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Selection of topical corticosteroids in children atopic dermatitis Aurelia Stephanie; Prima Sanjiwani Saraswati Sudarsa; Luh Mas Rusyati
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 2 No. 2 (December 2019)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/xmbe0178

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically starts in childhood with classic symptoms of dry and itchy skin that occurs continuously and recurrences and even causes sleep disorders and skin that is susceptible to infection. AD sufferers often have atopic comorbidities such as asthma and allergic rhinitis in themselves and their families. The effects of this itching cycle result in growth disturbance and decreased quality of life for AD patients and their parents. Moderate and severe AD have an impact on parents, the stress in medication, and care, which takes up time and money. Atopic dermatitis is due to damage to the skin barrier, so the principle of management is to improve the skin barrier so that the inflammatory process can be avoided. The course of AD is chronic and relapsing; generally, patients come for treatment with an acute phase that sometimes requires topical corticosteroids. However, topical corticosteroids (TC) are used only to treat the acute phase for a short period. After the acute lesions have subsided, corticosteroids can be stopped immediately to prevent side effects and continue with daily skincare. Conclusion: Topical corticosteroids are first-line therapy in the acute phase. The choice of TC is based on age, body location, dosage, and severity of AD. If the acute lesion has subsided, then corticosteroids can be stopped and substituted with other antipruritic therapy and moisturizer.

Focus on the dabrafenib, vemurafenib, and trametinib in the clinical outcome of melanoma: A systematic review and meta-analysis Ida Ayu Widya Anjani; Anak Agung Bagus Putra Indrakusuma; I Gede Krisna Arim Sadeva; Putri Ayu Wulandari; Luh Made Mas Rusyanti; Prima Sanjiwani Saraswati Sudarsa; I Gede Putu Supadmanaba; Desak Made Wihandani
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 3 No. 2 (December 2020)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/myphje28

Background: Melanoma is the most severe lethal skin cancer, affecting melanin producer cells (melanocytes). Surgery is the most common treatment, whereas, for the advanced stage, the development of treatment is recommended. BRAF (Dabrafenib and Vemurafenib) inhibitor or MEK inhibitor (Trametinib) is the most frequently targeted melanoma therapy due to more than 80% of patients with positive BRAF mutation. In this review, those treatments will be investigated systematically to identify their clinical outcome. Method: This systematic literature review (SLR) was performed from Cochrane, Science Direct, Google Scholar, and Pubmed. Cochrane Risk-of-Bias Tool RoB2 is used to assess RCT studies and New-castle Ottawa Scale Assessment to assess cohort studies by three different assessors. Data analysis was carried out by using Review Manager (RevMan 5.4). Heterogenicity test was assessed by I2 and Chi2 statistic Result: There are 20 studies used in this article (13 RCT and seven cohorts). The overall survival (OS) and progression-free survival (PFS) of the survey that using targeted therapy (vemurafenib, trametinib, or dabrafenib) compare other treatments (chemotherapy, immunotherapy, etc.) showed risk ratio (RR) was 1.12 (95%CI 1.07,1.17; I2=100%; p<0,00001). The OS and PFS with monotherapy compare of vemurafenib, trametinib, or dabrafenib with combination therapy showed RR was 1.09 (95%CI.06,1.13; I2=99%; p<0,00001). Conclusion: BRAF and MEK targeted therapy has a good prognosis for a patient with a positive BRAF gene mutation and could be combined with other treatments for better clinical outcomes rather than monotherapy.

A case of pemphigus vulgaris in a patient with abdominal tumor as collaborative disease Prima Sanjiwani Saraswati Sudarsa; Marvin Giantoro; Luh Gede Melia Puspita Sari; I Made Setiadji
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 5 No. 2 (December 2022)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/bs6cm636

Background: Pemphigus is an autoimmune disease with clinical manifestations of chronic intraepidermal bullae on the skin, mucosa, and loose walls.Pemphigus can be categorized into four types, namely pemphigus vulgaris (PV), pemphigus vegetans, pemphigus foliaceus, and paraneoplastic pemphigus. Pemphigus vulgaris is the most common form of with the highest epidemiology. Pemphigus vulgaris with abdominal tumors cannot be associated where abdominal tumors do not trigger the occurrence of PV. However, abdominal tumors can increase morbidity and provide poor prognosis. Case Description: A male, 46 years old, Balinese, Indonesian, came to the Sanglah Hospital Emergency Room with the chief complaint of painful sores around the body, hands, and feet since 20 days ago. Initially the patient said that there were loose, watery blister filled with serous fluid, which after a few days burst and left sores. The blister start on the feet and then spread to the hands and body. The patient was diagnosed with pemphigus vulgaris and abdominal tumors by the digestive surgery doctor. The patient had never had a similar complaint before. History of applying oil, traditional ingredients and topical drugs was denied. The patient was treated mainly with methylprednisolone and showed clinical improvement. Conclusion: We report a case of PV in a 46-year-old man with abdominal tumors. This case report is expected to add insight on how to diagnose PV, how to determine therapy, the wound healing process, how to treat wounds, prevent disease expansion, and the relationship between abdominal tumors and PV.

The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1499

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.

The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1499

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.

Therapeutic Outcomes of Secukinumab 300 mg in Severe Psoriasis Vulgaris with Metabolic Comorbidities: A Retrospective Cohort Study in Bali Prima Sanjiwani Saraswati Sudarsa; Mario Korwa; Nyoman Suryawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1552

Background: Psoriasis vulgaris is a systemic inflammatory disease increasingly prevalent in Southeast Asia, often complicated by metabolic syndrome. While Secukinumab, an IL-17A inhibitor, is established in Western cohorts, real-world data on its efficacy in Indonesian populations with high adiposity burdens are scarce. This study evaluates the therapeutic response and safety of Secukinumab 300 mg in a Balinese cohort characterized by severe disease and metabolic risk factors. Methods: We conducted a retrospective cohort study at a tertiary referral center in Bali from January 2023 to December 2024. The study included 39 adult patients with moderate-to-severe psoriasis treated with Secukinumab 300 mg. The primary endpoint was the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75) at Week 17. Fisher’s Exact Test was employed to analyze response differences between obese and non-obese subgroups. Results: The cohort exhibited a high systemic burden: 44.2% were obese (Body Mass Index greater than or equal to 25 kg/m2), and 53.8% had concomitant psoriatic arthritis. Baseline disease severity was high with a median body surface area of 25.0%. At week 17, 32 patients (82.1%; 95% confidence interval: 67.3–91.0%) achieved PASI 75. Subgroup analysis revealed no statistically significant difference in response rates between obese and non-obese patients (p > 0.99), suggesting efficacy is maintained despite metabolic burden. No severe adverse events or discontinuations were documented in the medical records. Conclusion: Secukinumab 300 mg demonstrates substantial efficacy in an Indonesian population with a severe phenotypic profile, maintaining therapeutic clearance in metabolically compromised patients. The safety profile appears favorable, though limited by retrospective data capture.

Therapeutic Outcomes of Secukinumab 300 mg in Severe Psoriasis Vulgaris with Metabolic Comorbidities: A Retrospective Cohort Study in Bali Prima Sanjiwani Saraswati Sudarsa; Mario Korwa; Nyoman Suryawati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1552

Background: Psoriasis vulgaris is a systemic inflammatory disease increasingly prevalent in Southeast Asia, often complicated by metabolic syndrome. While Secukinumab, an IL-17A inhibitor, is established in Western cohorts, real-world data on its efficacy in Indonesian populations with high adiposity burdens are scarce. This study evaluates the therapeutic response and safety of Secukinumab 300 mg in a Balinese cohort characterized by severe disease and metabolic risk factors. Methods: We conducted a retrospective cohort study at a tertiary referral center in Bali from January 2023 to December 2024. The study included 39 adult patients with moderate-to-severe psoriasis treated with Secukinumab 300 mg. The primary endpoint was the proportion of patients achieving a 75% reduction in the Psoriasis Area and Severity Index (PASI 75) at Week 17. Fisher’s Exact Test was employed to analyze response differences between obese and non-obese subgroups. Results: The cohort exhibited a high systemic burden: 44.2% were obese (Body Mass Index greater than or equal to 25 kg/m2), and 53.8% had concomitant psoriatic arthritis. Baseline disease severity was high with a median body surface area of 25.0%. At week 17, 32 patients (82.1%; 95% confidence interval: 67.3–91.0%) achieved PASI 75. Subgroup analysis revealed no statistically significant difference in response rates between obese and non-obese patients (p > 0.99), suggesting efficacy is maintained despite metabolic burden. No severe adverse events or discontinuations were documented in the medical records. Conclusion: Secukinumab 300 mg demonstrates substantial efficacy in an Indonesian population with a severe phenotypic profile, maintaining therapeutic clearance in metabolically compromised patients. The safety profile appears favorable, though limited by retrospective data capture.

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