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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

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.

Maternal Atopy Diathesis on The Newborn’s Skin Acidity and Hydration Putri, Osdatilla Esa; Widhiati, Suci; Mawardi, Prasetyadi; Kusumawardani, Arie; Mulianto, Nurrachmat; Hidayah, Dwi; Endraputra, Pristiawan
Jurnal Ners Vol. 9 No. 4 (2025): OKTOBER 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jn.v9i4.50222

Background: Atopic diathesis, a hereditary predisposition to allergic disorders such as atopic dermatitis, asthma, and allergic rhinitis, is more strongly transmitted maternally. Maternal atopy may influence neonatal skin barrier development, but evidence on its effect on neonatal skin pH and hydration is limited. Methods: This cross-sectional study was conducted at Dr. Moewardi General Hospital, Surakarta, Indonesia, between March–April 2025. Neonates (28–41 weeks gestation), <24 hours old, and delivered by cesarean section were included. Skin pH was measured on the volar forearm and axilla using a calibrated pH meter, and hydration (water and oil content) was assessed with a Skin Tester. Maternal atopy diathesis was classified by the Erlangen Atopy Score (EAS). Results: Twenty-nine neonates were enrolled, comprising 12 with and 17 without maternal atopy. No significant association was found between maternal atopy and neonatal hydration (water: p = 0.460; oil: p = 0.997) or skin pH (p = 0.876). Conclusion: Maternal atopy diathesis was not associated with neonatal skin pH or hydration in the first 24 hours of life. Early neonatal skin physiology appears to be influenced more by intrinsic maturation than maternal atopic status. Longitudinal studies are needed to assess potential delayed effects.

Dermoscopy Of Onychomycosis: A Literature Review Primisawitri, Pratiwi Prasetya; Mulianto, Nurrachmat
Indonesian Basic and Experimental Health Sciences Vol. 13 No. 1 (2024): November
Publisher : Rumah Sakit Umum Daerah Dr. Moewardi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/ibehs.vol13iss1pp23-33

Background: Onychomycosis is a fungal infection of the nails. Onychomycosis is caused by dermatophytes, non-dermatophyte molds, and non-dermatophyte fungi. Dermoscopy examination has gradually been used as a modern diagnostic method to assess non-invasive nail abnormalities that are easy and inexpensive to visualize abnormal microscopic features of the nail. However, it is still uncommon for medical personnel to diagnose onychomycosis using dermoscopy. Purpose: To provide information on the benefits of the nail dermoscopy technique that can diagnose onychomycosis and describe observable dermoscopic findings. Results: Dermoscopy findings on onychomycosis showed a diverse picture depending on the type. Distal and lateral subungual onychomycosis shows the proximal margin of the onycholytic area with spikes leading to proximal folds and longitudinal striae. White superficial onychomycosis shows large, brittle, irregularly spreading white-yellow patches on the nail's surface. Proximal subungual onychomycosis has one or more transverse white bands on the inner nail plate, while total dystrophic onychomycosis shows longitudinal striae and spikes and irregular distal terminations. Conclusion: Nail dermoscopy improves quality and simplifies examination to establish the diagnosis of onychomycosis because it can guide clinicians in conducting screening, choosing the best time for mycological sampling, and making therapeutic decisions.

The Differential Biopsychosocial Burden of Psoriasis and Vitiligo: A Comparative Analysis of Participation Restriction and its Clinical and Psychiatric Correlates Nurrachmat Mulianto; Shelly Lavenia Sambodo; Muhammad Eko Irawanto; Arie Kusumawardani
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 6 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i6.805

Visible skin diseases like psoriasis vulgaris and vitiligo impose a significant psychosocial burden. However, the comparative impact on real-world functioning and the interplay of clinical, social, and psychiatric factors remain poorly understood, particularly in non-Western populations. This study aimed to quantitatively compare participation restriction between these two conditions and to identify its key biopsychosocial predictors. This comparative cross-sectional study, conducted in a tertiary Indonesian hospital, enrolled 50 patients (25 with psoriasis vulgaris, 25 with non-segmental vitiligo). The primary outcome was participation restriction, measured by the 18-item Participation Scale (P-Scale). Clinical severity was assessed using the Psoriasis Area and Severity Index (PASI) and Vitiligo Area Scoring Index (VASI). Crucially, depressive and anxiety symptoms were screened using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale, respectively. A hierarchical multiple linear regression analysis was performed to identify predictors of participation restriction. Patients with psoriasis reported profoundly higher mean P-Scale scores (43.16 ± 5.01) compared to those with vitiligo (25.72 ± 4.21; p < 0.001), indicating more severe restrictions. Psoriasis patients also exhibited significantly higher scores for depressive symptoms (PHQ-9: 11.52 ± 3.18 vs. 5.68 ± 2.29; p < 0.001) and anxiety symptoms (GAD-7: 10.24 ± 2.95 vs. 5.12 ± 2.15; p < 0.001). The hierarchical regression model was highly significant (F(7, 42) = 28.14, p < 0.001), explaining 82.4% of the variance in P-Scale scores. After controlling for demographic and clinical factors, a diagnosis of psoriasis (β = 0.45, p < 0.001), higher clinical severity (β = 0.28, p = 0.002), and higher depressive symptom severity (PHQ-9 score; β = 0.39, p < 0.001) were significant independent predictors of greater participation restriction. In conclusion, psoriasis vulgaris is associated with a dramatically greater burden of participation restriction than vitiligo. This burden is driven by a complex interplay of the disease's clinical severity, its inherent diagnosis-specific factors, and, critically, comorbid depressive symptoms. These findings underscore the necessity of a biopsychosocial approach in dermatology, advocating for routine mental health screening and integrated care models to address the multifaceted drivers of disability in patients with chronic inflammatory skin disease.

The Clinical Relevance of Serum Interleukin-21 in Grading Acne Vulgaris Dewi, Ayu Kusuma; Irawanto, Muhammad Eko; Kusumawardani, Arie; Dharmawan, Nugrohoaji; Mulianto, Nurrachmat
Journal of Social Research Vol. 4 No. 11 (2025): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v4i10.2795

Acne vulgaris (AV) is an inflammatory skin disorder with multifactorial pathogenesis involving genetics, hormones, and immune dysregulation. Interleukin-21 (IL-21), a pleiotropic cytokine mainly secreted by T follicular helper and Th17 cells, has been implicated in various inflammatory skin diseases. However, its role in AV remains unclear. This cross-sectional study included 46 patients with AV, classified into mild (n=19), moderate (n=16), and severe (n=11) groups. Serum IL-21 levels were measured using an enzyme-linked immunosorbent assay (ELISA). Baseline characteristics were compared across groups, and interobserver reliability of AV severity grading was evaluated using Cohen’s kappa test. One-way ANOVA was applied to assess differences in IL-21 levels among severity groups, with a significance level set at p<0.05. The mean serum IL-21 level was highest in the severe AV group (303.53 pg/mL), followed by the moderate (223.7 pg/mL) and mild (213.2 pg/mL) groups. Although there was a trend toward increasing IL-21 levels with higher AV severity, statistical analysis revealed no significant difference among the three groups (p=0.130). Serum IL-21 levels were elevated in AV patients compared with previously reported healthy controls but did not differ significantly across severity levels. These findings suggest that IL-21 may play a role in the pathophysiology of AV, though it is not a reliable marker of clinical severity. Further case-control and tissue-based studies are needed to clarify its role.

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

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.

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

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

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.

Onychomycosis with Green Nail Discoloration in an Immunocompromised Patient: A Case Report Mulianto, Nurrachmat; Oktaviani, Trya
Health and Medical Journal Vol 7, No 3 (2025): HEME September 2025
Publisher : Universitas Baiturrahmah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33854/heme.v7i3.1816

Candida onychomycosis is an infection of the nails of the hands or feet caused by Candida sp. Green nail discoloration (GND) is a greenish discoloration of the nail due to bacterial infection, fungal infection or polymicrobial infection. Candida species fungi are fungal pathogens reported to be associated with GND. A 22-year-old female complained of greenish-yellow colored right thumb nail since 3 months ago. The patient has a history of systemic lupus erythematosus (SLE) since 1 year ago. Dermatological status examination of the digiti I manus dexter region showed onychodystrophy, subungual hyperkeratosis and greenish yellow discoloration of the nail plate. Based on the results of history, physical examination and supporting examination, the patient was diagnosed onychomycosis with GND. The diagnosis of onychomycosis can be established by history taking, physical examination and supporting examination in the form of dermoscopy, microscopic nail scraping with 20% KOH, fungal culture and nail biopsy with Periodic Acid-Schiff's (PAS) histochemical painting. Green nail discoloration is one of the clinical manifestations in cases of onychomycosis. Candida sp. is reported as one of the fungal pathogens associated with GND. Management of onychomycosis requires a long time and aims to eliminate fungal pathogens and improve nail condition.

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

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.

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