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All Journal Berkala Ilmu Kesehatan Kulit dan Kelamin Buletin Ilmiah Nagari Membangun Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Ners Warta Pengabdian Andalas: Jurnal Ilmiah Pengembangan Dan Penerapan Ipteks Bioscientia Medicina : Journal of Biomedicine and Translational Research Jurnal Ilmu Kesehatan Indonesia (JIKSI)
Rina Gustia
Bagian Ilmu Penyakit Kulit Dan Kelamin Fakultas Kedokteran Universitas Andalas / RSUP. DR. M. Djamil Padang
Agriculture, Biological Sciences & Forestry Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Economics, Econometrics & Finance Education Engineering Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Veterinary Other

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The 15-Year Shadow: Borderline Lepromatous Leprosy with Erythema Nodosum Leprosum Following Prolonged Treatment Default Rendra Darmasatria; Tutty Ariani; Yosse Rizal; Rina Gustia; Irdawaty Izrul
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1405

Abstract

Background: Leprosy, caused by Mycobacterium leprae, persists as a global health issue where the primary challenges are not merely microbial but are deeply rooted in delayed diagnosis and poor treatment adherence. These delays, often driven by profound social stigma, lead to progressive, irreversible disability and sustain community transmission. Erythema Nodosum Leprosum (ENL), an acute immunological complication, further devastates patients' quality of life and complicates management. Case presentation: A 53-year-old Indonesian farmer presented with a 15-year history of untreated leprosy, a journey of neglect initiated by fear of treatment side effects and community ostracism. Clinical examination revealed advanced borderline lepromatous (BL) leprosy with diffuse skin infiltration, multiple anesthetic plaques, and thickened, tender peripheral nerves. He had established WHO Grade 1 disability, characterized by significant sensory loss in his hands and feet and early intrinsic muscle atrophy. A slit-skin smear confirmed a bacteriological index of +3 with a morphological index of 5%, indicating a high load of viable bacilli. Histopathology confirmed BL leprosy with a concurrent mild ENL reaction. A comprehensive, patient-centered management plan was initiated, including a 12-month course of multidrug therapy (MDT-MB), adjunctive care, and intensive counseling. Conclusion: This case powerfully illustrates the "shadow effect" of leprosy—how years of untreated disease, fueled by psychosocial barriers, culminate in a complex nexus of advanced infection, immunological reaction, and permanent neurological impairment. The patient's successful re-engagement with the health system underscores that eradicating the burden of leprosy requires a paradigm shift from a purely pharmacological approach to a deeply humanistic one. Effective control hinges on building compassionate health systems that actively dismantle stigma, empower patients with knowledge, and deliver holistic, multidisciplinary care to prevent the profound human cost of neglect.
Nummular Dermatitis Masquerading as Recalcitrant Tinea Corporis: A Diagnostic Pitfall Resolved by Dermoscopy and Histopathology Rina Gustia; Deasy Archika Alvares; Mutia Sari
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 10 (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.v9i10.1406

Abstract

Background: The morphological mimicry between nummular dermatitis (ND) and tinea corporis represents a significant source of diagnostic error in clinical practice. This convergence on a similar clinical phenotype—the annular plaque—often leads to inappropriate antifungal therapy and a protracted, debilitating course for the patient, as powerfully illustrated in this case. Case presentation: We present the case of a 22-year-old female with a five-year history of chronic, recalcitrant, and intensely pruritic annular plaques on her lower legs, with a baseline pruritus score of 8/10 on a Visual Analog Scale (VAS). Previous treatments based on presumptive diagnoses, including potent topical corticosteroids and systemic antifungals, had failed. This report demonstrates a pivot from a morphology-based assessment to a multimodal diagnostic algorithm. The cornerstone of this shift was dermoscopy, which revealed patchy, irregularly distributed red dotted vessels—a classic signature of an eczematous process—and a notable absence of features suggestive of a dermatophyte infection. The diagnosis was confirmed by histopathology. A strong correlation between disease flares and psychosocial stressors was identified, and a holistic management plan targeting the cutaneous inflammation, the compromised skin barrier, and the neurogenic triggers led to a rapid and substantial improvement in her clinical status and quality of life, with the Dermatology Life Quality Index (DLQI) score decreasing from 9 to 3 and the pruritus VAS score dropping to 1/10. Conclusion: This case argues for a revised diagnostic paradigm for chronic annular lesions, one that de-emphasizes ambiguous morphology and prioritizes the integration of a detailed psychodermatological history with in-vivo microscopic analysis via dermoscopy. This approach not only prevents therapeutic futility but also underscores that successful, long-term management of ND is contingent upon a patient-centered strategy that addresses the interconnectedness of the skin barrier, the immune system, and the psycho-neuro-cutaneous axis.
Co-Authors Abdiana Abdiana, Abdiana Afriwardi Afriwardi Agustin Vira Aisyah Elliyanti Andrini Ariesti Anum, Qaira Arina Widya Murni Astria Rima Rara Yuswir Cherry Chalik Deasy Archika Alvares Dia Rofinda, Zelly Dia Dian Pertiwi Dwi Sabtika Julia Ellyza Nasrul Elmatris Sy Ennesta Asri Fadila Esmeralda Ilmi Fesdia Sari Firdawati Firdawati Gardenia Akhyar Hendriati, Hendriati Ilahi, Fitratul Indah Indria Sari Irdawaty Izrul Jefrizal Wirman Jessica Herlianez Saiful Julita Julita Kemala Sayuti Laras Surakusuma Miftah Irrahmah Millenia Calista Mutia Sari Mutia Sari Nolanda Trikanti Novian Novian Putri Sabila Hidayat Rauza Sukma Rita Rendra Darma Satria Rendra Darmasatria Rika Desviorita Rizki Dwayana Satya Wydya Yenni Satya Wydya Yenny Sri Lestari Tisa Hamzany Tofrizal Tutty Ariani Tutty Ariani Vitresia, Havriza Yevri Zulfiqar Yosse Rizal Yulistini, Yulistini