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Octarica, Stella Gracia
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Successful Combination Therapy with Phototherapy and Topical Corticosteroid in a Rare Case : 57 Years Old Male Patient with Lichen Amyloidosis Sambodo, Shelly Lavenia; Mawardi, Prasetyadi; Tansil, Ivana; Dewi, Ayu Kusuma; Utama, Rahmat Firdaus Dwi; Octarica, Stella Gracia; Adjie, Sugih Primas
Indonesian Journal of Medicine Vol. 9 No. 4 (2024)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2024.9.4.745

Abstract

Background: : Lichen Amyloidosis (LA) is one of the most common forms of primary localized cutaneous amyloidosis, with clinical manifestations of itchy blackish brown hyperkeratotic papules. The most predilection site is the upper extensor of the legs. This case report aims to improve the clinician’s knowledge regarding clinical features and supporting examinations to the provision of appropriate therapy in LA. Case Report: A 57 years old farmer presented to dermatology and venereology outpatient clinic of Dr. Moewardi general hospital with itchy black spots on nearly all over his body since 2 years ago. Dermatology examination obtained generalized papules and scaly hyperpigmented patches. Dermoscopy revealed a scar-like center with a whitish color in the center. Histopathological examination showed an amorphous eosinophilic (amyloid) in the dermis. Congo red examination demonstrated a reddish-orange amyloid. We treated the patient with oral cetirizine 10 mg/day, desoximetasone 0.25% cream applied twice a day in the morning and in the evening, Carmed® cream 20% cream applied twice a day in the afternoon and night, phototherapy 350 MJ/cm2 twice a week. We observed for 14 weeks. The lesion and itching started improving in week 8. Result: Lichen amyloidosis is resulted from amyloid deposits in the papillary dermis which are derived from degradation of basal keratinocytes. The diagnosis is based on history taking, clinical examination, dermoscopy and skin biopsy. The combination of phototherapy and topical corticosteroid can be an option for LA therapy, especially for the symptom of pruritus. Conclusion: Lichen Amyloidosis is the most common type of primary localized cutaneous amyloidosis, presents as blackish brown hyperkeratotic papules. The combined therapy of topical corticosteroids and phototherapy can significantly improve pruritus and skin lesions.
Topical Polypeptide Gel in Diabetic Ulcers: Clinical Insights Into a New Adjunctive Treatment Modality Octarica, Stella Gracia; Widhiati, Suci; Ellistasari, Endra Yustin; Dharmawan, Nugrohoaji; Julianto, Indah
Journal of Social Research Vol. 4 No. 10 (2025): Journal of Social Research
Publisher : International Journal Labs

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55324/josr.v4i9.2794

Abstract

Diabetic ulcers are a common and challenging complication of diabetes, contributing to morbidity, infection, and a high risk of amputation. Innovative adjuncts, such as topical polypeptide gel, which contains amino acids to support tissue regeneration, are proposed to accelerate wound healing; however, supporting clinical data are limited. A quasi-experimental analysis was conducted in 11 patients. Each received a daily topical 7% polypeptide gel in addition to standard care. Ulcer area was measured at baseline (day 0) and after 14 days using digital documentation analysis using ImageJ. The primary outcome was the percentage reduction in ulcer size. Patients were analysed for associations between percentage of improvement with age, gender, diabetes type, and ulcer site. Eleven patients with diabetic ulcers completed the 14-day treatment protocol. The cohort comprised 54.5% females with a mean age of 54.1 ± 7.3 years and predominantly insulin-dependent diabetes (72.7%). Baseline ulcer area averaged 982.1 ± 1315.1 mm², reducing to 184.0 ± 297.7 mm² by day 14, representing an 86.2 ± 6.7% mean area reduction. All patients achieved ?76% healing, with 45.5% achieving ?90% area reduction and 9.1% achieving complete healing. The Wilcoxon signed-rank test demonstrated statistically significant ulcer area reduction (Z = -2.934, p = 0.003). No significant associations were found between healing percentage and patient demographics, diabetes type, ulcer location, or comorbidity burden (all p > 0.05). No treatment-related adverse events were reported during the study period. Topical polypeptide gel demonstrated rapid wound surface area reduction in the majority of the subjects over 14 days, independent of patient age, gender, diabetes type, or ulcer location. These findings suggest its promise as an adjunctive early-phase therapy for diabetic ulcers.
Elephantiasis Nostras Verrucosa Bilateral Sebagai Komplikasi Limfedema Tarda: Satu Laporan Kasus Octarica, Stella Gracia; Mulianto, Nur M. Rachmat
Jurnal Impresi Indonesia Vol. 4 No. 10 (2025): Indonesian Impression Journal (JII)
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/jii.v4i10.7036

Abstract

Latar belakang : Elephantiasis Nostras Verrucosa (ENV) merupakan manifestasi klinis akibat limfedema kronis yang terdiri dari lesi hiperkeratotik, verukosa dan papilomatosis. Penyakit ENV disebabkan kelainan regional maupun penyakit sistemik yang menyebabkan limfedema primer dan sekunder. Faktor predisposisi ENV sangat bervariasi, sehingga pendekatan multidisiplin diperlukan untuk dapat memberikan tatalaksana yang tepat kepada pasien. Kasus : Seorang laki-laki usia 72 tahun dengan keluhan bengkak pada kedua kaki sejak 30 tahun disertai benjolan-benjolan dengan ukuran dan konsistensi yang bervariasi di permukaan kaki. Status dermatologi didapatkan regio ekstremitas inferior bilateral tampak papul dan nodul multipel menyatu membentuk permukaan verukosa menyerupai gambaran cobblestone appearance disertai woody edema. Pemeriksaan histopatologi epidermis tampak parakeratosis, akantosis dan papilomatosis, serta dermis tampak edema dengan deposisi kolagen tebal, dilatasi pembuluh limfe dan infiltrat perivaskuler. Luka paska biopsi yang membentuk ulkus dilakukan pemeriksaan kultur pus dan didapatkan bakteri Pseudomonas aeruginosa. Pemeriksaan USG Doppler dan CT scan dengan kontras tampak non suspicious limfadenopati inguinal bilateral dan tidak ditemukan kelainan vaskular yang dapat menyebabkan limfedema. Pasien diberikan terapi konservatif dengan edukasi pembatasan aktivitas dan elevasi tungkai saat istirahat, perawatan kulit dan kuku, pemijatan dan pembalutan dengan elastic bandage. Pasien mendapat terapi topikal dengan asam salisilat 30% dalam vaselin album yang dioleskan pada lesi hiperkeratotik setiap hari sekali dan dibalut oklusif dengan cling wrap dan medikasi ulkus dengan NaCl 0.9% selama 10 menit kemudian dioles gentamisin salep 0.1% ditutup dengan kasa lembab kering. Klinis pasien mengalami perbaikan yang cukup signifikan. Diskusi : Elephantiasis nostras verrucosa merupakan manifestasi klinis dari limfedema kronik. Akumulasi cairan limfe di jaringan interstisial menstimulasi fibroblas untuk membentuk serat kolagen berlebih yang akan tampak sebagai gambaran cobblestone. Penegakkan diagnosis ENV harus menyeluruh dan fokus untuk mencari penyebab utama limfedema. Manajemen ENV meliputi tatalaksana konservatif dan medikamentosa dengan agen keratolitik berupa asam salisilat terbukti efektif memperbaiki klinis pasien.
Profile And Risk Factors of Stevens Johnson Syndrome–Toxic Epidermal Necrolysis on Adult Patients in Dr. Moewardi General Hospital Surakarta from January 2019 – December 2022 Putri, Osdatilla Esa; Oktavriana, Triasari; Octarica, Stella Gracia; Anandita, Benedikta Lauda; Pradestine, Sesia; Oktaviani, Trya
Health and Medical Journal Vol 6, No 2 (2024): HEME May 2024
Publisher : Universitas Baiturrahmah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33854/heme.v6i2.1517

Abstract

Background: Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and life-threatening skin diseases, commonly induced by medications. Study on SJS/TEN in Indonesia was still limited, hence knowledge about the profile and risk factors of SJS/TEN patients is still required to provide appropriate management and reduce patient mortality rate. This study aimed to determine the profile and risk factors of adult SJS/TEN patients in the inpatient installation of RSDM Surakarta. Methods: We conducted a cross sectional study using secondary data from medical records of SJS/TEN patients at the inpatient installation of Dr. Moewardi hospital, Surakarta from 2019 – 2022. Correlation tests on characteristics, comorbidity with length of stay (LoS) and discharge status were analyzed. Results: Of the total 147,531 inpatients, 35 (0.02%) of them were diagnosed with SJS/TEN, dominated by females (57.14%) with the mean  of 45.74 years old.  Most subjects were diagnosed with SJS (48.57%), followed by SJS/TEN (40.0%) and TEN (11.43%). The mean LoS was  ± 8 days. Most subjects were discharged alive (85.71%). Paracetamol was the most common causative drug (25.71%), followed by cefadroxil (11.43%). Acute kidney injury (AKI) was the most common comorbidity (14.29%, p = 0.040). Spearman Rank test obtained no correlation between comorbidities and LoS (r = 0.028 ; p = 0.842) as well as discharge status (r = 0.063 ; p = 0.651). Conclusion: SJS/TEN is rare case with high mortality rate. Patients’ comorbidities have a very weak correlation with LoS and discharge status. Initial knowledge of the patient’s profile and risk factors including comorbidity and causative drugs can optimise comprehensive therapy for SJS/TEN patients.
Co-Authors Adjie, Sugih Primas Anandita, Benedikta Lauda Ayu Kusuma Dewi Dharmawan, Nugrohoaji Ellistasari, Endra Yustin Indah Julianto, Indah Mulianto, Nur M. Rachmat Oktaviani, Trya Pradestine, Sesia Prasetyadi Mawardi Putri, Osdatilla Esa Shelly Lavenia Sambodo Tansil, Ivana Triasari Oktavriana Utama, Rahmat Firdaus Dwi Widhiati, Suci