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METOTREKSAT DAN METFORMIN SEBAGAI ALTERNATIF PENGOBATAN TERKINI ERITEMA NODUSUM LEPROSUM BERULANG Handelia Phinari; Ni Nyoman Ayu Sutrini
Jurnal Medika Hutama Vol. 3 No. 03 April (2022): Jurnal Medika Hutama
Publisher : Yayasan Pendidikan Medika Indonesia

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Eritema Nodosum Leprosum (ENL) merupakan reaksi kusta tipe II yang paling sering dilaporkan. ENL paling sering terjadi pada kusta tipe lepromatosa (LL). Pengobatan ENL dengan prednisolon terbukti efektif namun memberikan efek samping berat seperti hiperglikemia, diabetes, osteoporosis, hipertensi, katarak dan imunosupresi bila digunakan dalam jangka waktu panjang, sedangkan pengobatan dengan talidomid sangat terbatas karena memiliki efek teratogenik. Penggunaan metotreksat dan metformin pada ENL bekerja sebagai agen anti-inflamasi yang memberikan berbagai keuntungan berdasarkan profil keamanan, pengaturan dosis yang mudah, dan biaya yang rendah. Kedua obat ini dapat menjadi pilihan obat monoterapi maupun sebagai obat tambahan yang dikombinasikan dengan kortikosteroid. Keywords: ENL; Metotreksat ; Metformin

Gray Patch Tinea Capitis by Microsporum canis in a Child: A Case Report Highlighting Environmental Risk Factors and Diagnostic Nuances Mario Korwa; Luh Made Mas Rusyati; Handelia Phinari; Andrew Wicaksono; Nandya Dwizella
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.v9i11.1429

Background: Tinea capitis, a dermatophytosis of the scalp, is a leading cause of hair loss in children. Its successful management hinges on understanding its complex etiology, including host susceptibility and pathogen virulence. Microsporum canis, a zoophilic fungus, is a primary causative agent, yet its transmission pathways and diagnostic markers are not fully elucidated. Case presentation: A 3-year-old female presented with a two-week history of progressive, pruritic alopecia. Clinical history was notable for the absence of animal contact but revealed significant environmental exposure at a hair salon. Dermatological examination showed multiple, well-demarcated, alopecic patches with fine scaling, characteristic of gray patch tinea capitis. While Wood's lamp examination was negative, trichoscopy revealed comma hairs and Morse code-like hairs, suggesting fungal infection. Microscopic examination of hair shafts confirmed an ectothrix invasion pattern, and fungal culture definitively identified Microsporum canis. The patient achieved complete resolution following a six-week course of oral griseofulvin and adjuvant topical ketoconazole. Conclusion: This case demonstrates that indirect fomite transmission from environmental reservoirs like hair salons is a critical risk factor for zoophilic tinea capitis, independent of animal contact. It further establishes trichoscopy as an essential tool for accurate, rapid diagnosis when classic signs, such as Wood's lamp fluorescence, are absent, thereby optimizing patient management and public health outcomes.

Gray Patch Tinea Capitis by Microsporum canis in a Child: A Case Report Highlighting Environmental Risk Factors and Diagnostic Nuances Mario Korwa; Luh Made Mas Rusyati; Handelia Phinari; Andrew Wicaksono; Nandya Dwizella
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.v9i11.1429

Background: Tinea capitis, a dermatophytosis of the scalp, is a leading cause of hair loss in children. Its successful management hinges on understanding its complex etiology, including host susceptibility and pathogen virulence. Microsporum canis, a zoophilic fungus, is a primary causative agent, yet its transmission pathways and diagnostic markers are not fully elucidated. Case presentation: A 3-year-old female presented with a two-week history of progressive, pruritic alopecia. Clinical history was notable for the absence of animal contact but revealed significant environmental exposure at a hair salon. Dermatological examination showed multiple, well-demarcated, alopecic patches with fine scaling, characteristic of gray patch tinea capitis. While Wood's lamp examination was negative, trichoscopy revealed comma hairs and Morse code-like hairs, suggesting fungal infection. Microscopic examination of hair shafts confirmed an ectothrix invasion pattern, and fungal culture definitively identified Microsporum canis. The patient achieved complete resolution following a six-week course of oral griseofulvin and adjuvant topical ketoconazole. Conclusion: This case demonstrates that indirect fomite transmission from environmental reservoirs like hair salons is a critical risk factor for zoophilic tinea capitis, independent of animal contact. It further establishes trichoscopy as an essential tool for accurate, rapid diagnosis when classic signs, such as Wood's lamp fluorescence, are absent, thereby optimizing patient management and public health outcomes.

Factors affecting quality of life in vitiligo patients at Dermatology and Venereology Polyclinic Bali Mandara General Hospital Handelia Phinari; Betsy Yosia Nadeak; Luh Putu Dina Wahyuni
Bali Dermatology Venereology and Aesthetic Journal BDVJ - Vol. 5 No. 1 (June 2022)
Publisher : Explorer Front

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/ckpcaf07

Introduction: Vitiligo is a chronic and asymptomatic skin depigmentation disorder due to progressive loss of melanocytes. Vitiligo can affect a patient’s psychological condition that causes disturbances in the quality of life. This study aims to identify factors affecting the quality of life (QoL) in vitiligo patients at Dermatology and Venereology Polyclinic Bali Mandara General Hospital. Research Methods: Cross-sectional study was conducted using Dermatology Life Quality Index (DLQI) questionnaire given to vitiligo patients who came to the Dermatology and Venereology Polyclinic at Bali Mandara General Hospital Denpasar in January 2022. Results: Among the 71 respondents, seven respondents felt no impact, 33 respondents had a small impact, 18 respondents had a moderate impact, and 13 respondents had a very large impact on quality of life. There was a significant relationship between occupation and location of vitiligo with quality of life (p ≤0.05), and partially the location of vitiligo lesions had a significant effect on the quality of life (p ≤0.05). Conclusion: This study shows that vitiligo has a significant impact on quality of life. Relevant counseling and supportive therapy play an important role in the management of vitiligo patients

The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 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.v10i2.1499

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.

The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 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.v10i2.1499

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.

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