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What Are The Differences In Melasma Diagnosis And Management Across Diverse Ethnic Populations With Varying Skin Types? : A Systematic Review Juliave Dora Odheta Purba; Ketut Kwartantaya Winaya; Pande Agung Mahariski
The Indonesian Journal of General Medicine Vol. 13 No. 1 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/wxrcgp16

Introduction: Melasma presents significant therapeutic challenges due to its varied presentation across diverse ethnic populations and skin types. There is a critical need for treatment strategies tailored to a patient's ethnic background and Fitzpatrick skin type to optimize efficacy while minimizing risks such as post-inflammatory hyperpigmentation (PIH), particularly in darker skin tones (Fitzpatrick III-V). Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, Semantic Scholar, Springer, and Sagepub databases was performed using a PICO-based strategy to identify studies on melasma diagnosis and management with respect to ethnic variations or skin types. Thirty studies met the inclusion criteria for final analysis. Results: The Melasma Area and Severity Index (MASI) was the most common diagnostic tool. Treatment efficacy varied significantly by population. In Indian cohorts, salicylic-mandelic acid peels and topical tranexamic acid were found to be safe and effective. Asian populations showed a preference for combination laser therapies, such as dual toning and picosecond lasers, to reduce the risk of rebound hyperpigmentation. Triple combination creams were effective in Middle Eastern skin , and non-hydroquinone alternatives demonstrated efficacy across multi-ethnic groups. High recurrence rates and PIH remain major challenges, especially in darker skin. Conclusion: The evidence confirms that a 'one-size-fits-all' approach to melasma is obsolete. Effective management requires a personalized strategy that considers the patient's ethnicity and skin phototype to balance efficacy with pigmentary safety. Combination therapies targeting multiple pathogenic pathways are superior , and the use of versatile agents like tranexamic acid alongside strict sun protection is crucial. Individualizing treatment is paramount for achieving sustained improvement and managing this chronic condition.

Karakteristik Kanker Kulit Berdasarkan Tipe Histopatologi dan Tindakan Operatif di Bagian Dermatology dan Venereology RSUD Sumbawa Tahun 2024-2025 Zulkifli Maku; Ketut Kwartantaya Winaya; Yogi Triatmakusuma
The Indonesian Journal of General Medicine Vol. 15 No. 2 (2025): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/n5ce4r95

Latar Belakang: Kanker kulit, khususnya Kanker Kulit Non-Melanoma (KKNM) yang terdiri dari Karsinoma Sel Basal (KSB) dan Karsinoma Sel Skuamosa (KSS), merupakan keganasan dengan insiden tertinggi di seluruh dunia. Meskipun data epidemiologi global telah mapan, data yang meliput karakteristik pasien di tingkat regional Indonesia, seperti di Kabupaten Sumbawa, masih sangat terbatas. Penelitian ini bertujuan untuk memberikan gambaran awal mengenai profil kanker kulit di wilayah tersebut. Tujuan: Mendeskripsikan karakteristik pasien kanker kulit di RSUD Sumbawa berdasarkan profil demografi (usia dan jenis kelamin), fitur klinis (lokasi lesi), tipe histopatologi, dan tatalaksana operatif yang diterima. Metode: Penelitian ini menggunakan desain studi deskriptif dengan pendekatan retrospektif. Data dikumpulkan dari rekam medis dan laporan patologi anatomi 12 pasien yang didiagnosis dan ditatalaksana untuk kanker kulit di Bagian Dermatologi dan Venereologi RSUD Sumbawa selama periode 1 Januari 2024 hingga 31 Desember 2025. Variabel yang dianalisis meliputi usia, jenis kelamin, lokasi lesi, diagnosis histopatologi, dan jenis tindakan operatif. Hasil: Studi ini melibatkan 12 pasien, terdiri dari 8 perempuan (66.7%) dan 4 laki-laki (33.3%). Rentang usia pasien adalah 51 hingga 85 tahun, dengan usia rerata 66.8 tahun. KSB merupakan diagnosis yang paling sering ditemukan (10 kasus, 83.3%), diikuti oleh Karsinoma Basoskuamosa (1 kasus, 8.3%) dan KSS (1 kasus, 8.3%). Di antara kasus KSB, subtipe nodular adalah yang paling umum (7 dari 10 kasus). Lesi secara dominan berlokasi di area yang terpapar sinar matahari, dengan regio wajah menjadi lokasi tersering (11 kasus, 91.7%). Seluruh pasien (100%) dalam kohort ini menjalani tatalaksana bedah berupa eksisi luas yang dilanjutkan dengan rekonstruksi menggunakan skin flap. Simpulan: Dalam kohort ini, kanker kulit lebih banyak ditemukan pada perempuan usia lanjut, dengan KSB tipe nodular sebagai diagnosis histopatologi yang paling umum dan wajah sebagai lokasi predileksi utama. Penggunaan universal teknik rekonstruksi skin flap mengindikasikan bahwa pasien cenderung datang dengan lesi yang berukuran signifikan atau berlokasi di area kritis secara kosmetik, menyoroti potensi adanya keterlambatan diagnosis dan pentingnya program deteksi dini di komunitas.

Mixed Type Basal Cell Carcinoma Treated with Excision and Defect Closure Using Advancement Flap: A Case Report Darmaputra, I Gusti Nyoman; Ketut Kwartantaya Winaya; Adelia Suryani; Herman Saputra; Putu Setiani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (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.v8i2.931

Background: Basal cell carcinoma (BCC) is a localized malignant tumor in the basal layer of the epidermis thought to be the result of prolonged sun exposure and associated with gene mutations in most cases. Although rarely metastazises, BCC can cause high levels of morbidity due to its locally destructive nature. There are several modalities for managing BCC, and the defect caused by the lesion can reconstructed by local flap. Case presentation: We present a 55-year-old woman with a chief complaint of a blackish lump on the left maxillary region, growing bigger, and frequent episodes of bleeding. The lesion was excised and followed by histopathological examination, which revealed mixed subtype BCC. Closure of the defect with an advancement flap was performed with favorable results. Conclusion: Surgical excision is the best option for managing BCC, while a skin flap is preferred to close defects for lesions on the cheek.

High levels of zinc (Zn) as a protective factor and negatively correlated with IgM anti PGL-1 levels among household contact with multibacillary leprosy patients Adeline Santoso; Luh Made Mas Rusyanti; Ketut Kwartantaya Winaya
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/mpyc7w03

Background: Close contacts may develop subclinical leprosy with no symptoms but with M. leprae in their blood. Zinc is said to help in the prevention of M. leprosy infection. This study aimed to determine the correlation between zinc (Zn) serum levels and IgM anti PGL-1 levels in household contacts of multibacillary type leprosy patients. Methods: This study is cross-sectional and involves 48 leprosy subjects (33 multibacillary leprosy household contact and 15 non-contact subjects). Subjects were selected based on the inclusion and exclusion criteria. Zinc and IgM anti PGL-1 levels were derived from venous blood examined with ELISA. Results: This study showed the mean serum zinc level of the contact groups of 60.88 ± 15.92 μg/dl and the non-contact group of 90.00 ± 7.61 μg / dl (p <0.001; CI 95%: 20.38 - 37.85). The median (interquartile range) serum levels of IgM anti PGL-1 in the contact groups was 613.00 (40 - 1433) u/ml and the non-contact groups was 99.00 (14 - 695) u/ml (p = 0.001; 95% CI: 154.162 – 610.116). The correlation analysis between serum zinc levels and IgM anti PGL-1 serum levels r= 0.644 (p<0.05). A high serum zinc level is a protective factor against high IgM anti PGL-1 levels in household contact with leprosy (PR: 0.47; 95% CI: 0.20-1.09). Conclusion: Zinc levels negatively correlate with IgM anti PGL-1 levels in subjects with household contact with multibacillary type leprosy. A high serum zinc level protects against high IgM anti PGL-1 levels.

Mixed Type Basal Cell Carcinoma Treated with Excision and Defect Closure Using Advancement Flap: A Case Report Darmaputra, I Gusti Nyoman; Ketut Kwartantaya Winaya; Adelia Suryani; Herman Saputra; Putu Setiani
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 2 (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.v8i2.931

Background: Basal cell carcinoma (BCC) is a localized malignant tumor in the basal layer of the epidermis thought to be the result of prolonged sun exposure and associated with gene mutations in most cases. Although rarely metastazises, BCC can cause high levels of morbidity due to its locally destructive nature. There are several modalities for managing BCC, and the defect caused by the lesion can reconstructed by local flap. Case presentation: We present a 55-year-old woman with a chief complaint of a blackish lump on the left maxillary region, growing bigger, and frequent episodes of bleeding. The lesion was excised and followed by histopathological examination, which revealed mixed subtype BCC. Closure of the defect with an advancement flap was performed with favorable results. Conclusion: Surgical excision is the best option for managing BCC, while a skin flap is preferred to close defects for lesions on the cheek.

Psoriasiform Digital Bowen’s Disease: A Diagnostic Challenge and Short-Term Response to Liquid Nitrogen Cryotherapy Putu Resika Melarosa; Ketut Kwartantaya Winaya; Lettisia Amanda Ruslan; Made Sri Adnyasitarini; Putu Ayu Paramitha Saraswaty
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1513

Background: Bowen’s disease (BD), or squamous cell carcinoma in situ, classically presents as a slowly enlarging erythematous plaque on sun-exposed skin. However, digital Bowen’s disease represents a distinct and rare clinical subset that frequently poses a significant diagnostic dilemma. Due to its unique anatomical location and morphological variability, digital BD often masquerades as benign inflammatory dermatoses, particularly psoriasis or chronic eczema, leading to dangerous therapeutic delays. Case presentation: We report the case of a 46-year-old male presenting with a solitary, rough, erythematous plaque on the dorsal aspect of the left index finger that had persisted for one year. The lesion was initially misdiagnosed and treated as an inflammatory condition without success. Detailed dermoscopic evaluation revealed a specific "psoriasiform" vascular pattern characterized by clustered glomerular vessels and surface scaling, raising suspicion for malignancy. Histopathological analysis confirmed the diagnosis of Bowen’s disease, demonstrating full-thickness epidermal atypia with psoriasiform hyperplasia. Notably, the presence of histological koilocytic atypia suggested a potential synergistic etiology involving Human Papillomavirus (HPV) infection alongside chronic ultraviolet exposure. The patient was treated with a tissue-sparing protocol of liquid nitrogen cryotherapy to preserve digital function. Conclusion: Complete clinical resolution of the lesion was observed at the three-week follow-up interval, resulting in a hypopigmented macule with full preservation of joint mobility. This case highlights the critical necessity of distinguishing "psoriasiform" malignancies from true inflammatory diseases through the recognition of specific vascular arrangements in dermoscopy. Furthermore, it suggests that cryotherapy is a pragmatic, function-sparing alternative to surgical excision for digital malignancies, provided that rigorous long-term surveillance is maintained to monitor for recurrence.

Psoriasiform Digital Bowen’s Disease: A Diagnostic Challenge and Short-Term Response to Liquid Nitrogen Cryotherapy Putu Resika Melarosa; Ketut Kwartantaya Winaya; Lettisia Amanda Ruslan; Made Sri Adnyasitarini; Putu Ayu Paramitha Saraswaty
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1513

Background: Bowen’s disease (BD), or squamous cell carcinoma in situ, classically presents as a slowly enlarging erythematous plaque on sun-exposed skin. However, digital Bowen’s disease represents a distinct and rare clinical subset that frequently poses a significant diagnostic dilemma. Due to its unique anatomical location and morphological variability, digital BD often masquerades as benign inflammatory dermatoses, particularly psoriasis or chronic eczema, leading to dangerous therapeutic delays. Case presentation: We report the case of a 46-year-old male presenting with a solitary, rough, erythematous plaque on the dorsal aspect of the left index finger that had persisted for one year. The lesion was initially misdiagnosed and treated as an inflammatory condition without success. Detailed dermoscopic evaluation revealed a specific "psoriasiform" vascular pattern characterized by clustered glomerular vessels and surface scaling, raising suspicion for malignancy. Histopathological analysis confirmed the diagnosis of Bowen’s disease, demonstrating full-thickness epidermal atypia with psoriasiform hyperplasia. Notably, the presence of histological koilocytic atypia suggested a potential synergistic etiology involving Human Papillomavirus (HPV) infection alongside chronic ultraviolet exposure. The patient was treated with a tissue-sparing protocol of liquid nitrogen cryotherapy to preserve digital function. Conclusion: Complete clinical resolution of the lesion was observed at the three-week follow-up interval, resulting in a hypopigmented macule with full preservation of joint mobility. This case highlights the critical necessity of distinguishing "psoriasiform" malignancies from true inflammatory diseases through the recognition of specific vascular arrangements in dermoscopy. Furthermore, it suggests that cryotherapy is a pragmatic, function-sparing alternative to surgical excision for digital malignancies, provided that rigorous long-term surveillance is maintained to monitor for recurrence.

FAKTOR-FAKTOR RISIKO GIZI PADA ANAK PENDERITA KUSTA: SEBUAH TINJAUAN SISTEMATIS Paulus, Stella Jessica; Putu Mahadevy Pradnyandhari Putri; Ketut Kwartantaya Winaya
Media Dermato-Venereologica Indonesiana Vol 52 No 4 (2025): 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.v52i4.566

Anak-anak dapat beresiko untuk mendapatkan penularan kusta akibat berbagai faktor risiko, salah satunya adalah kondisi gizi yang kurang. Penelitian ini bertujuan untuk menganalisis faktor risiko gizi pada anak dengan kusta berdasarkan studi yang telah dilakukan sebelumnya. Tinjauan sistematis ini menggunakan PRISMA 2020 guideline pada studi yang diterbitkan dalam bahasa Inggris dari tahun 2014 hingga 2024. Editorial dan artikel tinjauan yang tidak memiliki DOI dihilangkan untuk menjamin penggunaan sumber berkualitas tinggi. Tinjauan pustaka yang komprehensif dilakukan dengan menggunakan basis data terkemuka seperti ScienceDirect, PubMed, dan SagePub untuk menemukan studi yang relevan. Pencarian awal pada basis data mengidentifikasi lebih dari 1000 publikasi yang relevan dengan topik tersebut. Setelah melalui proses penyaringan tiga tahap yang cermat, delapan studi akhirnya dipilih berdasarkan kriteria inklusi yang telah ditetapkan sebelumnya dan dianggap sesuai untuk analisis mendalam. Studi-studi ini menjalani penilaian kritis menyeluruh untuk memastikan kualitas dan relevansinya, yang menyediakan landasan yang kuat untuk penyelidikan komprehensif mengenai hubungan antara faktor risiko gizi pada kusta pediatrik. Status gizi berperan penting dalam menentukan kerentanan terhadap kusta terutama pada anak.

HUBUNGAN JUMLAH KUNJUNGAN TERAPI INJEKSI TRIAMSINOLON ASETONID DENGAN RESPONS KLINIS KELOID: STUDI RETROSPEKTIF ANALITIK DI RSUD SUMBAWA Ketut Kwartantaya Winaya; Ida Ayu Agung Kirana Komalasari
The Indonesian Journal of General Medicine Vol. 30 No. 1 (2026): The Indonesian Journal of General Medicine
Publisher : International Medical Journal Corp. Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.70070/thzabg62

Pendahuluan: Keloid merupakan kelainan penyembuhan luka yang ditandai dengan proliferasi jaringan fibrosa yang melampaui batas luka asli. Kondisi ini sering kali menimbulkan keluhan subjektif berupa gatal, nyeri, serta gangguan kosmetik yang signifikan. Terapi standar yang paling efektif dan umum digunakan adalah injeksi kortikosteroid intralesi, khususnya triamsinolon asetonid. Efektivitas terapi ini sangat bergantung pada kepatuhan pasien dalam menjalani serangkaian kunjungan. Penelitian ini bertujuan untuk menganalisis hubungan antara frekuensi kunjungan terapi dengan perkembangan respons klinis pada pasien keloid di RSUD Sumbawa. Metode Penelitian: Penelitian ini menggunakan desain retrospektif analitik dengan mengambil data dari rekam medis pasien rawat jalan di Poliklinik Kulit dan Kelamin RSUD Sumbawa periode 2024-2025. Data mencakup 415 baris kunjungan yang dianalisis untuk mengidentifikasi profil demografis, pola kunjungan, diagnosis utama (ICD-10), dan diagnosis tambahan sebagai indikator respons klinis atau efek samping. Analisis data dilakukan secara deskriptif dan analitik untuk melihat keterkaitan jumlah sesi injeksi dengan stabilitas kondisi lesi. Hasil Penelitian: Hasil analisis menunjukkan bahwa mayoritas pasien ( > 95%) didiagnosis dengan hypertrophic scar atau keloid (L91.0). Terdapat variasi jumlah kunjungan yang lebar, mulai dari kunjungan tunggal hingga 14 kali kunjungan per pasien. Pasien dengan jumlah kunjungan yang lebih banyak ( > 6 kali) menunjukkan kecenderungan adanya diagnosis tambahan seperti hiperpigmentasi pasca-inflamasi (L81.0) dan xerosis kutis (L85.3), yang menandakan adanya respons kronis terhadap terapi. Sebagian besar pasien ( > 96%) menggunakan jaminan kesehatan BPJS, yang secara signifikan mendukung retensi kunjungan pasien. Diskusi: Injeksi triamsinolon asetonid bekerja dengan menekan mediator inflamasi dan menghambat aktivitas fibroblas. Frekuensi kunjungan yang rutin memungkinkan akumulasi efek farmakologis yang stabil untuk mendegradasi kolagen tipe I dan III. Di RSUD Sumbawa, ketersediaan dokter spesialis kulit dan kelamin (dr. YT, Sp.D.V.E) telah meningkatkan aksesibilitas layanan ini bagi masyarakat lokal, mengurangi angka rujukan ke luar daerah, dan memungkinkan manajemen kasus yang lebih komprehensif. Kesimpulan: Terdapat hubungan yang erat antara jumlah kunjungan dengan respons klinis keloid. Pasien dengan kunjungan rutin memiliki kemungkinan lebih besar untuk mencapai perataan lesi yang stabil dibandingkan pasien dengan kunjungan sporadis. Dukungan sistem pembiayaan kesehatan seperti BPJS sangat krusial dalam menjamin keberlangsungan terapi jangka panjang ini.

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