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All Journal Nexus Kedokteran Komunitas Berkala Ilmu Kesehatan Kulit dan Kelamin Bioscientia Medicina : Journal of Biomedicine and Translational Research Health and Medical Journal Jurnal Ners JOURNAL LA MEDIHEALTICO Open Access Indonesian Journal of Medical Reviews Bioscientia Medicina : Journal of Biomedicine and Translational Research Cermin Dunia Kedokteran Journal of Social Research MEDICINUS Indonesian Basic and Experimental Health Sciences
Nurrachmat Mulianto
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Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary

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Journal : Bioscientia Medicina : Journal of Biomedicine and Translational Research

 1 
An Unusual Case of Pemphigus Foliaceus Arising in a Patient with Psoriasis Vulgaris Nurrachmat Mulianto; Osdatilla Esa Putri
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (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.v9i2.1190

Abstract

Background: Pemphigus foliaceus (PF) is a rare autoimmune blistering disease characterized by superficial, fragile blisters. Psoriasis vulgaris, a chronic inflammatory skin condition, has been rarely associated with PF. This case report presents an unusual instance of PF developing in a patient with a history of psoriasis vulgaris. Case presentation: A 54-year-old Indonesian woman presented with a one-year history of scaly skin and reddish spots across her body, worsening over the past week. She had a prior diagnosis of psoriasis vulgaris and was undergoing methotrexate therapy (15 mg/week) without significant improvement. Three months prior, she developed loose blisters on her back that spread to her hands, rupturing easily and leaving painful sores. The patient denied any mucosal involvement. One week before her presentation, her symptoms worsened following relocation-related stress. Dermatological examination revealed generalized multiple erythematous patches with scales, some with ruptured blisters leaving erosions, and a positive Nikolsky sign. Histopathological examination confirmed PF. The patient was treated with intravenous methylprednisolone, oral erythromycin and paracetamol, topical mupirocin, and clobetasol. After one month, due to a lack of improvement, azathioprine was added, leading to lesion improvement without side effects. Conclusion: This case highlights the rare but potential development of PF in patients with psoriasis vulgaris. The complex interplay between these two conditions warrants further investigation. Early diagnosis and appropriate treatment are crucial for managing PF and improving patient outcomes.
Deep Mycosis in Central Java, Indonesia: Occupational Risk Factors and Diagnostic Challenges in a Single Center Dr. Moewardi General Hospital Nurrachmat Mulianto; Ivani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 2 (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.v9i2.1192

Abstract

Background: Deep mycosis, a spectrum of invasive fungal infections affecting deeper tissues, poses significant diagnostic and therapeutic challenges, particularly in tropical regions like Central Java, Indonesia. This study aimed to investigate the epidemiological trends, occupational risk factors, and diagnostic challenges associated with deep mycosis in this region. Methods: A retrospective study was conducted at a single center, Dr. Moewardi General Hospital, in Central Java, Indonesia, analyzing medical records of patients diagnosed with deep mycosis between 2019 and 2024. Data on demographics, occupation, clinical presentation, diagnostic methods, and treatment outcomes were collected and analyzed. Results: A total of 12 cases of deep mycosis were identified. The majority of patients were male (75%) and engaged in agricultural activities (50%). Chromoblastomycosis (66.7%) and maduromycosis (25%) were the most common clinical diagnoses. Diagnostic delays were frequent (mean delay: 5.1 months), primarily due to non-specific clinical presentations and limited access to diagnostic facilities. Conclusion: Deep mycosis predominantly affects individuals involved in agriculture in Central Java, highlighting the need for enhanced awareness and preventive strategies among high-risk occupational groups. Improved diagnostic facilities and healthcare infrastructure are crucial for timely diagnosis and effective management of deep mycosis in resource-constrained settings.
Drug-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Retrospective Study on Causative Agents and Patient Profiles in an Indonesian Hospital Setting Nurrachmat Mulianto; Lidjaja, Lifesia Natali
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 7 (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.v9i7.1327

Abstract

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) represent rare, severe mucocutaneous adverse drug reactions characterized by extensive epidermal necrosis and significant morbidity and mortality. Understanding the specific causative agents and patient profiles within local populations is crucial for early diagnosis and management. This study aimed to characterize SJS/TEN cases in a tertiary hospital setting in Indonesia. Methods: A retrospective descriptive study was conducted using secondary data from medical records of patients diagnosed with SJS, SJS/TEN overlap, and TEN admitted to the inpatient installation of Dr. Moewardi General Hospital, Surakarta, Indonesia, between January 2022 and December 2024. Data collected included demographics (age, gender), comorbidities, diagnosis classification (SJS, SJS/TEN overlap, TEN), suspected causative drugs, length of hospital stay, SCORTEN score, and patient outcome (discharged alive or deceased). Total sampling was employed, excluding records with incomplete data. Data were compiled and analyzed descriptively. Results: Fifty-one patients were included, with a slight female predominance (52.94%). The largest age group affected was 19-59 years (60.78%). The distribution of diagnoses was SJS (41.18%), SJS/TEN overlap (31.37%), and TEN (27.45%). The mean SCORTEN score for the cohort was 2. The most common suspected causative drug classes were antibiotics (25.71%), followed by analgesic-antipyretics (24.29%), and anticonvulsants (22.86%). Carbamazepine (11.43%) and amoxicillin (10%) were frequent individual culprits. Epilepsy (13.73%) and diabetes mellitus (11.76%) were common comorbidities, although a significant portion (33.33%) had no recorded comorbidity. The mean length of stay was 9 days. Overall mortality was 15.68%, with higher rates observed in TEN (28.57%) compared to SJS (9.52%) and SJS/TEN overlap (12.5%). Conclusion: SJS/TEN affected predominantly adults, with antibiotics, analgesics, and anticonvulsants being the most implicated drug classes. While mortality was considerable, it appeared lower than some international reports, particularly for TEN. Recognizing common causative agents and patient risk factors, such as specific comorbidities like epilepsy and diabetes, can aid clinicians in early identification and prompt management of these life-threatening conditions.
Menthol-Camphor-Thymol-Eucalyptus Compound as a Novel Adjuvant Therapy in Fluconazole-Treated Candida parapsilosis Onychomycosis: A Case Report Nurrachmat Mulianto; Nurul Hidayati
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (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.v9i8.1348

Abstract

Background: Onychomycosis, a fungal infection of the nail apparatus, presents a therapeutic challenge due to its recalcitrant nature and the limitations of current antifungal regimens, including potential side effects and prolonged treatment durations. Candida parapsilosis is an increasingly recognized, yet less commonly reported, yeast pathogen in onychomycosis, particularly in immunocompromised individuals or those with specific comorbidities. The exploration of effective, safe, and accessible adjuvant therapies is crucial to enhance treatment outcomes. This report details the use of an over-the-counter menthol-camphor-thymol-eucalyptus compound as an adjuvant to oral fluconazole. Case presentation: A 69-year-old male, a gold washer by occupation with a two-month history of rheumatoid arthritis (RA) treated with methotrexate, hydroxychloroquine, methylprednisolone, and celecoxib, presented with a four-month history of yellowish-brown discoloration, uneven texture, and brittleness of both thumb nails. Dermatological examination revealed onychodystrophy, subungual hyperkeratosis, and yellowish-brown discoloration of the bilateral thumb nail plates. Dermoscopy confirmed these findings. Fungal culture of nail clippings identified Candida parapsilosis. The patient was treated with oral fluconazole 150 mg weekly for three months and twice-daily topical application of menthol-camphor-thymol-eucalyptus compound under plastic occlusion. Significant clinical improvement in nail color and texture, with no onycholysis, was observed at the 6-week follow-up. At the 3-month evaluation, fungal culture was negative, and liver function tests remained within normal limits. Conclusion: This case demonstrates the successful use of a menthol-camphor-thymol-eucalyptus compound as an adjuvant to oral fluconazole in treating Candida parapsilosis onychomycosis in an elderly patient with RA. The combination therapy was well-tolerated and led to clinical and mycological resolution, suggesting a promising, accessible, and cost-effective adjunctive therapeutic strategy.
UVB-Induced Oxidative Collapse and Melanogenic Activation in a Rat Model of Cutaneous Hyperpigmentation: A Multi-Parametric Analysis Sesia Pradestine; Endra Yustin Ellistasari; Nurrachmat Mulianto; Indah Julianto; Muhammad Eko Irawanto; Nugrohoaji Dharmawan
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.v9i11.1442

Abstract

Background: Ultraviolet B (UVB) radiation is a primary driver of cutaneous hyperpigmentation disorders, with oxidative stress recognized as a key pathogenic mechanism. However, a comprehensive, multi-level characterization of the causal link between chronic UVB exposure and the resulting oxidative, histological, and melanogenic responses is needed. This study aimed to quantitatively validate a preclinical model of UVB-induced hyperpigmentation by characterizing the reciprocal regulation of key oxidative stress biomarkers and correlating these changes with objective histological evidence of hyperpigmentation. Methods: This controlled in vivo experimental study used 14 male Sprague Dawley rats, divided into a control group (KN; n=7) and a UVB-exposed group (KP; n=7). The KP group received chronic UVB radiation (300 mJ/cm² daily, 5 days/week for 4 weeks). Dorsal skin tissue was harvested for analysis. Oxidative stress was assessed by quantifying malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) levels via ELISA. Hyperpigmentation was objectively validated and quantified using Fontana-Masson staining for melanin deposition and immunohistochemistry for microphthalmia-associated transcription factor (MITF). Results: Chronic UVB exposure induced significant hyperpigmentation, confirmed by a 5.8-fold increase in epidermal melanin content (p < 0.001) and a 4.1-fold increase in the number of MITF-positive melanocytes (p < 0.001) in the KP group. This was accompanied by a profound oxidative imbalance: MDA levels increased by 7.5-fold (p < 0.001), while the activities of SOD, CAT, and GPx decreased by 80.5%, 65.2%, and 71.4%, respectively (all p < 0.001). A strong negative correlation was observed between MDA and all antioxidant enzymes, particularly SOD (r = -0.985, p < 0.001). Conclusion: Chronic UVB exposure directly triggers a collapse of the cutaneous antioxidant network, leading to severe lipid peroxidation. This state of profound oxidative stress is causally linked to melanocyte activation and excessive melanin synthesis, driving the hyperpigmentation phenotype. This robustly validated preclinical model provides a powerful platform for investigating the molecular pathophysiology of UVB-induced pigmentary disorders and for evaluating novel therapeutic interventions.
A Retrospective Analysis of Clinical Characteristics and Neutrophil-to-Lymphocyte Ratio in Hospitalized Indonesian Patients with Pemphigus Vulgaris and Bullous Pemphigoid: A Single-Center Experience Azhar Arrosyid; Nurrachmat Mulianto
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.v9i11.1445

Abstract

Background: Comprehensive clinical-epidemiological data on severe autoimmune bullous diseases (ABDs) from Southeast Asian populations are notably scarce. Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are the most common ABDs, and understanding their presentation in diverse ethnic and geographic contexts is crucial for global health equity. This study’s primary aim was to characterize a cohort of hospitalized ABD patients in Central Java, Indonesia, and to secondarily explore the behavior of the neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker within this real-world clinical setting. Methods: A retrospective, cross-sectional study was conducted at a tertiary referral hospital in Surakarta, Indonesia. The study included all patients admitted with a final diagnosis of PV or BP between January 2019 and December 2023. Comprehensive data on demographics, documented comorbidities, duration of hospitalization, and admission hematological parameters were extracted from medical records. Clinical characteristics were compared, and the non-parametric Mann-Whitney U test was used to analyze the difference in NLR. A post-hoc power analysis was performed to contextualize the hematological findings. Results: This study provides a detailed clinical profile of 30 hospitalized ABD patients. The PV cohort (n=17) was characterized by a younger age of onset (mean age 54.29 ± 14.83 years) and a strong female predominance (70.6%). In contrast, the BP cohort (n=13) was older (mean age 63.08 ± 22.01 years) with a balanced gender distribution. A key finding was that patients with PV had a significantly longer duration of hospitalization than those with BP (13.24 vs. 10.15 days, p < 0.05). The mean NLR was descriptively higher in BP (10.56 ± 7.22) than in PV (9.43 ± 6.14), but this difference was not statistically significant (p = 0.770), a finding consistent with the study’s critically low statistical power of 9.8%. Conclusion: This study presents a valuable clinical and epidemiological snapshot of hospitalized patients with PV and BP in an underrepresented Indonesian population, highlighting a significantly greater clinical burden for PV as quantified by length of stay. The exploratory analysis of the NLR was inconclusive and should not be interpreted as definitive evidence against its utility. Instead, it serves as a powerful illustration of how the effects of low statistical power and overwhelming, unmeasured confounding from disease severity and corticosteroid treatment present profound challenges to the validation of non-specific biomarkers in complex, real-world clinical scenarios.
Erythema Nodosum Leprosum as a Harbinger of Relapse in Multibacillary Leprosy: A Clinico-Histopathological Case Study Benedikta Lauda; Nurrachmat Mulianto
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.v9i12.1468

Abstract

Background: Leprosy, a chronic granulomatous disease caused by Mycobacterium leprae, presents formidable long-term management challenges. In the post-elimination era, differentiating a true bacteriological relapse from a late-onset Erythema Nodosum Leprosum (ENL) reaction in patients who have completed multidrug therapy (MDT) is a critical diagnostic dilemma. Misdiagnosis can lead to inappropriate treatment, risking disease progression and irreversible nerve damage. Case presentation: A 30-year-old male presented with a severe, systemic inflammatory illness two years after completing MDT for lepromatous leprosy. His symptoms included crops of painful, erythematous nodules, fever, and arthralgia. While clinically suggestive of a severe ENL reaction, a slit-skin smear revealed a paradoxically high bacterial index (BI) of +5 with a morphological index (MI) of 0%. A skin biopsy was performed for definitive diagnosis. Histopathology revealed a dual pathology: a diffuse infiltrate of foamy macrophages typical of lepromatous leprosy, alongside a dense neutrophilic panniculitis characteristic of ENL. Crucially, Fite-Faraco staining demonstrated vast numbers of intact, solid-staining acid-fast bacilli, providing unequivocal evidence of active bacterial proliferation. Conclusion: This case demonstrates that a diagnostic algorithm integrating a high index of clinical suspicion with comprehensive bacteriological and histopathological methods is essential for accurately identifying relapse masked by ENL. The presence of viable bacilli confirms that ENL can be a direct clinical harbinger of relapse, mandating a dual therapeutic strategy that combines aggressive anti-inflammatory treatment with the immediate re-initiation of MDT.
Dose- and Time-Dependent Efficacy of Topical Hydroquinone in Establishing a C57BL/6 Mouse Model of Vitiligo Benedikta Lauda; Nurrachmat Mulianto; Endra Yustin Ellistasari; Muhammad Eko Irawanto
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1481

Abstract

Background: Vitiligo is a complex autoimmune depigmenting disorder driven by melanocyte-specific CD8+ T cells, oxidative stress, and genetic susceptibility. The lack of standardized, accessible animal models that recapitulate these pathways hinders therapeutic development. This study aimed to systematically optimize and validate a chemically-induced vitiligo model in C57BL/6 mice. Methods: Eighty (80) male C57BL/6 mice were randomized into ten groups (n=8/group). Experimental groups received once-daily topical applications of hydroquinone (HQ) at 2.5%, 5%, or 10%, or monobenzone (MBZ) at 40% for 8 or 16 days. Vehicle-treated mice served as controls. Efficacy was assessed via quantitative histopathology (Masson-Fontana staining for melanin area), biomolecular assays for oxidative stress (Malondialdehyde [MDA] and Superoxide Dismutase [SOD]), and RT-qPCR for melanogenesis-related (Tyr) and inflammation-related (Tnf) gene expression. Results: A clear dose- and time-dependent depigmentation was observed. The 10% HQ 16-day protocol was maximally effective, inducing a profound reduction in epidermal melanin area (0.06 ± 0.02) compared to 16-day controls (0.40 ± 0.04; p < 0.001). This histopathological finding was significantly correlated with severe cutaneous oxidative stress, evidenced by a 3.75-fold increase in MDA (p < 0.001) and a 50% reduction in SOD activity (p < 0.001) versus controls. Furthermore, this regimen caused a potent suppression of Tyr expression (0.15-fold change; p < 0.001) and a significant upregulation of the pro-inflammatory cytokine Tnf (3.8-fold change; p < 0.001). Conclusion: The 16-day topical application of 10% hydroquinone is a reliable, rapid, and highly reproducible protocol for inducing vitiligo-like depigmentation in C57BL/6 mice. This model successfully recapitulates key pathophysiological pillars of human vitiligo, including melanocytotoxicity, profound oxidative stress, and a pro-inflammatory cutaneous environment, establishing it as a valuable platform for preclinical therapeutic screening.
Combination Therapy of Topical Antioxidant Gel and Platelet-Rich Plasma (PRP) in Pyoderma Gangrenosum Ulcer: A Case Report Kamilah, Lian; Bobby Febrianto; Nurrachmat Mulianto; Nugrohoaji Dharmawan; Harijono Kariosentono
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 8 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i8.1046

Abstract

Background: Pyoderma gangrenosum (PG) is a rare necrotic ulcerative skin disease, often associated with an underlying systemic condition. Bacterial coinfection in PG can worsen the course of the disease and slow healing. Case presentation: We report the case of a 25-year-old woman with PG of her left leg complicated by Pseudomonas aeruginosa co-infection. The patient had a history of poorly treated psoriasis. The diagnosis is made based on disease history, physical examination, microbiological examination, and histopathological examination. The patient was treated with oral levofloxacin and topical combination therapy of astaxanthin and platelet-rich plasma (PRP) with wound debridement. Significant clinical improvement was achieved within six weeks. Conclusion: PG with bacterial coinfection requires appropriate diagnosis and treatment to achieve optimal results. Topical therapy combining astaxanthin and PRP with wound debridement proved effective in this case.
Co-Authors . Hardjono Achmad Satya Negara Adniana Nareswari Ahmad Fiqri, Ahmad Ambar Aliwardani Annisa Fildza Hashfi Arie Kusumawardani Arrochman, Ferry Astrid Astari Aulia Aulia Rahman Ayu Kusuma Dewi Azhar Arrosyid Benedikta Lauda Betaubun, Ance Imelda Bobby Febrianto Damayanti, Willa Danu Yuliarto Dhamayanti, Marsita Endy Dharmawan, Nugrohoaji Diana, Rina Dita Eka Novriana Dwi Hidayah Endra Yustin Ellistasari Endraputra, Pristiawan Farida Mustifah, Etty Fatiharani Dewi, Putty Fiska Rosita Harijono Kariosentono Indah Julianto Indah Julianto, Indah Irawanto, Muhammad Eko Ivani Kamilah, Lian Kariosentono, Harijono Kusumawardani, Arie Lidjaja, Lifesia Natali Mardiana - Mochtar, Moerbono Muhammad Eko Irawanto Murasmita, Alamanda Murastami, Ammarilis Niluh Wijayanti Novan Adi Setyawan Noviani, Laura Nugraha, Wibisono Nur Ismi Mustika Febriani Nurul Hidayati Oktaviani, Trya Oktriana, Putri Osdatilla Esa Putri Paramita Sari, Anggana Rafika Prasetyadi Mawardi Primisawitri, Pratiwi Prasetya Putri, Osdatilla Esa Putti Fatiharani Rafika Paramitasari, Anggana Rieka Sulaikha, Khalida Rinandari, Ummi Rini Hastuti Risman, Muhammad Rosmarwati, Ervina Satya Negara, Achmad Sesia Pradestine Shelly Lavenia Sambodo Siti Efrida Fiqnasyani Suci Widhiati Toha, Synthia Sari Tri Ifanti, Rakhma Tri Irfanti, Rakhma TUTIK RAHAYU Utama, Rahmat Firdaus Dwi Wibisono Nugraha Widhiati, Suci Winda Wijayanti Wirawan, Eka Putra