis Area Severity Index. The principle of scalp SD management is controlling the scalp condition in a cost-effective manner to make patients comfortable. The recommendations for treatment of adult SD are topical agents, such as antifungals, nonsteroidal anti-inflammatory agents with antifungal properties, corticosteroids, and calcineurin inhibitors. Conclusion: We have updated and added newer agents for the treatment of SD. The approach is divided into scalp or nonscalp and also adult or infantile SD.
Generalized pustular psoriasis and Cushing’s syndrome in childhood due to corticosteroids misuse Azizah, Fitri; Rahman, Yusnita; Rihatmadja, Rahadi; Agustin, Triana; Astriningrum, Rinadewi; Rahmayunita, Githa
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 3
Publisher : UI Scholars Hub

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Abstract

Background: Generalized pustular psoriasis (GPP) is characterized clinically by yellowish sterile pustules surrounded by erythema. GPP in children is very rare and may appear following steroid withdrawal in psoriasis vulgaris.Case Illustration: A 14-year-old female presented to the emergency unit with generalized erythematous plaques and multiple pustules with lake of pus after abruptly stopped oral and topical corticosteroid for two weeks. The patient had used topical and oral corticosteroids for almost a year to treat psoriasis. Physical examination revealed moderately ill and tachycardic, with short stature, moon face, amenorrhea, and multiple erythematous plaques with multiple pustules and lake of pus along with red-purple striae all over the body.Discussion: Adverse effects of steroid-induced adrenal insufficiency are time-dependent and generally reversible. Gradual discontinuation of steroids must adhere to physiological dose of steroids, mostly in 3.49 ± 2.92 months. Other treatments available are emollients, salicylic acid, calcipotriol, coal tar, topical steroids, phototherapy, retinoids, and cyclosporine. Topical steroids cannot be the main therapy in severe psoriasis due to the possible side effects of excessive usage. Conclusion: Misuse of topical and systemic steroid in children could lead to Cushing’s syndrome, a multisystem disorder resulting from prolonged exposure to excess glucocorticoids, either both systemic or topical. Children could easily develop systemic reactions to topical steroids due to their higher total body surface area to body weight ratio.
Co-Authors Aldri Frinaldi Aman B. Pulungan Anis Irawan Arini Astasari Widodo Ariyati Yosi Ariyati Yosi Arlha Aporia Debinta Astriningrum, Rinadewi Azizah, Fitri Benny E. Wiryadi Benny Effendi Wiryadi Cita R. S. Prakoeswa Dewi Sumaryani Soemarko Eliza Miranda Endi Novianto Erdina H. D Pusponegoro Erdina Pusponegoro Evita Halim Effendi Eyleny Meisyah Fitri Fifinela Raissa Hanny Nilasari Harijono Kariosentono Henry W. Lim Henry Wan-Peng Lim Herwinda Brahmanti Hikari Ambara Sjakti, Hikari Ambara Hutabarat, Rodinda Irwan Saputra Batubara Jacoeb, Tjut N.A. Jacoeb, Tjut Nurul Alam Krisanti, Inge Ade Kusmarinah Bramono Larisa Paramitha Lim, Henry W Lim, Henry W. Lusiana Lusiana M. Yulianto Listiawan Miranda, Eliza Nainggolan, Evelyn Nanda L. Prasetya Narla, Shanthi Nugraha, Heru Pusponegoro, Erdina H.D. Rahadi Rihatmadja Rahman, Yusnita Reshinta, Reisa Retno Widowati Soebaryo Rinadewi Astriningrum Rosandi, Ridha Sandra Widaty Sandra Widaty Shafira Anindya Purnawan Shannaz Nadia Yusharyahya Shanthi Narla Shwayder, Tor Siti A. Boediardja Siti Aisah Boediardja Siti Farida Sri L. Menaldi Sri Linuwih Susetyo Wardhani, Sri Linuwih Susetyo Sukma, Putu Martha Gerynda Suseno, Lis Surachmiati Tina W. Wisesa Titi L. Sugito Tor Shwayder Triana Agustin Windy Keumala Budianti Windy Keumala Budianti Wresti Indriatmi B. Makes Yosi, Ariyati