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All Journal Medical Journal of Indonesia Media Dermato-Venereologica Indonesiana Journal of General Procedural Dermatology and Venereology Indonesia Jurnal Kedokteran Meditek Cermin Dunia Kedokteran
Astriningrum, Rinadewi
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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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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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.
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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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.
Narrowband ultraviolet B phototherapy combined with topical treatment for vitiligo in 2 geriatric patients Astriningrum, Rinadewi; Legiawati, Lili; Chandrakesuma, Vivianne; Nadia, Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia – Dr. Ci
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 4, No. 2
Publisher : UI Scholars Hub

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Background: Narrowband ultraviolet B (NB-UVB) become the mainstay of widespread vitiligo therapy due to its great efficacy and safety compared with other modalities. The use of NB-UVB for vitiligo has been widely studied in adult patients, while studies on geriatric patients specifically are still very limited. This report aims to show the immediate response after the initial treatment, side effects of therapy, and other problems that were encountered during therapy in two geriatric patients with vitiligo who have been followed up for more than 12 months. Case Illustration: We reported two geriatric patients with vitiligo treated with NB-UVB phototherapy combined with topical treatment for more than 12 months. The first patient was 68-year-old woman, with Fitzpatrick skin type IV, who had vitiligo on her face, both lower arms and hands, and both legs and feet. The second patient was a 61-year-old man with Fitzpatrick skin type IV who had generalized vitiligo. The first repigmentation occurred on the 5th session in the first patient and on the 6th session in the second patient, using a cumulative dose of 1223 mJ/cm2 and 1541 mJ/cm2, respectively. Discussion: After NB-UVB phototherapy, there was a great improvement on the face in both patients, followed by the trunk and legs. However, the duration of treatment needed to achieve homogeneous repigmentation is longer in geriatric patients than in the general population. Conclusion: NB-UVB was well tolerated and showed good clinical response to treat vitiligo in the elderly. However, little is known about the safety and efficacy of phototherapy in elderly patients with vitiligo.
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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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.
Recent progress in immunotherapy for skin cancer Mughni, Fadhli Aulia; Astriningrum, Rinadewi; Hoemardani, Aida SD; Bramono, Kusmarinah; Sampurna, Adhimukti T.; Sutarjo, Agassi Suseno
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 6, No. 1
Publisher : UI Scholars Hub

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Skin cancer is a global health concern due to its growing incidence and high mortality rate. The most common therapeutic modalities in skin cancer include surgery, radiotherapy, and chemotherapy. However, those therapies do not specifically target cancer cells and may damage healthy tissues. Cancer induces immune response by releasing soluble antigens and danger signals caused by tumor cellular stress or death, while the immune system continuously monitor and control malignant proliferation through cancer immunoediting. Therefore, targeting this mechanism is a promising approach to manage cancer, especially those unresponsive to conventional therapies. Immunotherapy is a specific therapy that manipulates the immune system to fight the disease. Previous studies have shown promising results in its clinical use in melanoma and non-melanoma skin cancer (NMSC). However, its potential toxicity and tolerability may pose significant obstacles in developing effective cancer immunotherapy. Biomedical, immunological, and clinical research in skin cancer is still needed to elaborate further on its pathogenesis and design safe and effective therapy for each skin cancer.
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
Publisher : UI Scholars Hub

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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.
Herpes Zoster dengan Manifestasi Eritema Multiforme Bulosa pada Pasien Geriatri Imunokompromais: Laporan Kasus Halim, Dionisius Ivan Yonathan; Legiawati, Lili; Yusharyahya, Shannaz Nadia; Astriningrum, Rinadewi
Media Dermato-Venereologica Indonesiana Vol 52 No 2 (2025): 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.v52i2.531

Abstract

   Pendahuluan: Herpes zoster (HZ) merupakan sekumpulan gejala dan manifestasi klinis yang disebabkan oleh reaktivasi varicella-zoster virus (VZV). Faktor predisposisinya antara lain: usia lanjut, keadaan imunokompromi, obat imunosupresif, keganasan, stres psikologis, trauma, dan tindakan pembedahan. Manifestasinya bervariasi, namun manifestasi eritema multiforme (EM) bulosa jarang dilaporkan. Kasus: Seorang perempuan berusia 65 tahun mengeluhkan bercak gatal pada kedua lengan dan tungkai sejak 3 hari yang lalu. Pasien sedang menjalani kemoterapi atas indikasi kanker payudara metastasis tulang dengan multikomorbid. Pada pemeriksaan ditemukan lesi target tipikal EM yang beberapa berkembang menjadi EM bulosa. Terdapat riwayat demam. Pasien ditatalaksana dengan kortikosteroid serta terapi simptomatik. Satu minggu kemudian ditemukan lenting berkelompok di lengan kiri atas sampai ke leher kiri sesuai dermatom C4 dan C7 yang disertai rasa nyeri dan terbakar. Kortikosteroid dihentikan dan diobati dengan valasiklovir 3 x 1000 mg selama 10 hari dan terapi simptomatik. Setelah 2 minggu terdapat perbaikan klinis dan gejala. Diskusi: Kasus HZ aberans dengan manifestasi EM bulosa dapat terjadi pada individu dengan komorbid dan keadaan imunokompromi. Pada pasien ini terdapat usia lanjut riwayat kanker payudara, obat kemoterapi, serta komplikasi infeksi sekunder pasca tindakan pembedahan. Manifestasi HZ mirip dengan EM minor karena ditemukannya lesi target tipikal pada kedua ekstremitas tanpa lesi mukosa. Perubahan perjalanan penyakit menjadi vesikel berkelompok sesuai dermatom, kemungkinan HZ aberans lebih dipertimbangkan. Kesimpulan: Herpes zoster dapat menimbulkan manifestasi EM. Terapi dengan obat antiviral menunjukkan perbaikan baik klinis maupun gejala. Kemungkinan manifestasi EM pada HZ harus dipertimbangkan untuk diagnosis dini dan tatalaksana efektif.
PENDEKATAN KONSERVATIF PADA SINDROM BART: SEBUAH LAPORAN KASUS Sukmara, Isni Maulina; Agustin, Triana; Astriningrum, Rinadewi
Media Dermato-Venereologica Indonesiana Vol 52 No 3 (2025): 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.v52i3.544

Abstract

Pendahuluan: Sindrom Bart (SB), dikenal sebagai aplasia kutis kongenita (AKK) tipe VI, adalah kelainan genetik yang jarang ditemui, ditandai dengan AKK, pembentukan bula pada kulit dan selaput lendir, serta deformitas kuku. Pilihan pengobatan meliputi intervensi bedah terutama pada lesi yang luas. Pendekatan terapi secara konservatif berperan penting dalam mencegah kerusakan jaringan lebih lanjut dan mendukung proses penyembuhan. Kasus: Seorang bayi perempuan berusia 4 hari dibawa ibunya berobat dengan luka pada kedua tungkai bawah sejak lahir. Riwayat serupa ditemukan pada ayah pasien. Pasien lahir melalui persalinan pervaginam tanpa komplikasi. Pemeriksaan fisis menunjukkan kehilangan kulit dengan erosi-ekskoriasi pada kedua tungkai bawah, disertai krusta merah-kekuningan, skar hipopigmentasi, dan milia. Luka dirawat dengan balutan antibakteri, busa silikon, dan perban elastis yang diganti setiap tiga hari. Dalam dua bulan, luka menyembuh namun terjadi pembentukan bula pada kaki dan mukosa mulut hingga usia enam bulan. Berdasarkan riwayat penyakit dan pemeriksaan fisis, pasien didiagnosis sebagai SB. Diskusi: Diagnosis SB terutama ditegakkan berdasarkan temuan klinis. Epitelisasi cepat pada lesi AKK di ekstremitas telah dilaporkan pada beberapa kasus. Terapi konservatif efektif dalam mencegah kerusakan jaringan lebih lanjut dan mendukung penyembuhan. Kesimpulan: Laporan kasus ini menyoroti keberhasilan penggunaan terapi konservatif dalam menangani SB, sehingga tidak memerlukan intervensi bedah.
Perbaikan Klinis Green Nail Syndrome yang Signifikan pada Lanjut Usia dengan Terapi Kombinasi: Sebuah Serial Kasus Marizki Ramadhani, Reinanda; Nadia Yusharyahya, Shannaz; Legiawati, Lili; Astriningrum, Rinadewi; Gunardi, Keiko Yolanda; Reshinta, Reisa
Jurnal Kedokteran Meditek Vol 31 No 2 (2025): MARCH
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v31i2.3383

Abstract

Introduction: Green nail syndrome is a common bacterial infection of the nails and is characterized by green discolouration of the nail plate caused by Pseudomonas aeruginosa. It frequently occurs in people who are exposed to constant water and due to mechanical trauma, especially in elderly patients. Case Illustration: We reported 2 cases treated with a combination therapy of oral ciprofloxacin, 1% acetic acid dressing, gentamicin ointment and showed a significant clinical improvement. There are two cases: a 67-year-old man and a 64-year-old woman complained of black-greenish discolouration on his right big toenail, which has been accompanied by changes in the shape of the nail for 3 months. Both patients have a history of frequent and prolonged contact with water—dermoscopy results in greenish-black discolouration in the nail plate.  The culture results of both patients, Pseudomonas aeruginosa was found. Combination treatment showed significant clinical improvement in both patients. Discussion: Dressing of 1% acetic acid was useful as an adjuvant to improve the ointment penetration, inhibiting the formation of Pseudomonas aeruginosa biofilms. Gentamicin and ciprofloxacin are effective against aerobic gram-negative bacterial infections, such as Pseudomonas aeruginosa. Conclusion: The use of ciprofloxacin is recommended, especially in elderly patients. Combination therapy with oral ciprofloxacin, 1% acetic acid dressing, and gentamicin ointment is an effective option for patients with green nail syndrome
Diagnosis dan Tata Laksana Hydroa Vacciniforme Reshinta, Reisa; Rahmayunita, Githa; Rihatmadja, Rahadi; Astriningrum, Rinadewi
Cermin Dunia Kedokteran Vol 51 No 5 (2024): Kedokteran Umum
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v51i5.902

Abstract

Hydroa vacciniforme (HV) is a rare photodermatoses with the most frequent onset in childhood. The exact pathogenesis of HV is still not known. This disease is a spectrum with almost similar clinical symptoms, but with a very different prognosis. Classic HV has the best prognosis, but affects the quality of life due to scar formation, while hydroa vacciniforme-like lymphoma (HVLL) is the variant with the worst prognosis. HV needs to be considered as a differential diagnosis, especially in childhood-onset photodermatoses. Classical HV must be distinguishes from hydroa vacciniforme-like lymphoproliferative disorders (HVLPD) because it is related to prognosis. There is still no consensus or guidelines on diagnosis and management for HV. 
Co-Authors Adistri, Kara Andhira, Vega Arini Astasari Widodo Azizah, Fitri Chandrakesuma, Vivianne Githa Rahmayunita Gunardi, Keiko Yolanda Halim, Dionisius Ivan Yonathan Hartanto, David Dwiadiputra Hoemardani, Aida SD Isni Maulina Sukmara, Isni Maulina Jonlean, Reganedgary Kusmarinah Bramono Kusumawardhani, Dina Lili Legiawati Lim, Henry W. Marizki Ramadhani, Reinanda Mughni, Fadhli Aulia Nadia Yusharyahya, Shannaz Nadia, Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia – Dr. Cipto Mangunkusumo National Central General Hospital Jakarta, Indonesia Shannaz, Yusharyahya Narla, Shanthi Rahadi Rihatmadja Rahman, Yusnita Reshinta, Reisa Rheza, Agung Mohamad Sampurna, Adhimukti T. Shannaz Nadia Yusharyahya Shwayder, Tor Sirait, Sondang P. Sutarjo, Agassi Suseno Triana Agustin Yosi, Ariyati