Sri L. Menaldi
Department Of Dermatology And Venereology Faculty Of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital

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Lucio’s phenomenon: A report on six patients in a tertiary referral hospital in Indonesia Marissa, Melani; Rihatmadja, Rahadi; Surya, Denny; Lim, Henry W; Menaldi, Sri Linuwih
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
Publisher : UI Scholars Hub

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Background: Lucio's phenomenon (LP) is a rare variant of leprosy reaction, with the clinical manifestation of “necrotizing erythema.” LP was observed in patients with lepromatous leprosy who have not received or completed the treatment, and it is especially evident in patients with diffuse lepromatous leprosy (DLL), known as Lucio-Latapi’s leprosy. LP occurs due to M. leprae invading the blood vessels, causing endothelial damage that leads to thrombosis, ischemia, infarction, and tissue necrosis. The clinical features of the disease are erythematous lesions that can be accompanied by vesicles or bullae, with ulcers forming scar tissues. Histopathological examination can help establish the diagnosis of LP. Until now, there is still controversy about LP management. Multidrug therapy for multibacillary leprosy (MDT-MB) is the preferred line of treatment. Lucio-Latapi’s leprosy and LP are commonly found in Mexico and Central America, but rarely reported in Indonesia. Case Illustration: We report here the clinical description and development of six patients with LP observed in the tertiary referral hospital in Indonesia over a five-year period from 2013 to 2017. Discussion: All patients were diagnosed using clinical and histopathological examination, and all of them presented with ulceration and vasculitis. They were treated with MDT-MB WHO regimens and systemic corticosteroids. Five patients were alive, and one died due to extensive cutaneous lesions that lead to sepsis. Conclusion: Early diagnosis and prompt institution of multidrug therapy with systemic corticosteroids may improve the prognosis and outcome of LP.
Correlation between clinical and histopathological findings of five puzzling cases of cutaneous tuberculosis Miranda, Eliza; Widaty, Sandra; Sirait, Sondang Pandjaitan; Rizky, Luddwi Achmad; Menaldi, Sri Linuwih; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
Publisher : UI Scholars Hub

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Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings. Case Illustration: Five cases of cutaneous tuberculosis, which include two cases of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris were presented in this article. Four of the five cases demonstrated significant improvement after initiation of an antituberculosis drug regimen. Discussion: Diagnosis of cutaneous tuberculosis in these cases was confirmed through clinical findings and histopathological and microbiological examination. Conclusion: A negative result following microbiological examination does not completely exclude the diagnosis of cutaneous tuberculosis. Investigating the pathognomonic findings of cutaneous tuberculosis through histopathological examination is important to differentiate among its types correctly. Therefore, correlations between clinical and histopathological results are essential to establish a diagnosis of cutaneous tuberculosis.
Purpuric lesion in a patient with leprosy: Was it a Lucio’s phenomenon or an epiphenomenon? Menaldi, Sri Linuwih; Marissa, Melani; Chairista, Inadia Putri; Lim, Henry W.; Rihatmadja, Rahadi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
Publisher : UI Scholars Hub

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Background: Lucio’s phenomenon (LP) is a severe necrotizing cutaneous reaction that occurs in patients with Lucio’s leprosy. The exact pathomechanism is not fully understood, but typically abundant acid-fast bacilli in the walls of blood vessels point to direct perturbation of blood supply to the epidermis. We report a case of LP where epidermal necrosis occurred in the absence of vascular invasion by mycobacteria, raising the question whether this was an epiphenomenon or a true LP. Case Illustration: A 34-year-old male was referred for an episodic swelling of his hands and feet that persisted for two years. There were signs of leprosy (diffuse shiny skin lesions, anesthesia, and anhidrosis of the extremities) with purpuric patches on lower extremities. The slit-skin smear test revealed a high index of acid- fast bacilli. Histopathological examination revealed epidermal necrosis and leukocytoclastic vasculitis without demonstrable bacillus. WHO multidrug regimen for leprosy and corticosteroids successfully cured the patient and prevented ulcer development. Discussion: Despite the presence of classical LP characteristics clinically and histologically, mycobacterium was absent in the vessels’ walls. We hypothesized that, in LP, vascular impairment might also be secondary due to antigen–antibody reaction and hypercoagulable state.Conclusion: Purpuric patches in Lucio’s leprosy might be the first sign of skin necrosis or vascular damage (purpura and ulceration). Besides the antimycobacterial drugs, anti-inflammatory drugs should be administered. Laboratory test for hemostasis might be advised.
Comparison between oral pentoxifylline + corticosteroid andoral corticosteroid alone for severe erythema nodosum leprosum Martinus, Martinus; Rihatmadja, Rahadi; Menaldi, Sri Linuwih
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 6, No. 1
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Background: Severe erythema nodosum leprosum (ENL) is common but difficult to treat. Long term use of systemic corticosteroid causes side effects. This study compares the use of a combination of pentoxifylline + oral corticosteroids with a single oral corticosteroid in leprosy patients with severe ENL reactions. Parameters measured include skin RSA score, systemic RSA, total corticosteroid dose, resolution time of skin lesions, improvement of pain VAS and treatment side effects.Methods: 29 subjects with severe ENL reactions are allocated randomly into two groups which receive oral pentoxifylline + methylprednisolone, and oral placebo + methylprednisolone for 12 weeks. The starting dose of pentoxifylline are 400 mg thrice daily for 4 weeks, tapered to 400 mg daily every 4 weeks. Methylprednisolone is based on WHO guideline. Results: In the end, the median of cutaneous RSA score in pentoxifylline vs placebo group is 4 (0-5) vs 3 (0-5). The median of systemic RSA score in pentoxifylline vs placebo group is 0 (0-6) vs 0 (0-5). The median of total corticosteroid doses in pentoxifylline vs placebo group is 156 (120-200) mg vs 136 (96-200) mg. The median of resolution time in pentoxifylline vs placebo group is 6 (0-12) weeks vs 6 (0-12) weeks. The median of change of pain VAS score in pentoxifylline vs placebo group is 5 (0-6) vs 3 (-3-6). No statistically significant difference (p>0,05) are found in all parameters, including side effects. Conclusion: Combination of oral pentoxifylline + corticosteroid is not proven to be more effective. Both are safe.
Item generation in the development of a questionnaire for predicting multidrug therapy compliance in leprosy Siskawati, Yulia; Asih, Sali Rahadi; Kekalih, Aria; Menaldi, Sri Linuwih; Herqutanto, Herqutanto; Bramono, Kusmarinah
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 7, No. 2
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Background: Lengthy therapeutic regimens in leprosy are prone to defaults, contributing to more antibiotic-resistant Mycobacterium. Intervening patients’ medical habits midway would be more complicated than understanding their perception of undergoing such regimens in advance. We study the factors considered relevant to leprosy patients’ compliance to construct a novel self-reporting questionnaire that can predict the patients’ adherence before initiating multidrug therapy. Methods: According to the Delphi methods, we conducted three rounds of interviews with twenty-three respondents from various backgrounds, including dermatologists, government officials, healthcare workers, and patients with leprosy, to infer the associated factors of the included items. Each item was scored using the Likert scale, and accepted items (scores above 75%) were classified into six-dimensional categories based on the health belief model theory. Result: The initial 236 items were simplified to 72 items. Then, a panel discussion was conducted to score each item. Finally, 48 items were accepted and categorized into 12 indicators from 6 dimensions. The 12 indicators encompass knowledge about leprosy, its severity, therapeutical options, stigma, challenges in the treatment maintenance, availability of medical facilities and workers, therapeutic impact, drug regulation, health personnel, personal beliefs, attitude, and motivation. (p Conclusion: The study identified 12 critical factors influencing adherence to leprosy treatment, contributing to the prevention of antibiotic-resistant mycobacterium and providing valuable insights through the predictive self-reporting questionnaire.
KEGAGALAN TERAPI PADA KUSTA TIPE LEPROMATOSA DAN FAKTOR YANG MEMENGARUHINYA: SEBUAH LAPORAN KA Joanne Natasha; Sri Linuwih Menaldi; Melani Marissa; Rizka Farah Hilma
Media Dermato-Venereologica Indonesiana Vol 49 No 2 (2022): 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.v49i2.339

Abstract

Children is a group that is nine times more likely to contract leprosy. The finding of new cases of leprosy in children is a strong indicator that indicates the disease transmission is still ongoing. World Health Organization (WHO) in 2019 reported 14,981 out of 202,185 (7.4%) new cases of children. Cases of resistance to multidrug therapy (MDT) can be primary or secondary. It is important to detect drug resistance earlier considering children’s quality of life would be affected by leprosy complication. A 14 years old girl from Lebak Regency, Rangkasbitung, Banten was diagnosed as lepromatous type (LL) leprosy and a second grade disability on the 5th finger of her left hand. Unimproved clinical and increasing the morphological index (IM) on the 9th month of treatment from 0.16% to 1%, leading the patient experience the drug resistance. The polymerase chain reaction (PCR) examination did not show any mutation in the RpoB gene. Inadequate and irregular MDT consumption have the potential to cause secondary resistance and the risk of becoming primary resistance later. It is not easy to determine drug resistance in endemic areas. Morphological index monitoring should be closely watched before treatment is complete thus the modified therapy can be given earlier.
DIAGNOSIS DAN TATA LAKSANA KEKAMBUHAN KUSTA Caroline Oktarina; Melani Marissa; Wresti Indriatmi; Sri Linuwih Menaldi
Media Dermato-Venereologica Indonesiana Vol 49 No 2 (2022): 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.v49i2.340

Abstract

Leprosy relapse is defined as the reappearance of leprosy’s signs and symptoms following completion of adequate Multidrug Therapy (MDT) regimen. Indonesia is the third biggest contributor for leprosy relapse with 284 cases in 2018. Several factors contribute to the occurrence of relapse, which include presence of persisters, history of inadequate therapy, drug resistance, history of irregular treatment, history of dapsone monotherapy, high initial bacteriological index, high number of skin and nerve lesions, negative lepromin test, history of antireaction therapy, human immunodeficiency virus (HIV) infection, and pregnancy. Diagnosis of relapse can be established based on clinical, bacteriological, and therapeutic criteria, also histopathological and serological criteria, if possible. With those criteria, it should be easier to differentiate relapse from reaction, resistance, reactivation, and reinfection. The principal management for leprosy relapse is re-administration of MDT according to the type of relapse; however, therapy should be modified if there are any evidences of drug resistance. Things which are important to be taken into account during relapse treatment are leprosy type, past medication history, and the possibility of drug resistance. With proper knowledge and diagnostic algorithm, it is expected that the treatment can be administered immediately in order to prevent disability and transmission of infection.
Epidemiology of Leprosy in Indonesia: a Retrospective Study Lubis, Ramona Sari; Anum, Qaira; Argentina, Fifa; Menaldi, Sri Linuwih; Gunawan, Hendra; Yuniati, Renni; Mulianto, Nur Rachmat; Siswati, Agnes Sri; Widasmara, Dhelya; Rusyati, Luh Made Mas; Mamuaja, Enricco Hendra; Muchtar, Vitayani; Cita Rosita Sigit Prakoeswa; Agusni, Regitta Indira; Bagus Haryo Kusumaputra; Medhi Denisa Alinda; Listiawan, Muhammad Yulianto
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 34 No. 1 (2022): APRIL
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikk.V34.1.2022.29-35

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Background: According to WHO data, the number of new cases of leprosy has decreased in 2019. However, Indonesia continues to provide a significant number of cases. According to statistics, India, Brazil, and Indonesia account for 79 percent of all instances. Purpose: This study aims to describe the profile of leprosy patients, and involves all Dermatology and Venereology Academic Hospitals in Indonesia. Methods: This study was a retrospective study of 2461 patients from Dermatology and Venereology Outpatient Clinic at 13 Academic Hospitals in Indonesia between January 2018 and December 2020. Result: Subjects in this study were dominated by males (66.8%) and aged > 14 years (95.3%). The most common type of leprosy was multibacillary (MB) (86.2%), and erythema nodosum leprosum (ENL) was the most leprosy reaction (20.3%). Majority of the subjects experienced disability in the hands (26.6%), in grade 1. Conclusion: Leprosy cases in Indonesia are mostly experienced by adult males. The most common type of leprosy is MB, with ENL being the most common leprosy reaction. Grade 1 disability is the most prevalent, therefore proper education is necessary to keep patients from progressing to grade 2 disability.
Inhibitor Transient Receptor Potential Vanilloid Type 1: Penggunaan Topikal pada Berbagai Dermatosis Muhammad, Parikesit; Paramitha Wibawa, Larisa; Keumala Budianti, Windy; Legiawati, Lili; Menaldi, Sri Linuwih; Rosdiana, Dewi Selvina
Jurnal MedScientiae Vol. 3 No. 2 (2024): Agustus
Publisher : Fakultas Kedokteran dan Ilmu Kesehatan Ukrida

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/JMedScientiae.v3i2.3179

Abstract

Transient receptor potential vanilloid type 1 (TRPV1) plays an important role in the pathophysiology of pruritus and pain. TRPV1 inhibitors can reduce the sensation of itching and pain by blocking nociceptive signals from peripheral nerve fibers to the central nervous system. Topical TRPV1 inhibitors is also thought to improve skin barrier function. Therefore, TRPV1 inhibitors are considered as potential therapy in various dermatoses. Topical TRPV1 inhibitors that are currently being studied are asivatrep for atopic dermatitis and trans-4-tert-butylcyclohexanol for various dermatoses associated with sensitive skin. Further studies with better quality and longer duration are needed to assess the efficacy and safety profile of TRPV1 inhibitors.
PERAN TERAPI ANTIOKSIDAN PADA MELASMA Diahtantri, Riyanti Astrid; Mughni, Fadhli Aulia; Menaldi, Sri Linuwih
Jurnal Muara Medika dan Psikologi Klinis Vol. 4 No. 1 (2024): Jurnal Muara Medika dan Psikologi Klinis
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat Universitas Tarumanagara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24912/jmmpk.v4i1.34338

Abstract

Melasma adalah penyakit hiperpigmentasi pada kulit yang terpajan sinar matahari dan dapat bersifat kronik rekuren. Penyebab pasti melasma belum diketahui akan tetapi spesies oksigen reaktif (ROS) akibat pajanan sinar ultraviolet (UV) diduga berperan dalam patogenesis melasma. Mekanisme pertahanan terhadap toksisitas ROS mencakup antioksidan enzimatik, yang terdiri atas katalase, superoksida dismutase (SOD), dan glutation peroksidase, serta antioksidan non-enzimatik. Dalam tulisan ini akan dijelaskan jenis-jenis ROS, antioksidan, dan stres oksidatif serta pengobatan melasma yang berhubungan dengan penggunaan antioksidan untuk menetralisir efek stres oksidatif.
Co-Authors Agnes Sri Siswati Ahmad Fuady Aldri Frinaldi Alida Widiawaty Anum, Qaira Aria Kekalih Augustine D. Sukarlan Bagus Haryo Kusumaputra Bani, Anna Puspitasari Caroline Oktarina Chairista, Inadia Putri Cita Rosita Sigit Prakoeswa Dewi Matindas Dewi Sumaryani Soemarko Dharmayati B. Utoyo Dhelya Widasmara Diahtantri, Riyanti Astrid Emmy Soedarmi Sjamsoe Emmy Soedarmi Sjamsoe-Daili Erika Zoulba Evita H. Effendi Fifa Argentina Fifinela Raissa Fitri Octaviana Githa Rahmayunita Hansen Angkasa Herqutanto - Hirzi Zulkarnain Irawan, Yudo Irawati, Yunia Iwan Dwiprahasto Jayawarsa, A.A. Ketut Joanne Natasha Keumala Budianti, Windy Kurniawardhani, Dewinta Retno Kusmarinah Bramono Larisa Paramitha Lidwina Anissa Lili Legiawati Lim, Henry W Lim, Henry W. Lubis, Ramona Sari Luh Karunia Wahyuni, Luh Karunia Luh Made Mas Rusyati M. Yulianto Listiawan Mamuaja, Enricco Hendra Marissa, Melani Martinus, Martinus Medhi Denisa Alinda, Medhi Denisa Melani Marissa Melani Marissa Miranda, Eliza Muchtar, Vitayani Mughni, Fadhli Aulia Muhammad, Parikesit Mulianto, Nur Rachmat Olivia, Taruli Ova Emilia Rahadi Rihatmadja Regitta Indira Agusni Renni Yuniati Rizka Farah Hilma Rizky, Luddwi Achmad Rosdiana, Dewi Selvina Saleha Sungkar Sali Rahadi Asih Sandra Widaty SD, Emmy Soedarmi Sirait, Sondang Pandjaitan Siskawati, Yulia Siskawati, Yulia Sjamsoe, Emmy Soedarmi Sjamsoe-Daili, Emmy Soedarmi Surya, Denny Taruli Olivia Triana Agustin Victor Santawi Widiawaty, Alida Wresti Indriatmi B. Makes Yayi S. Prabandari Yeni Dwi Lestari Yudo Irawan Zoulba, Erika