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The Rhomboid Flap for Facial Reconstruction Following Basal Cell Carcinoma Excision: A Case Report on Achieving Optimal Aesthetic and Functional Outcomes Tilesky Caprizio Phoanda; Ferra Olivia Mawu; Oktavia Reymond Leomer Sondakh; Paulus Mario Christopher
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.v9i10.1401

Background: Reconstruction of the lower eyelid following oncologic surgery presents a formidable challenge due to the region's unique anatomy and functional importance. The primary goal is to restore the lamellar structure while avoiding ectropion, a complication with significant functional and aesthetic consequences. This report details the successful application of a rhomboid flap, a classic transposition flap, for a moderate-sized defect in this high-risk anatomical subunit. Case presentation: A 75-year-old male farmer presented with a 2x1 cm nodular basal cell carcinoma on his left lower eyelid. After surgical excision with 4 mm margins, a superolaterally based rhomboid flap was designed to close the defect. The procedure was performed under local anesthesia. The postoperative course was uncomplicated. Objective functional assessment at 12 weeks confirmed a normal lower lid position with margin-to-reflex distance 2 (MRD2) symmetrical to the contralateral eye and no evidence of ectropion or lagophthalmos. The cosmetic outcome was assessed as favorable using the Patient and Observer Scar Assessment Scale (POSAS), and the patient reported high satisfaction (5/5 on a Likert scale). Conclusion: This case report illustrates the successful use of a rhomboid flap for a moderate-sized lower eyelid defect, resulting in a favorable functional and aesthetic outcome without complications in the short-term follow-up period. The technique successfully restored tissue volume and preserved normal eyelid function, critically preventing ectropion. It supports the rhomboid flap as a robust and reliable option in the reconstructive surgeon's toolkit for this challenging anatomical area.

The Rhomboid Flap for Facial Reconstruction Following Basal Cell Carcinoma Excision: A Case Report on Achieving Optimal Aesthetic and Functional Outcomes Tilesky Caprizio Phoanda; Ferra Olivia Mawu; Oktavia Reymond Leomer Sondakh; Paulus Mario Christopher
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.v9i10.1401

Background: Reconstruction of the lower eyelid following oncologic surgery presents a formidable challenge due to the region's unique anatomy and functional importance. The primary goal is to restore the lamellar structure while avoiding ectropion, a complication with significant functional and aesthetic consequences. This report details the successful application of a rhomboid flap, a classic transposition flap, for a moderate-sized defect in this high-risk anatomical subunit. Case presentation: A 75-year-old male farmer presented with a 2x1 cm nodular basal cell carcinoma on his left lower eyelid. After surgical excision with 4 mm margins, a superolaterally based rhomboid flap was designed to close the defect. The procedure was performed under local anesthesia. The postoperative course was uncomplicated. Objective functional assessment at 12 weeks confirmed a normal lower lid position with margin-to-reflex distance 2 (MRD2) symmetrical to the contralateral eye and no evidence of ectropion or lagophthalmos. The cosmetic outcome was assessed as favorable using the Patient and Observer Scar Assessment Scale (POSAS), and the patient reported high satisfaction (5/5 on a Likert scale). Conclusion: This case report illustrates the successful use of a rhomboid flap for a moderate-sized lower eyelid defect, resulting in a favorable functional and aesthetic outcome without complications in the short-term follow-up period. The technique successfully restored tissue volume and preserved normal eyelid function, critically preventing ectropion. It supports the rhomboid flap as a robust and reliable option in the reconstructive surgeon's toolkit for this challenging anatomical area.

Complete Clinical and Trichoscopic Remission of Refractory Patch Alopecia Areata with a Multi-Modal Microneedling and Vitamin D3 Protocol: A Case Report Stephanie Lukita; Ferra Olivia Mawu; Thigita Aga Pandaleke
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1493

Background: Refractory patch alopecia areata (AA) presents a significant therapeutic challenge, as many patients fail first-line treatments. This gap necessitates the exploration of novel, mechanistically-targeted therapeutic strategies. Case presentation: We present the case of a 44-year-old female with a 2.5 × 3.0 cm patch of AA, refractory to a 3-month compliant trial of topical 0.25% desoximetasone and 5% minoxidil. Baseline diagnostics included histopathology (peribulbar lymphocytic infiltrate), quantitative trichoscopy (yellow dots, black dots, exclamation mark hairs), and laboratory workup, which revealed a serum 25-hydroxyvitamin D [25(OH)D] insufficiency (18.2 ng/mL). A multi-modal protocol was initiated: (1) systemic 5,000 IU/day oral cholecalciferol, (2) 10 sessions of 1.5 mm microneedling at two-week intervals, and (3) immediate post-procedure application of topical 100,000 IU cholecalciferol. Significant regrowth of pigmented terminal hairs was observed by week 12. After 20 weeks (10 sessions), complete clinical regrowth was achieved. Final quantitative trichoscopy confirmed the full resolution of all pathological markers, with a healthy density of terminal hairs. The patient’s systemic 25(OH)D level was corrected to 41.5 ng/mL. The treatment was well-tolerated. Conclusion: This case report documents a complete remission associated with a multi-modal protocol. The contribution of the systemic vitamin D repletion is a major, unresolvable confounder, making attribution impossible. However, this hypothesis-generating case suggests a combined (systemic, physical, and topical) approach may represent a potential rescue strategy for refractory patch AA, warranting further controlled investigation.

Complete Clinical and Trichoscopic Remission of Refractory Patch Alopecia Areata with a Multi-Modal Microneedling and Vitamin D3 Protocol: A Case Report Stephanie Lukita; Ferra Olivia Mawu; Thigita Aga Pandaleke
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 1 (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.v10i1.1493

Background: Refractory patch alopecia areata (AA) presents a significant therapeutic challenge, as many patients fail first-line treatments. This gap necessitates the exploration of novel, mechanistically-targeted therapeutic strategies. Case presentation: We present the case of a 44-year-old female with a 2.5 × 3.0 cm patch of AA, refractory to a 3-month compliant trial of topical 0.25% desoximetasone and 5% minoxidil. Baseline diagnostics included histopathology (peribulbar lymphocytic infiltrate), quantitative trichoscopy (yellow dots, black dots, exclamation mark hairs), and laboratory workup, which revealed a serum 25-hydroxyvitamin D [25(OH)D] insufficiency (18.2 ng/mL). A multi-modal protocol was initiated: (1) systemic 5,000 IU/day oral cholecalciferol, (2) 10 sessions of 1.5 mm microneedling at two-week intervals, and (3) immediate post-procedure application of topical 100,000 IU cholecalciferol. Significant regrowth of pigmented terminal hairs was observed by week 12. After 20 weeks (10 sessions), complete clinical regrowth was achieved. Final quantitative trichoscopy confirmed the full resolution of all pathological markers, with a healthy density of terminal hairs. The patient’s systemic 25(OH)D level was corrected to 41.5 ng/mL. The treatment was well-tolerated. Conclusion: This case report documents a complete remission associated with a multi-modal protocol. The contribution of the systemic vitamin D repletion is a major, unresolvable confounder, making attribution impossible. However, this hypothesis-generating case suggests a combined (systemic, physical, and topical) approach may represent a potential rescue strategy for refractory patch AA, warranting further controlled investigation.

Sporadic Coexistence of Multiple Trichoepitheliomas and Solitary Neurofibroma: Mimicking Brooke–Spiegler Syndrome Rivano Frits Henry Pandaleke; Shienty Gaspersz; Ferra Olivia Mawu; Tara Sefanya Kairupan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1522

Background: The simultaneous presentation of multiple adnexal tumors and neural sheath tumors on the face typically heralds a genodermatosis, most notably Brooke–Spiegler syndrome (BSS) or neurofibromatosis type 1 (NF1). The sporadic, non-syndromic coexistence of these entities in the same anatomical region is a diagnostic pitfall that challenges the principle of parsimony. Case presentation: We report the case of a 24-year-old Asian female presenting with a 12-month history of 18 disseminated, skin-colored papules restricted to the centrofacial region, followed by the rapid development of a 3.0 cm solitary tumor on the right buccal region. Dermoscopic evaluation revealed a dichotomy in tumor morphology: the papules exhibited ivory-white backgrounds with multiple rosette signs and milia-like cysts, while the buccal tumor displayed a structureless pink pattern with absence of pigment networks. Detailed physical examination ruled out cutaneous stigmata of NF1. Histopathological analysis confirmed the diagnosis of multiple trichoepitheliomas and a solitary localized neurofibroma based on characteristic morphological features, including papillary mesenchymal bodies and mast cell presence. Immunohistochemistry was not utilized due to setting-specific resource limitations. Conclusion: This case underscores the potential for sporadic benign tumors to mimic syndromic phenotypes (phenocopies). It highlights the critical importance of recognizing key hematoxylin and eosin morphological markers and clinical signs to establish accurate diagnoses in resource-limited settings where molecular genetics and immunohistochemical staining are unavailable.

Hydrostatic Pressure versus Passive Diffusion: A Split-Face Comparative Analysis of Intradermal Injection and Microneedling-Assisted Delivery of Botulinum Toxin Type A for Facial Pore Refinement Jill N Pairunan; Marlyn Grace Kapantow; Ferra Olivia Mawu
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1529

Background: Enlarged facial pores, medically termed dilated pilosebaceous follicles, represent a prevalent aesthetic concern driven by seborrhea, follicular hypertrophy, and loss of perifollicular elasticity. Microbotox, the intradermal administration of dilute OnabotulinumtoxinA (BoNT-A), targets these mechanisms through sebosuppression and arrector pili inhibition. However, the optimal delivery vehicle—active intradermal injection versus passive microneedling-assisted transport—remains debated regarding clinical delivery efficiency. Case presentation: A 23-year-old female with Fitzpatrick Skin Type IV, severe pore enlargement (Kim’s Score 5), and seborrhea participated in a split-face comparative study. The right cheek received standard intradermal microdroplet injections of BoNT-A (20 U diluted in 1.0 mL saline). The left cheek underwent automated microneedling at a depth of 2.0 mm immediately followed by topical application of the same BoNT-A solution. Evaluation was performed at baseline, Day 7, and Day 14 using blinded clinical scoring and digital dermoscopic analysis. At Day 14, the intradermal injection side demonstrated superior pore reduction (Kim’s Score 5 to 3) compared to the microneedling side (Score 5 to 4). Digital quantification confirmed a 45% reduction in mean pore diameter on the injected side versus 18% on the microneedling side. While both modalities effectively reduced sebum scores to 1, the microneedling side exhibited delayed pore refinement, likely attributed to post-traumatic edema and the wash-out effect of blood flow antagonizing passive diffusion. Conclusion: Direct intradermal injection provides superior clinical delivery efficiency for BoNT-A, resulting in more rapid and significant pore contraction. Microneedling-assisted delivery, particularly at depths inducing vascular injury, acts as a secondary adjunct for textural remodeling but is inferior for immediate pharmacological delivery of large-molecule toxins.

The Steel-Blue Peppering and Systemic Eosinophilia: Dermoscopic-Histopathological Correspondence of the Tyndall Effect in Generalized Fixed Drug Eruption William Yudistha Anggawirya; Shienty Gaspersz; Ferra Olivia Mawu; Thigita Aga Pandaleke; Anggi Anastasia Ursula Dien
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1538

Background: Generalized fixed drug eruption (GFDE) represents a severe and distinctive variant of delayed-type hypersensitivity, characterized by widespread, recurrent pigmentary lesions involving at least three anatomical sites. Its clinical presentation often mimics extensive lichenoid dermatoses or infectious conditions such as Hansen’s disease, leading to significant diagnostic delays, particularly in geriatric populations with polypharmacy. While dermoscopy offers a non-invasive bridge to histopathology, specific correlative studies in generalized cases remain scarce. Case presentation: We report the case of a 69-year-old male presenting with diffuse, well-demarcated, violaceous plaques affecting the face, trunk, extremities, and genitalia. The eruption demonstrated a pathognomonic acute latency, recurring at identical anatomical sites within six hours of re-exposure to an unprescribed analgesic cocktail. High-definition non-contact polarized dermoscopy identified two distinct morphological patterns: a brown starburst pattern with central clearing on the extremities and diffuse steel-blue peppering on femoral lesions. Notably, the patient exhibited a mixed immunophenotype characterized by marked eosinophilia (2,080 cells per microliter) and elevated total immunoglobulin E (2,295 IU per milliliter). Parasitic infection was rigorously excluded via negative stool examination and serology, and a Naranjo probability score of 10 confirmed a definite adverse drug reaction. Histopathological examination confirmed interface dermatitis with necrotic keratinocytes and marked pigment incontinence. Conclusion: This study illustrates that steel-blue peppering is a reliable dermoscopic surrogate for deep dermal pigment incontinence via the Tyndall effect. The discrepancy between high systemic eosinophilia and low tissue eosinophilia suggests a complex, potentially mixed-hypersensitivity phenotype in generalized cases, distinct from classic localized fixed drug eruption.

Sporadic Coexistence of Multiple Trichoepitheliomas and Solitary Neurofibroma: Mimicking Brooke–Spiegler Syndrome Rivano Frits Henry Pandaleke; Shienty Gaspersz; Ferra Olivia Mawu; Tara Sefanya Kairupan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1522

Background: The simultaneous presentation of multiple adnexal tumors and neural sheath tumors on the face typically heralds a genodermatosis, most notably Brooke–Spiegler syndrome (BSS) or neurofibromatosis type 1 (NF1). The sporadic, non-syndromic coexistence of these entities in the same anatomical region is a diagnostic pitfall that challenges the principle of parsimony. Case presentation: We report the case of a 24-year-old Asian female presenting with a 12-month history of 18 disseminated, skin-colored papules restricted to the centrofacial region, followed by the rapid development of a 3.0 cm solitary tumor on the right buccal region. Dermoscopic evaluation revealed a dichotomy in tumor morphology: the papules exhibited ivory-white backgrounds with multiple rosette signs and milia-like cysts, while the buccal tumor displayed a structureless pink pattern with absence of pigment networks. Detailed physical examination ruled out cutaneous stigmata of NF1. Histopathological analysis confirmed the diagnosis of multiple trichoepitheliomas and a solitary localized neurofibroma based on characteristic morphological features, including papillary mesenchymal bodies and mast cell presence. Immunohistochemistry was not utilized due to setting-specific resource limitations. Conclusion: This case underscores the potential for sporadic benign tumors to mimic syndromic phenotypes (phenocopies). It highlights the critical importance of recognizing key hematoxylin and eosin morphological markers and clinical signs to establish accurate diagnoses in resource-limited settings where molecular genetics and immunohistochemical staining are unavailable.

Hydrostatic Pressure versus Passive Diffusion: A Split-Face Comparative Analysis of Intradermal Injection and Microneedling-Assisted Delivery of Botulinum Toxin Type A for Facial Pore Refinement Jill N Pairunan; Marlyn Grace Kapantow; Ferra Olivia Mawu
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1529

Background: Enlarged facial pores, medically termed dilated pilosebaceous follicles, represent a prevalent aesthetic concern driven by seborrhea, follicular hypertrophy, and loss of perifollicular elasticity. Microbotox, the intradermal administration of dilute OnabotulinumtoxinA (BoNT-A), targets these mechanisms through sebosuppression and arrector pili inhibition. However, the optimal delivery vehicle—active intradermal injection versus passive microneedling-assisted transport—remains debated regarding clinical delivery efficiency. Case presentation: A 23-year-old female with Fitzpatrick Skin Type IV, severe pore enlargement (Kim’s Score 5), and seborrhea participated in a split-face comparative study. The right cheek received standard intradermal microdroplet injections of BoNT-A (20 U diluted in 1.0 mL saline). The left cheek underwent automated microneedling at a depth of 2.0 mm immediately followed by topical application of the same BoNT-A solution. Evaluation was performed at baseline, Day 7, and Day 14 using blinded clinical scoring and digital dermoscopic analysis. At Day 14, the intradermal injection side demonstrated superior pore reduction (Kim’s Score 5 to 3) compared to the microneedling side (Score 5 to 4). Digital quantification confirmed a 45% reduction in mean pore diameter on the injected side versus 18% on the microneedling side. While both modalities effectively reduced sebum scores to 1, the microneedling side exhibited delayed pore refinement, likely attributed to post-traumatic edema and the wash-out effect of blood flow antagonizing passive diffusion. Conclusion: Direct intradermal injection provides superior clinical delivery efficiency for BoNT-A, resulting in more rapid and significant pore contraction. Microneedling-assisted delivery, particularly at depths inducing vascular injury, acts as a secondary adjunct for textural remodeling but is inferior for immediate pharmacological delivery of large-molecule toxins.

The Steel-Blue Peppering and Systemic Eosinophilia: Dermoscopic-Histopathological Correspondence of the Tyndall Effect in Generalized Fixed Drug Eruption William Yudistha Anggawirya; Shienty Gaspersz; Ferra Olivia Mawu; Thigita Aga Pandaleke; Anggi Anastasia Ursula Dien
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (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.v10i3.1538

Background: Generalized fixed drug eruption (GFDE) represents a severe and distinctive variant of delayed-type hypersensitivity, characterized by widespread, recurrent pigmentary lesions involving at least three anatomical sites. Its clinical presentation often mimics extensive lichenoid dermatoses or infectious conditions such as Hansen’s disease, leading to significant diagnostic delays, particularly in geriatric populations with polypharmacy. While dermoscopy offers a non-invasive bridge to histopathology, specific correlative studies in generalized cases remain scarce. Case presentation: We report the case of a 69-year-old male presenting with diffuse, well-demarcated, violaceous plaques affecting the face, trunk, extremities, and genitalia. The eruption demonstrated a pathognomonic acute latency, recurring at identical anatomical sites within six hours of re-exposure to an unprescribed analgesic cocktail. High-definition non-contact polarized dermoscopy identified two distinct morphological patterns: a brown starburst pattern with central clearing on the extremities and diffuse steel-blue peppering on femoral lesions. Notably, the patient exhibited a mixed immunophenotype characterized by marked eosinophilia (2,080 cells per microliter) and elevated total immunoglobulin E (2,295 IU per milliliter). Parasitic infection was rigorously excluded via negative stool examination and serology, and a Naranjo probability score of 10 confirmed a definite adverse drug reaction. Histopathological examination confirmed interface dermatitis with necrotic keratinocytes and marked pigment incontinence. Conclusion: This study illustrates that steel-blue peppering is a reliable dermoscopic surrogate for deep dermal pigment incontinence via the Tyndall effect. The discrepancy between high systemic eosinophilia and low tissue eosinophilia suggests a complex, potentially mixed-hypersensitivity phenotype in generalized cases, distinct from classic localized fixed drug eruption.

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