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Widyasari, Indah
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Medicine & Pharmacology

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A rare case of late onset reticulate acropigmentation of Kitamura without involvement of the palms and soles Melly, Conny; Sularsito, Sri Adi; Sirait, Sondang Panjaitan; Rihatmadja, Rahadi; Widyasari, Indah; Onmaya, Vini
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 1
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Background: Reticulate acropigmentations of Kitamura (RAPK) is an autosomal dominant inherited disorder characterized by pigmented, angulated, irregular freckle-like lesion with atrophy on the surface, arranged in a reticulate pattern on the dorsa of the hands and feet. It was first described by Kitamura and Akamatsu in Japan in 1943. The usual age of onset is the first and second decades of life. Palms and soles reveal pits and breaks in the epidermal ridge pattern. The histopathological examination show epidermal atrophy, digitate and filiform elongated rete ridges with clumps of heavy melanin pigmentation at their tips. Case: A 59-year-old male presented with asymptomatic and progressive brownish-black discoloration in a reticulate pattern on the dorsal aspect of his hands and feet. The lesions initially appeared when the patient was 45 years old. It was not preceded by any erythema or inflammation. There was no similar case in the family. Laboratory findings were within normal limits. Discussion: Skin biopsy taken from the dorsal of the hand and foot revealed hyperkeratosis, thinning of epithelium, filiform elongation of the rete ridges, increased melanocyte numbers in the basal layer, and lymphocyte infiltration in the dermis. Based on the clinical and histological findings he was diagnosed as RAPK. From some reports, sporadic cases without the involvement of other family members may occur, like our patient. Palms and soles involvement in RAPK is still debated, some considered it as a characteristic sign of this disorder while others refuted it.
Acquired vulvar lymphangioma: Report of two cases Widyasari, Indah; Fathan, Hafiza; Wibawa, Larisa Paramitha; Cipto, Herman; Sampurna, Adhimukti T; Sirait, Sondang Pandjaitan
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
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Vulvar lymphangioma is a rare case and often being misdiagnosed as genital wart. This acquired disorder manifests as dilatation of superficial lymph vessel due to obstruction. It is caused by urogenital infection and most often occurs following surgery and radiotherapy of cervical cancer. The diagnosis is established based on clinical and histopathological features. Treatment aimed to eliminate the cause of obstruction. This article reports two cases of vulvar lymphangioma found in our Hospital. First case was a 43-year-old female with a history of surgery and radiation for cervical cancer 10 years ago presented with vesicular skin lesion in genital area, oozing copious clear fluid since 4 years ago. There are multiple lenticular vesicles containing clear fluid in vulvar area accompanied with bilateral lymphedema of lower extremities. Histopathological features demonstrated dilated superficial lymph vessels. Second case was a 44-year-old female with enlargement of lower abdomen with vesicular lesion containing clear fluid in genital area since 3 years ago. Abdominal USG showed enlarged inguinal lymph node. Histopathological features demonstrated dilated superficial lymph vessels. The treatment for both cases were gradual electrosurgery. In both cases,vulvar dermis’ superficial lymph node dilatation caused the skin lesions. Obstruction of lymph vessel due to radiation and surgery for cervical cancer in the first case and of inguinal lymph node in the second case lead to increased lymphatic pressure in the dermis and later on the dilatations. The treatment in both cases using electrical excision produced good responses; however, we should be attentive on recurrent case.
Atypical mycobacterial infection resembles sporotrichosis in elderly patient Fauziah, Siti Nurani; Legiawati, Lili; Sularsito, Sri Adi; Yusharyahya, Shannaz Nadia; Rihatmadja, Rahadi; Sirait, Sondang P.; Huda, Fifi Mifta; Widyasari, Indah
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
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Atypical mycobacterial (AM) infection is caused by Mycobacterium species other than M.tuberculosis. AM skin infection has clinical manifestations that resemble M. tuberculosis infection and deep fungal infection. Laboratory workup is necessary to confirm the diagnosis. An 83-year old female came with a painful lump and swelling on her right lower extremity since three months before admission. Physical examination revealed a plaque consisting, of multiple erythematous and hyperpigmented papules and nodules, diffuse erythematous lesion, and shallow ulcers partially covered with pus and crust. Histopathological features showed tuberculoid granuloma. Direct test and periodic acid-Schiff (PAS) staining of the skin biopsy found no fungal element nor acid-fast bacilli (AFB). Culture and polymerase chain reaction (PCR)of M. tuberculosis were negative. The working diagnosis was atypical mycobacterial infection and treatment with 450 mg rifampicin and 100 mg minocycline daily were administered accordingly. In two months observation following the treatment, the pain was no longer exist, the ulcers were completely healed, and some nodules were in the process of healing Among other Mycobacterium spp, M.marinum is the most common cause of AM infrections. Clinical manifestation of M. marinum infection may present as solitary or multiple nodules on the hands, feet, elbows and knees with sporotrichoid spreading patern. The diagnosis of AM was established based on clinical and laboratory examination. The diagnosis was also confirmed by good clinical response to minocycline and rifampicin.
Co-Authors Fathan, Hafiza Fauziah, Siti Nurani Herman Cipto Huda, Fifi Mifta Lili Legiawati Melly, Conny Onmaya, Vini Rahadi Rihatmadja Sampurna, Adhimukti T Shannaz Nadia Yusharyahya Sirait, Sondang P. Sirait, Sondang Pandjaitan Sirait, Sondang Panjaitan Sri Adi Sularsito Winnugroho Wiratman, Manfaluthy Hakim, Tiara Aninditha, Aru W. Sudoyo, Joedo Prihartono