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Epidermolisis bulosa tipe distrofik resesif dengan gizi buruk tipe marasmus pada seorang anak laki-laki: sebuah laporan kasus Made Hermina Laksmi; Ni Luh Putu Ratih Vibriyanti Karna; Herman Saputra; Aurelia Stephanie; Putu Gde Hariwangsa
Intisari Sains Medis Vol. 13 No. 2 (2022): (In Press : 1 August 2022)
Publisher : DiscoverSys Inc.

Background: Epidermolysis bullosa (EB) is characteristized of epithelial cell adhesion disorders that cause skin fragility and bullae after minor trauma or friction. EB Classification is based on the skin's morphological appearance and the degree to which The following reports a case of recessive dystrophic bullous epidermolysis with marasmus type malnutrition Case Report: An 8-year-old man, with complaints of wounds almost all over his body, initially in the form of bubbles filled with fluid which then burst into sores and over time, the bullae spread almost all over the body and oral mucosa. The patient has difficulty eating because of the frequent appearance of sores, so he becomes malnourished with the type of marasmus. The type of ED is inherited in an autosomal recessive manner. Since the age of 4 years, the patient's teeth began to decay, and the patient's fingers and toes were pseudosyndactyly. Histopathological examination results support severe generalized dystrophic recessive type EB (Hallopeau-Siemens). The patient treats with a compress of 0.9% NaCl for 10-15 minutes every 8 hours topically on erosional lesions, giving Petroleum jelly every 12 hours on the whole body, treating the wound using tulle, and then covering it with gauze every 24 hours, providing clinical improvement. Conclusion: Epidermolysis bullosa (EB) can be inherited in an autosomal recessive manner. Complaints of the fragility of the skin already appear at the age of children. Nutritional disorders are a problem that strengthens the condition of EB patients. Multidisciplinary management is needed to provide a good outcome. Latar Belakang: Epidermolysis bullosa (EB) memiliki karakteristik gangguan adhesi sel epitel yang menyebabkan kerapuhan pada kulit dan bula setelah terkena trauma atau gesekan ringan. Berikut dilaporkan satu kasus epidermolisis bulosa distrofik resesif dengan gizi buruk tipe marasmus Laporan Kasus: Laki- laki usia 8 tahun, dengan keluhan adanya luka hampir pada seluruh tubuh, berbentuk awal berupa gelembung berisi cairan yang kemudian pecah menjadi luka dan seiring jalannya waktu bula menyebar hampir seluruh tubuh hingga bagian mukosa mulut. Pasien mengalami kesulitan makan karena sering muncul luka sehingga menjadi gizi buruk dengan tipe marasmus. Tipe ED diturunkan secara autosomal resesif. Sejak usia 4 tahun gigi pasien mulai keropos, jari tangan dan jari kaki pasien pseudosyndactyly. Hasil pemeriksaan histopatologi menunjang gambaran epidermolisis bulosa. Pasien mengarah pada EB tipe resesif distrofik generalisata berat (Hallopeau-Siemens). Penatalaksanaan berupa kompres terbuka NaCl 0.9% selama 10-15 menit tiap 8 jam topikal pada lesi erosi, pemberian Petroleum jelly tiap 12 jam pada seluruh tubuh, rawat luka menggunakan tulle kemudian ditutup dengan kasa tiap 24 jam memberikan perbaikan klinis Simpulan: Epidermolysis bullosa dapat diturunkan secara autosomal resesif. Keluhan kerapuhan pada kulit sudah tampak pada usia anak-anak. Gangguan nutrisi menjadi permasalahan yang mempererat keadaan penderita EB. Tatalaksana multidisiplin diperlukan untuk memberikan luaran yang baik

Borderline Lepromatous Leprosy with Severe Erythema Nodosum Leprosum: A Case Report Nevristia Pratama; Luh Made Mas Rusyati; Prima Sanjiwani Saraswati Sudarsa; IGAA Dwi Karmila; NLP Ratih Vibriyanti Karna
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 34 No. 3 (2022): DECEMBER
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikk.V34.3.2022.210-216

Background: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae (M. leprae) that primarily infects Schwann cells in the peripheral nerves, leading to nerve damage and the development of disabilities. In 2018, Indonesia was the third country with the most leprosy cases in the world. Erythema nodosum leprosum (ENL), also known as type II leprosy reaction, is a severe immune-mediated complication of multibacillary leprosy. Purpose: To report a case of borderline lepromatous leprosy with severe ENL. Case: A 49-year-old Balinese man presented with multiple tender erythematous skin nodules all over his body, fever, arthralgia, bilateral cervical lymphadenopathy, and sensory loss for the past week. The acid-fast bacilli bacteriological examination showed a positive result. The patient was diagnosed with borderline lepromatous (BL) leprosy with severe ENL and was treated with multibacillary multidrug therapy (MB MDT), methylprednisolone, and other symptomatic medications. After 1 month of treatment, there was an improvement in skin lesions. The MB-MDT treatment was continued and methylprednisolone was planned to be tapered down gradually. Discussion: Approximately 20-50% of all leprosy patients show leprosy reactions in the course of the disease. The goals of treatment for severe ENL are to control inflammation, reduce pain, treat neuritis to prevent nerve dysfunction and contractures, and prevent recurring ENL. The prognosis of leprosy with ENL reactions depends on the severity of the occurring leprosy reaction; early diagnosis and prompt treatment; and patient compliance with treatment. Conclusion: Early diagnosis and treatment are essential to avoid deformities in leprosy patients.

EFEKTIVITAS TERAPI SISTEMIK DAN TOPIKAL DALAM PENGOBATAN MELASMA Ni Made Ari Purwaningrum; Sang Ayu Arta Suryantari; Ni Luh Putu Ratih Vibriyanti Karna
GEMA KESEHATAN Vol. 12 No. 2 (2020): Desember 2020
Publisher : POLTEKKES KEMENKES JAYAPURA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47539/gk.v12i2.136

Melasma secara klinis digambarkan sebagai makula tidak teratur atau bercak hiperpigmentasi kronis yang umumnya terjadi pada wajah. Patogenesis melasma belum diketahui secara pasti namun berkaitan dengan paparan sinar ultraviolet (UV). Karena sifatnya yang kronis dan sering kambuh, melasma sulit untuk ditangani. Pengobatan yang tersedia saat ini seringkali memiliki efek samping yang tidak diinginkan dan hasil yang kurang optimal. Ulasan sistematis dibuat untuk merangkum efektivitas dan rekomendasi terapi sistemik dan topikal pada pengobatan melasma. Metode: Pencarian artikel di basis data PubMed, Cochrane library dan Medline dari Januari 2010 sampai Desember 2019. Hanya studi RCT, meta-analisis dan ulasan sistematis yang berfokus pada terapi sistemik dan topikal pada melasma yang dilakukan ekstraksi, analisis dan didiskusikan. Didapatkan total 17 artikel yang sesuai dengan kriteria tersebut. Terapi sistemik dan topikal yang diulas yaitu glutathione, asam traneksamat melatonin, cysteamine, flutamide, methimazole dan serum pengoreksi pigmen. Agen tersebut terbukti efektif, aman dan ditoleransi dengan baik. Berbagai bukti terapi sistemik, topikal dan kombinasi saat ini memiliki kelebihan dan kekurangan masing-masing. Pilihan modalitas pengobatan harus disesuaikan dengan tingkat keparahan, luas dan lokasi melasma. Pemahaman yang lebih baik tentang melasma melalui penelitian lebih lanjut dapat meningkatkan pilihan terapi dengan efek samping yang paling sedikit.

A Rare Case of Orbital Cellulitis with Tolosa-Hunt Syndrome Caused by Methicillin-Resistant Staphylococcus aureus (MRSA): a Case Report Bharata, Putu Evindya Vipascitadewi Nandanaya; Suryawati, Nyoman; Karna, Ratih Vibriyanti; Duarsa, Putu Laksmi Anggari Putri; Juliari, Gusti Ayu Made
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 34 No. 2 (2022): AUGUST
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikk.V34.2.2022.137-142

Background: Orbital cellulitis is an active infection of the orbital soft tissue posterior to the orbital septum, which can cause Tolosa-Hunt Syndrome (THS) complication. Purpose: We reported a child with orbital cellulitis with THS complication caused by methicillin-resistant Staphylococcus aureus (MRSA). Case: A two-year-old girl complained of swelling and pain in the left eye accompanied by fever. In nasal region and left eye showed multiple erythema patches with geographic shape, size 1x2cm - 4x5cm, unclear border, erosion with sizes 0.5x1cm - 1x1.5 cm size covered with blackish crusts. After several days of hospitalization, she complained of proptosis and pain in moving her eye. We did the magnetic resonance imaging (MRI) scan examination, which showed a mass size of 2.2 x1.1 x 0.9 cm in a left intraconal orbital and dilation of the left-sided cavernous sinus. The blood culture showed MRSA bacteria. She was diagnosed with orbital cellulitis with THS complication and showed a good response with Meropenem, Methylprednisolone, cendo lyteers eye drops, levofloxacin eye drops, and gentamicin eye ointment. Discussion: Orbital cellulitis presents as ill-defined erythema, edema, warmth, and pain around the nasal and the orbital region and is more often found in children. The THS complication is characterized by ophthalmoplegia, unilateral orbital or periorbital pain, unilateral headache, and leukocytosis. Orbital cellulitis management includes antibiotic intravenous, corticosteroid, and eye care. Conclusion: THS is a rare complication of orbital cellulitis. Early diagnosis and management of orbital cellulitis are essential to prevent THS complication.

Serum Interleukin-6 Levels are Positively Correlated with the Severity of Acne Vulgaris Triatmakusuma, Yogi; Praharsini, I Gusti Ayu Agung; Darmaputra, I Gusti Nyoman; Winaya, Ketut Kwartantaya; Karna, Ni Luh Putu Ratih Vibriyanti; Puspawati, Ni Made Dwi
Journal La Medihealtico Vol. 5 No. 1 (2024): Journal La Medihealtico
Publisher : Newinera Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37899/journallamedihealtico.v5i1.1056

Acne vulgaris is a chronic inflammatory disease that affects the pilosebaceous unit. This disease occurs on the skin of the face, body, back, and other areas of the body, and can leave scars on the skin which can be temporary or permanent. Recent data shows that the inflammatory process is the initial process in the pathogenesis of acne, several pro-inflammatory cytokines, one of which is interleukin 6 (IL-6), which plays a role in acne vulgaris. Analytical observational study with a cross-sectional approach. The research was carried out from February - November 2023 at the Skin and Venereology Polyclinic, RSUP Prof. Dr. I.G.N.G. Ngoerah Denpasar and the Clinical Pathology Laboratory of Prof IGNG Ngoerah Hospital. The sample consisted of 47 samples of patients with acne and 20 samples without acne aged 8 - 45 years who were selected through consecutive sampling according to inclusion and exclusion criteria. A sample of 3 milliliters of venous blood is taken which will then be checked for IL-6 with an ELISA kit. Data analysis with SPSS version 24 and p value <0.05 is significant. The mean IL-6 serum levels in the acne group was 110.2 ± 88.3 pg/ml while in the non-acne group it was 26.7 ± 23.7 pg/ml. There was a significant difference in the category of IL-6 levels in the acne and non-acne groups (95% CI 55.1 - 155.3, p<0.001). The correlation analysis of IL-6 levels with the severity of acne was strongly positive (r=0.951, p<0.001).

Beyond the Usual Suspects: Phialophora verrucosa Chromoblastomycosis in a Swimming Pool Attendant and Gardener Andrew Wicaksono; Ni Luh Putu Ratih Vibriyanti Karna; Mario Korwa; Nandya Dwizella; Herman Saputra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1422

Background: Chromoblastomycosis (CBM) is a chronic, debilitating subcutaneous mycosis caused by traumatic inoculation of dematiaceous fungi. As a Neglected Tropical Disease, it poses significant diagnostic and therapeutic challenges, particularly in the endemic tropical and subtropical regions where it is most prevalent. While Fonsecaea pedrosoi is the most common etiologic agent, infections by other species are crucial to document for accurate epidemiological surveillance. Case presentation: A 26-year-old immunocompetent male presented with a four-year history of a slowly progressive, verrucous plaque on his right hand, initiated by minor trauma. His history was notable for regular gardening without protective gear. A comprehensive diagnostic workup was performed. Dermoscopy revealed features characteristic of CBM, including reddish-black dots and yellowish-orange areas. While direct microscopy of skin scrapings was negative, histopathology of a skin biopsy confirmed a suppurative granulomatous reaction with pathognomonic muriform cells. Fungal culture on Sabouraud's dextrose agar definitively identified the causative agent as Phialophora verrucosa. The patient showed marked clinical improvement after three months of treatment with oral itraconazole (200 mg/day). Conclusion: This case highlights the successful diagnosis of a rare CBM pathogen in Indonesia through a systematic, multimodal approach. It reinforces the need for a high index of suspicion for this mycosis in patients from endemic areas with chronic verrucous lesions and a history of cutaneous trauma. The essential role of mycology culture for definitive species identification is underscored, a critical step for guiding therapy and informing public health strategies.

A Methodical Approach to a 15-Year Diagnostic Enigma: Unmasking Acrodermatitis Continua of Hallopeau Through Dermoscopy, Histopathology, and Structured Therapeutic Sequencing Luh Putu Sustiana Kartika Sari; Ni Luh Putu Ratih Vibriyanti Karna
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1460

Background: Acrodermatitis continua of Hallopeau (ACH) is a rare, debilitating variant of pustular psoriasis. Its profound clinical mimicry of common infections, particularly onychomycosis, often leads to extensive diagnostic delays and ineffective treatments, causing significant patient morbidity. This report details a case with a 15-year history of misdiagnosis, illustrating a structured methodological approach to diagnosis and management. Case presentation: A 40-year-old Indonesian woman presented with a 15-year history of painful pustular lesions and severe onychodystrophy affecting seven digits, refractory to numerous antimicrobial therapies. The diagnostic process was systematically re-evaluated; dermoscopy revealed features inconsistent with onychomycosis (dotted vessels, hemorrhagic spots), prompting a definitive skin and nail matrix biopsy. Histopathology confirmed pustular psoriasis with pathognomonic Kogoj's spongiform pustules and Munro's microabscesses. Treatment was initiated with cyclosporine (3.3 mg/kg/day), leading to rapid remission. However, the development of gingival hyperplasia and hypertension necessitated a transition to weekly methotrexate (15 mg). The patient achieved and maintained clinical remission on this regimen. Conclusion: This case underscores the necessity of a high index of suspicion for ACH in chronic, treatment-resistant nail dystrophy. It demonstrates that a methodical application of dermoscopy and histopathology is indispensable for overcoming clinical mimicry. The main lesson is that structured diagnostic evaluation and sequenced therapy, responsive to adverse events, are crucial for achieving long-term remission and restoring quality of life.

A Methodical Approach to a 15-Year Diagnostic Enigma: Unmasking Acrodermatitis Continua of Hallopeau Through Dermoscopy, Histopathology, and Structured Therapeutic Sequencing Luh Putu Sustiana Kartika Sari; Ni Luh Putu Ratih Vibriyanti Karna
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1460

Background: Acrodermatitis continua of Hallopeau (ACH) is a rare, debilitating variant of pustular psoriasis. Its profound clinical mimicry of common infections, particularly onychomycosis, often leads to extensive diagnostic delays and ineffective treatments, causing significant patient morbidity. This report details a case with a 15-year history of misdiagnosis, illustrating a structured methodological approach to diagnosis and management. Case presentation: A 40-year-old Indonesian woman presented with a 15-year history of painful pustular lesions and severe onychodystrophy affecting seven digits, refractory to numerous antimicrobial therapies. The diagnostic process was systematically re-evaluated; dermoscopy revealed features inconsistent with onychomycosis (dotted vessels, hemorrhagic spots), prompting a definitive skin and nail matrix biopsy. Histopathology confirmed pustular psoriasis with pathognomonic Kogoj's spongiform pustules and Munro's microabscesses. Treatment was initiated with cyclosporine (3.3 mg/kg/day), leading to rapid remission. However, the development of gingival hyperplasia and hypertension necessitated a transition to weekly methotrexate (15 mg). The patient achieved and maintained clinical remission on this regimen. Conclusion: This case underscores the necessity of a high index of suspicion for ACH in chronic, treatment-resistant nail dystrophy. It demonstrates that a methodical application of dermoscopy and histopathology is indispensable for overcoming clinical mimicry. The main lesson is that structured diagnostic evaluation and sequenced therapy, responsive to adverse events, are crucial for achieving long-term remission and restoring quality of life.

Leprosy Trophic Ulcer Management Karna, Ni Luh Putu Ratih Vibriyanti
Review of Primary Care Practice and Education Vol 8, No 1 (2025): January
Publisher : Faculty of Medicine, Public Health, and Nursing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/rpcpe.103179

Background: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, also a polymorphic disease with a wide range of neurocutaneous manifestations. Unfortunately, delayed diagnosis and treatment are still an issue in endemic poor resource settings and in non-endemic countries due to global migration. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio’s phenomenon (LP), or secondary to neuropathies. Objective:To study the treatment options to manage leprosy trophic ulcer. Method: The Google-scholar, Science-Direct database, and ResearchGate from 2010 until September 2023 were searched using the keywords “leprosy ulcer”, “leprosy trophic ulcer”, “plantar leprosy ulcer”, and “leprosy ulcer management.” All available cohort studies, case-series, case-reports, and expert reviews were included with an emphasis on leprosy trophic ulcer management. Results: The trophic ulcer evolves initially from a trauma/deep fissure/callosity or tenderness over pressure-bearing areas of palms and soles. Anesthesia of the foot is the central factor in the pathogenesis of plantar ulcer. Sufficient rest for a simple ulcer is essential for ulcer healing. Topical treatment to promote wound healing includes phenytoin, zinc oxide, platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and hydrocolloid dressing. Various surgical methods are available for management of plantar ulcers, including skin grafts and different types of flaps. In primary care settings, early detection, patient education, and self-care practices are essential in preventing severe ulcerations and recurrence. A clinical sign that can be suspected is the stage of threatened ulcer, called the pre-ulcerative with aseptic inflammation, usually occurring under a joint or a bony prominence of the foot and characterized by edematous lesions. Initial management in primary care including wound care and protection, limiting mobility, and reducing heavy loads on the wound area, especially in the lower extremities. Conclusion: Leprosy trophic ulcer management includes sufficient rest, topical treatment to promote wound healing, and various surgical methods.

Kadar Transforming Growth Factor- Serum Berkorelasi Positif dengan Kadar Immunoglobulin M Anti-Phenolic Glycolipid-1 pada Narakontak Serumah Pasien Kusta Multibasiler Primasari, Putu Yunita; Rusyati, Luh Made Mas; Karmila, I Gusti Ayu Agung Dwi; Winaya, Ketut Kwartantaya; Suryawati, Nyoman; Karna, Ni Luh Putu Ratih Vibriyanti
Jurnal Biomedika dan Kesehatan Vol 6 No 2 (2023)
Publisher : Fakultas Kedokteran Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/JBiomedKes.2023.v6.146-157

Background Leprosy is a chronic progressive infectious disease. Phenolic glycolipid-1 (PGL-1) is an antigen of Mycobacterium leprae, which can trigger the host’s antibody response. Transforming growth factorβ (TGF-β) plays an immunosuppressive role when the host is exposed to PGL-1 antigen or other M. leprae antigens. This study aims to determine the correlation of TGF-β levels with IgM anti-PGL-1 levels in patients with multibacillary leprosy household contacts. Methods Observational analytical study with a cross-sectional approach. The study subjects consisted of 48 household contact subjects and 24 non-household contact subjects aged 15-65 years old who were selected by consecutive sampling based on inclusion and exclusion criteria. 3 mL of venous blood samples were taken and then examined for IgM anti-PGL-1 and TGF-β with the ELISA kit. Data analysis was carried out using SPSS version 23, and a p-value <0.05 was significant. Results The mean level of IgM anti-PGL-1 in the household contact group was 685.46 ± 290.79 u/mL, while in the non-household contact group was 345.50 ± 206.58 u/mL. The mean TGF-β level in household contact groups was 256.69 ± 127.41 pg/mL, while in the non-household contact group was 144.85 ± 36.73 pg/mL (p<0.001). This study found a moderate positive relationship (r=0.450, p<0.001) between levels of TGF-β and IgM anti-PGL-1 household contacts and non-household contacts group. Conclusions The mean level of IgM anti-PGL-1 and TGF-β in household contacts is higher than in non-household contacts, with a significant difference. There is a moderate positive significant relationship between levels of TGF-β and IgM anti-PGL-1 household contacts and non-household contacts group.

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