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Retrospective Study: Type 1 Leprosy Reaction Pratamasari, Meita Ardini; Listiawan, M. Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 27, No 2 (2015): BIKKK AGUSTUS 2015
Publisher : Faculty Of Medicine Airlangga University

Background: Type 1 reaction (T1R) of leprosy occurs due toaltered balance between cell mediated immunity and M. leprae bacilli in the skin and nerves, with upgrading/reversal or downgrading as final result. Leprosy subpolar types have unstable immunity, this cause them often experience recurrence T1R, especially BB type.Clinical findings of T1R are inflammation in the skin or nerves, and can lead to disability if not treated properly. Aim: To evaluate the distribution, diagnosis, trigger factors, and therapy of T1R. Methods: Retrospective study using medical record of leprosy new patients in Dermatology and Venereology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya, during 2010 â 2013. Database, anamnesis, examination, and T1R therapy were recorded. Results: The total of new leprosy patients with T1R within 2010-2013 were 117 patients (19,7% of all new leprosyÂ patients). Most of them were men (70,1%), aged between 15â34 years (42,8%), with BB as the most frequent type (70,9%). Skin symptom of T1R could be thickening of old lesion (52,1%). T1R most occurred when patients still consume MDT (71,8%). NSAID (37,6%) andcorticosteroid (38,5%)were prescribed as T1R therapy. Conclusions: T1R diagnosis should established accurately by history taking and physical examination.For recurrent T1R,trigger factors should be considered.Key words: type 1 reaction, CMI, reversal, downgrading.

Reverse Transcription Polymerase Chain Reaction (RT-PCR) untuk Mendeteksi Viabilitas Mycobacterium leprae pada Pasien Kusta Tipe Multibasiler Pascapengobatan MDT-WHO Gayatri, Lunni; Listiawan, M. Yulianto; Agusni, Indropo
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 26, No 2 (2014): BIKKK AGUSTUS 2014
Publisher : Faculty Of Medicine Airlangga University

Latar belakang: Kusta masih menjadi masalah besar di Indonesia. Penatalaksanaan dengan MDT-WHO telah menjadi regimen standar untuk pasien kusta sejak lama. Pada pasien kusta tipe multibasiler (MB), indeks bakteriologis (IB) belum mencapai nilai nol, meskipun telah menyelesaikan terapi 12 regimen. Metode Reverse Transcription-Polymerase Chain Reaction (RT-PCR) memiliki sensitivitas tinggi untuk mendeteksi viabilitas M. leprae. Tujuan: Mengevaluasi viabilitas M. leprae dengan metode RT-PCR pada pasien kusta tipe MB yang telah menyelesaikan regimen MDT 12 di RSUD Dr. Soetomo Surabaya. Metode: 15 pasien kusta tipe MB yang telah menyelesaikan pengobatan MDT-WHO 12 regimen dengan IB positif dilakukan biopsi kulit untuk pemeriksaan RT-PCR. Hasil: Terdapat 13 pasien (86,7%) dengan viabilitas M. leprae positif sementara seluruh pasien tersebut (100%) memiliki Indeks Morfologis (IM) 0%. Dua belas pasien (80%) memiliki Indeks Bakteriologis 2+ dan 10 pasien diantaranya adalah pasien kusta tipe Lepromatous Leprosy (LL) polar. Delapan pasien yang memiliki viabilitas positif tidak mendapatkan kortikosteroid oral selama siklus MDT. Simpulan: Pasien kusta yang telah menyelesaikan terapi MDT dengan MI 0%, didapatkan viabilitas M. Leprae positif dengan metode RT-PCR. Spektrum klinis pasien yang ditentukan dari imunitas seluler nampaknya menjadi faktor terpenting dalam viabilitas M. leprae.Katakunci: viabilitas, M. leprae, kusta tipe multibasiler, RT-PCR.

Kesesuaian Gambaran Klinis Patognomonis Infestasi Skabies dengan Kepositifan Pemeriksaan Dermoskop dan Kerokan Kulit Kurniati, Kurniati; Zulkarnain, Iskandar; Listiawan, M. Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 26, No 1 (2014): BIKKK APRIL 2014
Publisher : Faculty Of Medicine Airlangga University

Latar belakang: Diagnosis infestasi skabies oleh klinisi umumnya ditegakkan dengan gejala klinis patognomonis skabies. Tetapi gejala skabies seringkali tidak khas akibat adanya kemiripan dengan penyakit lain terutama pada anak-anak dan kondisi imunokompromais, sehingga diagnosis klinis seringkali keliru dan mengakibatkan kesalahan pemberian terapi. Diperlukan penegakan diagnosis definitif untuk menemukan Sarcoptes scabiei (S. scabiei) atau telurnya, yang secara konvensional dapat dilakukan dengan pemeriksaan mikroskopik dari kerokan lesi kulit penderita. Namun metode tersebut tidak praktis, membutuhkan keterampilan khusus, cenderung invasif, seringkali memerlukan beberapa kali kerokan, serta sulit dilakukan pada anak-anak, sehingga diperlukan metode yang mudah, non-invasif, dan akurasi yang baik. Pemeriksaan dermoskop menawarkan solusi tersebut. Tujuan: Mengevaluasi kesesuaian gambaran klinis patognomonis infestasi skabies dengan kepositifan dermoskop dan pemeriksaan kerokan kulit Metode: Studi analitik observasional cross sectional, total sampling dalam satu kali observasi pada 243 populasi terjangkau yang berusia 5-14 tahun di satu pondok pesantren. Terdapat 44 sampel yang memenuhi kriteria penerimaan sampel yang dilakukan anamnesis dan pemeriksaan fisik untuk menentukan gejala klinis patognomonis skabies, selanjutnya diperiksa dengan dermoskop dan mikroskop dari kerokan kulit pada lesi. Analisis hasil dengan menghitung kappa agreement dan nilai prediksi positif. Hasil: Dari 44 sampel didapatkan 25 sampel klinis patognomonis skabies dan 19 sampel klinis non patognomonis skabies. Pemeriksaan dermoskopi ditemukan positif pada 25 sampel dan mikroskopik kerokan kulit positif pada 18 sampel. Kesesuaian dermoskopi dan kerokan kulit adalah 79,5%, kappa 0,601. Simpulan: Dermoskop berpotensi digunakan sebagai alat diagnostik definitif skabies pada lingkungan dengan prevalensi tinggi skabies. Kata kunci: skabies, dermoskop, kerokan kulit.

Dermoscopic Features of Alopecia Patient Paramita, Kartika; Listiawan, M. Yulianto; Rahmadewi, Rahmadewi
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol 27, No 3 (2015): BIKKK DESEMBER 2015
Publisher : Faculty Of Medicine Airlangga University

Backgroud: Alopecia is hair loss of the scalp that occurs in mostly men and about 30% of women during their lifetime. Prevalence of alopecia is increased along with age in both men and women. Using of dermoscope can help the diagnostic accuracy and avoid scalp biopsy for diagnosis. Purpose: Identifying dermoscope examination results and determine the pathophysiology of dermoscope features. Methods: Cross sectional and descriptiove observational study to all of alopecia patients who fulfilled the inclusion criteria at outpatient clinic Dr. Soetomo General Hospital Surabaya in December 2014 through February 2015 performed dermoscope examination Result: There were 20 patients who fulfilled the inclusion criteria, consisted of 3 patients with androgenetic alopecia, 8 alopecia areata, 4 tinea capitis, 2 discoid lupus erythematosus, 1 psoriasis vulgaris, 1 seborheic dermatitis, and 1 trichotilomania. Conclusion: Most of all dermoscope features accordance with the description in the literature, the most diagnosis is androgenetic alopecia.Key words: alopecia, dermoscope, zig-zag hair, black dots.

Kesesuaian Gambaran Klinis Patognomonis Infestasi Skabies dengan Kepositifan Pemeriksaan Dermoskop dan Kerokan Kulit Kurniati Kurniati; Iskandar Zulkarnain; M. Yulianto Listiawan
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 26 No. 1 (2014): BIKKK APRIL 2014
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikk.V26.1.2014.1-8

Latar belakang: Diagnosis infestasi skabies oleh klinisi umumnya ditegakkan dengan gejala klinis patognomonis skabies. Tetapi gejala skabies seringkali tidak khas akibat adanya kemiripan dengan penyakit lain terutama pada anak-anak dan kondisi imunokompromais, sehingga diagnosis klinis seringkali keliru dan mengakibatkan kesalahan pemberian terapi. Diperlukan penegakan diagnosis definitif untuk menemukan Sarcoptes scabiei (S. scabiei) atau telurnya, yang secara konvensional dapat dilakukan dengan pemeriksaan mikroskopik dari kerokan lesi kulit penderita. Namun metode tersebut tidak praktis, membutuhkan keterampilan khusus, cenderung invasif, seringkali memerlukan beberapa kali kerokan, serta sulit dilakukan pada anak-anak, sehingga diperlukan metode yang mudah, non-invasif, dan akurasi yang baik. Pemeriksaan dermoskop menawarkan solusi tersebut. Tujuan: Mengevaluasi kesesuaian gambaran klinis patognomonis infestasi skabies dengan kepositifan dermoskop dan pemeriksaan kerokan kulit Metode: Studi analitik observasional cross sectional, total sampling dalam satu kali observasi pada 243 populasi terjangkau yang berusia 5-14 tahun di satu pondok pesantren. Terdapat 44 sampel yang memenuhi kriteria penerimaan sampel yang dilakukan anamnesis dan pemeriksaan fisik untuk menentukan gejala klinis patognomonis skabies, selanjutnya diperiksa dengan dermoskop dan mikroskop dari kerokan kulit pada lesi. Analisis hasil dengan menghitung kappa agreement dan nilai prediksi positif. Hasil: Dari 44 sampel didapatkan 25 sampel klinis patognomonis skabies dan 19 sampel klinis non patognomonis skabies. Pemeriksaan dermoskopi ditemukan positif pada 25 sampel dan mikroskopik kerokan kulit positif pada 18 sampel. Kesesuaian dermoskopi dan kerokan kulit adalah 79,5%, kappa 0,601. Simpulan: Dermoskop berpotensi digunakan sebagai alat diagnostik definitif skabies pada lingkungan dengan prevalensi tinggi skabies. Kata kunci: skabies, dermoskop, kerokan kulit.

Reverse Transcription Polymerase Chain Reaction (RT-PCR) untuk Mendeteksi Viabilitas Mycobacterium leprae pada Pasien Kusta Tipe Multibasiler Pascapengobatan MDT-WHO Lunni Gayatri; M. Yulianto Listiawan; Indropo Agusni
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 26 No. 2 (2014): BIKKK AGUSTUS 2014
Publisher : Faculty of Medicine, Universitas Airlangga

Latar belakang: Kusta masih menjadi masalah besar di Indonesia. Penatalaksanaan dengan MDT-WHO telah menjadi regimen standar untuk pasien kusta sejak lama. Pada pasien kusta tipe multibasiler (MB), indeks bakteriologis (IB) belum mencapai nilai nol, meskipun telah menyelesaikan terapi 12 regimen. Metode Reverse Transcription-Polymerase Chain Reaction (RT-PCR) memiliki sensitivitas tinggi untuk mendeteksi viabilitas M. leprae. Tujuan: Mengevaluasi viabilitas M. leprae dengan metode RT-PCR pada pasien kusta tipe MB yang telah menyelesaikan regimen MDT 12 di RSUD Dr. Soetomo Surabaya. Metode: 15 pasien kusta tipe MB yang telah menyelesaikan pengobatan MDT-WHO 12 regimen dengan IB positif dilakukan biopsi kulit untuk pemeriksaan RT-PCR. Hasil: Terdapat 13 pasien (86,7%) dengan viabilitas M. leprae positif sementara seluruh pasien tersebut (100%) memiliki Indeks Morfologis (IM) 0%. Dua belas pasien (80%) memiliki Indeks Bakteriologis 2+ dan 10 pasien diantaranya adalah pasien kusta tipe Lepromatous Leprosy (LL) polar. Delapan pasien yang memiliki viabilitas positif tidak mendapatkan kortikosteroid oral selama siklus MDT. Simpulan: Pasien kusta yang telah menyelesaikan terapi MDT dengan MI 0%, didapatkan viabilitas M. Leprae positif dengan metode RT-PCR. Spektrum klinis pasien yang ditentukan dari imunitas seluler nampaknya menjadi faktor terpenting dalam viabilitas M. leprae.Katakunci: viabilitas, M. leprae, kusta tipe multibasiler, RT-PCR.

Retrospective Study: Type 1 Leprosy Reaction Meita Ardini Pratamasari; M. Yulianto Listiawan
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 27 No. 2 (2015): BIKKK AGUSTUS 2015
Publisher : Faculty of Medicine, Universitas Airlangga

Background: Type 1 reaction (T1R) of leprosy occurs due toaltered balance between cell mediated immunity and M. leprae bacilli in the skin and nerves, with upgrading/reversal or downgrading as final result. Leprosy subpolar types have unstable immunity, this cause them often experience recurrence T1R, especially BB type.Clinical findings of T1R are inflammation in the skin or nerves, and can lead to disability if not treated properly. Aim: To evaluate the distribution, diagnosis, trigger factors, and therapy of T1R. Methods: Retrospective study using medical record of leprosy new patients in Dermatology and Venereology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya, during 2010 – 2013. Database, anamnesis, examination, and T1R therapy were recorded. Results: The total of new leprosy patients with T1R within 2010-2013 were 117 patients (19,7% of all new leprosy patients). Most of them were men (70,1%), aged between 15–34 years (42,8%), with BB as the most frequent type (70,9%). Skin symptom of T1R could be thickening of old lesion (52,1%). T1R most occurred when patients still consume MDT (71,8%). NSAID (37,6%) andcorticosteroid (38,5%)were prescribed as T1R therapy. Conclusions: T1R diagnosis should established accurately by history taking and physical examination.For recurrent T1R,trigger factors should be considered.Key words: type 1 reaction, CMI, reversal, downgrading.

Dermoscopic Features of Alopecia Patient Kartika Paramita; M. Yulianto Listiawan; Rahmadewi Rahmadewi
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 27 No. 3 (2015): BIKKK DESEMBER 2015
Publisher : Faculty of Medicine, Universitas Airlangga

Backgroud: Alopecia is hair loss of the scalp that occurs in mostly men and about 30% of women during their lifetime. Prevalence of alopecia is increased along with age in both men and women. Using of dermoscope can help the diagnostic accuracy and avoid scalp biopsy for diagnosis. Purpose: Identifying dermoscope examination results and determine the pathophysiology of dermoscope features. Methods: Cross sectional and descriptiove observational study to all of alopecia patients who fulfilled the inclusion criteria at outpatient clinic Dr. Soetomo General Hospital Surabaya in December 2014 through February 2015 performed dermoscope examination Result: There were 20 patients who fulfilled the inclusion criteria, consisted of 3 patients with androgenetic alopecia, 8 alopecia areata, 4 tinea capitis, 2 discoid lupus erythematosus, 1 psoriasis vulgaris, 1 seborheic dermatitis, and 1 trichotilomania. Conclusion: Most of all dermoscope features accordance with the description in the literature, the most diagnosis is androgenetic alopecia.Key words: alopecia, dermoscope, zig-zag hair, black dots.

The Use of Thalidomide in Steroid Dependent Continous Erythema Nodosum Leprosum Leprosy Patient: A Case Report Dian Pertiwi Habibie; M Yulianto Listiawan
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 28 No. 2 (2016): AGUSTUS
Publisher : Faculty of Medicine, Universitas Airlangga

Background: Treatment thalidomide in erythema nodosum leprosum (ENL), can inhibits the transcription repression mediated by tumor necroting factor (TNF). Thalidomide can be used as sparing agents drug to reduce the dependency of steroid. Purpose: To report the effectiveness of thalidomide to treat ENL and of relinquish steroid dependency. Case: A 39 years old patient with leprosy borderline lepromatous type, came with complain bumps on skin accompanied with fever, occurring recurrently since 4 years ago if the steroid’s dose tappered off. He consumed steroid routinely every day for the last 4 years and if the dose was tapered to 4 mg once daily, the painful bumps reappeared often accompanied by fever. Thalidomide 50 mg twice daily and methyl prednisolone 4 mg once daily was given. The constant tapering off of methyl prednisolone done every week. After a month, the patient shown significant improvement. Discussion: Thalidomide is effective in ENL, it is regarded as first line in terms of clinical efficiency because it displays an effect on 90% of ENL patients. In this case, thalidomide was given and steroid dose was reduced slowly while observing the clinical manifestation and patient’s complain. There were no complain of recurrent ENL after discontinuation of steroid and thalidomide, no serious adverse event happened in this patient as well. Conclusion: The effectiveness of thalidomide in ENL is primarily due to its action on TNF but other mechanisms may contribute to its anti-inflammatory effect. Thalidomide is effective in the management of steroid dependent ENL patient. Key words: thalidomide, steroid dependent, methyl prednisolone, erythema nodosum leprosum

The Effects of Platelet Rich Plasma Topical Gel on Chronic Plantar Ulcer Healing in Leprosy Patient Diana Kartika Sari; M. Yulianto Listiawan; Diah Mira Indramaya
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 28 No. 3 (2016): DESEMBER
Publisher : Faculty of Medicine, Universitas Airlangga

Background: Plantar ulcer is a physical disability that most often occurs in approximately 10-20% of leprosy patient. Conventional therapies such as dressings, surgical debridement, and skin graft can not provide satisfactory improvement. Platelet rich plasma (PRP) has a variety of growth factors required in ulcer wound healing. Purpose: To prove the effect of PRP topical gel to the size of wound, macrophage activation, neovascularization, fibrosis, and formation of granulation tissue on chronic plantar ulcer healing in leprosy patients. Methods: The analytic cohort study of 20 leprosy patients with chronic plantar ulcer in Morbus Hansen Division, Dermatology and Venereology Outpatient Clinic, Dr. Soetomo Hospital Surabaya. Biopsies were performed before and after PRP topical gel treatment on leprosy patient with chronic plantar ulcers. Results: After two doses of PRP topical gel, wound size of 9 patients (45%) was reduced <0.5 cm. Statistycal analysis showed significant differences in size of lesions (p = <0.05), the number of macrophages (p = <0.001), number of capillaries (p = 0.003), and the amount of granulation (p = 0.032) before and after PRP topical gel treatment. While the results of the analysis of the number of fibroblasts showed no significant difference (p = <0.05). Conclusion: PRP topical gel treatment gives good results, in terms of improvement in wound size, an increase in macrophages, neovascularization and granulation tissue.

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