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Journal of General Procedural Dermatology and Venereology Indonesia

jdvi
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Published by Universitas Indonesia

ISSN : 24607991 EISSN : 24607991 DOI : 10.191

Core Subject : Health,

Medicine & Pharmacology

The initiation of JDVI (Journal of General - Procedural Dermatology & Venereology Indonesia) was done by leading dermatologists and venereologists from Indonesia who aspired to contribute in the field of scientific publication and research. Knowledge and science continue to evolve in the field of dermatology and venereology, especially with new diagnostic methods, therapeutic and procedural approaches, and new emerging diseases.

Arjuna Subject : -

Articles 106 Documents

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Prevalence of nail changes in patients infected with HIV - A cross sectional study Seethalakshmi Gangavellaisamy; Priya Jeyaraman; Kannan Gopalan
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Introduction: The spectrum of nail changes is wider and their frequency is higher among HIV patients. These changes magnify the range and multiplicity of AIDS manifestations. Their systematic examination is a non-invasive method of possible diagnostic value. Objective: The present study was conducted to study the frequency and types of nail changes in HIV infected individuals and to correlate the severity of nail changes with CD4 count. Material and Method: This was a cross sectional study, conducted in Skin & STD Out-Patient department in a tertiary care hospital between March 2018 and April 2019. A total of 176 HIV patients were included in the study. Standardized examination was performed in which the changes in surface, color, thickness and curvature of nail plates were recorded. Data were coded and analyzed. Results: The prevalence of nail changes in our study was 60.8%. Majority of the patients were in the age group of 34-41 years(38.1%) with a slight female preponderance Absent lunula (33.5%), diffuse pigmentation of nails (29.54%) and nail dystrophy (18.2%) occupied the top three changes followed by longitudinal melanonychia (13.06%), flat nails (4%), onychomycosis (3.4%) and pterygium (2.8%). Majority of the patients who had abnormal nails had CD4 count in the range of more than 500 cells/mm3(30.68%) because many patients in our study were having CD4 count more than 500 cells/mm3. The strength of association between abnormal nail changes and CD4 count was done by Chisquare test and the p value was 0.575 which was not statistically significant. Conclusion: This study infers that systematic nail examination of HIV patients is necessary, but their relation to the severity of immunosuppression requires further large scale, multicentric studies. Key words: CD4 count, HIV/AIDS, Nail changes, Anolunula

Reversal reaction with nodules clinical manifestations that initially diagnosed as erythema nodosum leprosum in borderline lepromatous leprosy Laila Tsaqilah; Pati Aji Achdiat; Hendra Gunawan
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: The reversal leprosy reaction generally manifest as larger, swollen, red and shiny the pre-existing skin lesions which are accompanied with pain. This reaction can be manifest as infiltration and nodules which resembles the features of erythema nodosum leprosum (ENL) leprosy reaction. Case Illustration: We present a case of 26-year-old woman with erythematous nodules on almost all the body since two weeks ago. She had pre-existing erythema plaque on the right elbow became more erythematous and arouse with partially felt pain, fever, and malaise. Nodule lesions in BL leprosy with reaction need to be distinguished between ENL and reversal reaction because they may affect therapy and prognosis. Discussion: The patient was diagnosed as BL leprosy with ENL reaction erythematous nodules on the face, both upper and lower arms, upper and lower limbs, knees, that partially felt pain, but after more careful history and histopathologic examination of the lesions, the nodules didn’t match to the histopathologic features of ENL reaction. Correlation between the clinical and histopathological findings in the form of acid fast bacilli (AFB) and granulomatous inflammation grenz zone with epithelioid cells and lymphocyte cells infiltrations in the dermis established the diagnosis of BL leprosy with reversal reaction. Conclusion: Erythema nodule lesions in leprosy can be an ENL or reversal reaction or a leprosy lesion in type BL leprosy. Reversal reaction should always be considered when diagnosing a skin-colored nodule in leprosy. Appropriate clinical and histopathological findings of the skin-colored nodules are needed to establish the definite diagnosis of reversal reaction. Keywords: leprosy, borderline lepromatous, nodule, reversal reaction, erythema nodosum leprosum

Cutaneous candidiasis mimicking inverse psoriasis lesion in a type 2 diabetes mellitus patient Steven Philip Surya; Regina Regina; Kardiana Purnama Dewi
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: Type 2 diabetes mellitus (T2DM) condition could affect the skin. The disease is among the greatest risk factors of skin infection such as cutaneous candidiasis and is also associated with autoimmune skin diseases such as psoriasis, which lesion morphologies and predilection areas are quite similar. These similarities are a source of confusion to clinicians.Case illustration: We present a 60-year-old female patient with uncontrolled T2DM and multiple erythematous plaques in the form of shiny lesions at the intertriginous area that developed 1 week prior to her hyperglycemic state. The lesions had recurred at the same site for approximately 10 years and were initially diagnosed as intertriginous candidiasis. Bedside testing revealed a positive Auspitz sign, while the patient’s fungal culture was unremarkable. She was diagnosed with inverse psoriasis (IP) and treated with 0.1% mometasone furoate cream twice a day. The lesions improved but were not completely resolved.Discussion: Inverse psoriasis is a subgroup of psoriasis characterized with thin, non-layered scales, and various predilection areas. The features of the primary lesion may be altered by a patient’s activities, such as use of cleansing soap, which may cause lesions to dry out and ooze, similar to cutaneous candidiasis. Additional examination, such as bedside testing and laboratory work, could help obtain a proper diagnosis. Conclusion: The similar morphologies and predilection areas of IP and cutaneous candidiasis lesions may confuse clinicians. In some limited cases, the correct diagnosis may be obtained by complete history taking, physical examination, and other simple tests.Keywords: inverse psoriasis, intertriginous cutaneous candidiasis, type 2 diabetes mellitus

Correlation between clinical and histopathological findings of five puzzling cases of cutaneous tuberculosis Eliza Miranda; Sandra Widaty; Sondang Pandjaitan Sirait; Luddwi Achmad Rizky; Henry Wan-Peng Lim; Sri Linuwih SW Menaldi
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings.Case Illustration: Five cases of cutaneous tuberculosis, which include two cases of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris were presented in this article. Four of the five cases demonstrated significant improvement after initiation of an antituberculosis drug regimen.Discussion: Diagnosis of cutaneous tuberculosis in these cases was confirmed through clinical findings and histopathological and microbiological examination.Conclusion: A negative result following microbiological examination does not completely exclude the diagnosis of cutaneous tuberculosis. Investigating the pathognomonic findings of cutaneous tuberculosis through histopathological examination is important to differentiate among its types correctly. Therefore, correlations between clinical and histopathological results are essential to establish a diagnosis of cutaneous tuberculosis.

Lucio’s phenomenon: A report on six patients in a tertiary referral hospital in Indonesia Melani Marissa; Rahadi Rihatmadja; Danny Surya; Henry Lim; Sri Linuwih Menaldi
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: Lucio's phenomenon (LP) is a rare variant of leprosy reaction, with the clinical manifestation of “necrotizing erythema.” LP was observed in patients with lepromatous leprosy who have not received or completed the treatment, and it is especially evident in patients with diffuse lepromatous leprosy (DLL), known as Lucio-Latapi’s leprosy. LP occurs due to M. leprae invading the blood vessels, causing endothelial damage that leads to thrombosis, ischemia, infarction, and tissue necrosis. The clinical features of the disease are erythematous lesions that can be accompanied by vesicles or bullae, with ulcers forming scar tissues. Histopathological examination can help establish the diagnosis of LP. Until now, there is still controversy about LP management. Multidrug therapy for multibacillary leprosy (MDT-MB) is the preferred line of treatment. Lucio-Latapi’s leprosy and LP are commonly found in Mexico and Central America, but rarely reported in Indonesia.Case Illustration: We report here the clinical description and development of six patients with LP observed in the tertiary referral hospital in Indonesia over a five-year period from 2013 to 2017.Discussion: All patients were diagnosed using clinical and histopathological examination, and all of them presented with ulceration and vasculitis. They were treated with MDT-MB WHO regimens and systemic corticosteroids. Five patients were alive, and one died due to extensive cutaneous lesions that lead to sepsis.Conclusion: Early diagnosis and prompt institution of multidrug therapy with systemic corticosteroids may improve the prognosis and outcome of LP. Keywords: Indonesia, Lucio-Latapi’s phenomenon, leprosy, reaction

Purpuric lesion in a patient with leprosy: Was it a Lucio’s phenomenon or an epiphenomenon? Sri Linuwih Menaldi; Melani Marissa; Inadia Putri Chairista; Henry W. Lim; Rahadi Rihatmadja
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: Lucio’s phenomenon (LP) is a severe necrotizing cutaneous reaction that occurs in patients with Lucio’s leprosy. The exact pathomechanism is not fully understood, but typically abundant acid-fast bacilli in the walls of blood vessels point to direct perturbation of blood supply to the epidermis. We report a case of LP where epidermal necrosis occurred in the absence of vascular invasion by mycobacteria, raising the question whether this was an epiphenomenon or a true LP.Case Illustration: A 34-year-old male was referred for an episodic swelling of his hands and feet that persisted for two years. There were signs of leprosy (diffuse shiny skin lesions, anesthesia, and anhidrosis of the extremities) with purpuric patches on lower extremities. The slit-skin smear test revealed a high index of acid- fast bacilli. Histopathological examination revealed epidermal necrosis and leukocytoclastic vasculitis without demonstrable bacillus. WHO multidrug regimen for leprosy and corticosteroids successfully cured the patient and prevented ulcer development.Discussion: Despite the presence of classical LP characteristics clinically and histologically, mycobacterium was absent in the vessels’ walls. We hypothesized that, in LP, vascular impairment might also be secondary due to antigen–antibody reaction and hypercoagulable state.Conclusion: Purpuric patches in Lucio’s leprosy might be the first sign of skin necrosis or vascular damage (purpura and ulceration). Besides the antimycobacterial drugs, anti-inflammatory drugs should be administered. Laboratory test for hemostasis might be advised.Keywords: Lucio’s phenomenon, mycobacteria, histopathology, vasculitis

Pathophysiology and management therapy of Steven-Johnson Syndrome (SJS) and Toxic Necrolysis Epidermal (TEN) Rina Diana; Tutik Rahayu; Eka Putra Wirawan; Marsita Endy Dhamayanti; Danu Yuliarto; Muhammad Eko Irawanto
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: Epidermal necrolysis (EN) is an acute mucocutaneous reaction syndrome characterized by extensive necrosis and epidermal exfoliation and can cause death. The initial lesion is in the form of erythematous macules, then progressively grow to sagging blister lesion and subsequent epidermal peeling. The causes of SJS and TEN may vary such as infections, vaccinations, drugs, systemic diseases, and food. However, the main cause is the drug as found in many cases. Methods: The pathophysiology of the EN is still unclear. Pathologically, tissue damage in the form of epidermal necrolysis is a picture of mass keratinocyte cell death through apoptosis. The stimuli that can induce apoptosis include cellular stress, DNA damage and intracellular cytokines. It may as a result of the role of cytotoxic T cells against keratinocytes, through perforin-granzyme B or Fas-FasL interactions and granulysin. Another theory of SJS-TEN pathophysiology is the slow acetylation (drug metabolic disorder) and the theory of genetic susceptibility.Result: Finally, we include a comprehensive review of well-established widely available therapies in SJS-TEN patients. Discussion: It requires rapid diagnosis, suspension of suspected drug as soon as possible, supportive therapy and specific therapyConclusion: An understanding of the pathophysiology and current management of SJS and TEN is expected to assist in the prevention of disease and early diagnosis and can provide more effective therapy for SJS-TEN treatment Keywords: Epidermal necrolysis, SJS-TEN, perforin-granzyme B, Fas-FasL interactions, granulysin

The management of seborrheic dermatitis 2020 Sandra Widaty; Kusmarinah Bramono; Muhammad Yulianto Listiawan; Ariyati Yosi; Eliza Miranda; Githa Rahmayunita; Herwinda Brahmanti; Henry Wan-Peng Lim
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 1 (2020): December 2020
Publisher : Universitas Indonesia

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Background: Seborrheic dermatitis (SD) is a chronic relapsing dermatitis manifesting in the seborrheic area, affecting infants or adults. In Indonesia, the prevalence of SD is 0.99–5.8% of all dermatology cases from 2013 to 2015. SD has been known to be a prominent manifestation among HIV patients, but there is an increasing trend in the general population. Therefore, in 2017, the Indonesian Society for Dermatology and Venereology proposed a consensus for the management of SD in Indonesia based on the discussion from 12 dermatological centers. Concurrent with the development of new drugs, this study aims to evaluate and develop a guideline for the treatment of seborrheic dermatitis in Indonesia to update the previous guidelines in 2017. Methods: Systematic review was based on evidence-based methods, and scientific evidences were acquired through systematic search. Evidence analysis was in accordance with the level of evidence. The available evidences were evaluated, and conclusion was based on the grade of recommendation. Critical appraisal was conducted by experts in dermatology and venereology.Results: Severity of SD can be determined by using the Seborrheic Dermatitis Area Severity Index. The principle of scalp SD management is controlling the scalp condition in a cost-effective manner to make patients comfortable. The recommendations for treatment of adult SD are topical agents, such as antifungals, nonsteroidal anti-inflammatory agents with antifungal properties, corticosteroids, and calcineurin inhibitors.Conclusion: We have updated and added newer agents for the treatment of SD. The approach is divided into scalp or nonscalp and also adult or infantile SD. Keywords: seborrheic dermatitis, management approach, diagnosis, Seborrheic Dermatitis Area Severity Index, guidelines

Clinical characteristics and treatment regimen of pemphigus patients: A retrospective study Windy Keumala Budianti; Eyleny Meisyah Fitri; Puti Rineska Meilinda; Endi Novianto; Shafira Anindya; Arlha Aporia Debinta
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 2 (2021): June 2021
Publisher : Universitas Indonesia

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Background: Pemphigus is a potentially life-threatening autoimmune bullous disease. In pemphigus, the therapeutic options are based on the clinical characteristics of each patient. However, other than corticosteroids, most therapeutic options for pemphigus are currently limited. Steroid-sparing agents might be considered since the initiation of therapy to prevent the side effects of corticosteroid. The objective of this study is to identify the clinical characteristics and therapy of choice in patients with pemphigus at Dr. Cipto Mangunkusumo General Hospital.Method:All cases of pemphigus from 2016 to 2018 at Dermato-Allergo-Immunology Clinic, Department of Dermatology and Venerology Dr. Cipto Mangunkusumo General Hospital were included in this study. Data were collected from medical records, including patient’s demographics, clinical data, and therapy. Data were analyzed using SPSS 20.Results:There were 24 new pemphigus cases from 2016 to 2018. Female to male ratio was 3.8:1 with median age of onset of 37.5 (16-73)years old. Pemphigus vulgaris was the most common subtype of pemphigus (75%), followed by pemphigus foliaceus. Number of patients with oropharyngeal mucosal involvement was found higher in pemphigus vulgaris compared to pemphigus foliaceus (p=0.012). Systemic steroid was given in 86.9% patients while the rest were treated with topical corticosteroid only. Steroid-sparing agents were given in 58.3% patients. Remission was achieved in 42.3% cases in average 5 (2-28) months.Conclusion:Pemphigus vulgaris is the most common subtype of pemphigus and corticosteroid remains to be its treatment of choice. The steroid-sparing agents most commonly used in this study are mycophenolate mofetil and azathioprine. Keywords:clinical characteristic, corticosteroid, pemphigus, sparing agent

A comparison of single-dose versus divided-dose of metronidazole on bacterial vaginosis among female sex workers in Surakarta Willa Damayanti; Rini Hastuti; Agung Triana Hartaty; Danu Yuliarto; Ardelia Dyah Ayu; Endra Yustin
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 5, No 2 (2021): June 2021
Publisher : Universitas Indonesia

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Background: Bacterial vaginosis (BV) is the most common vaginal infection in sexually active women. Metronidazole (MTZ) is still one of the recommended regimens for BV either as a single-dose or divided-dose. In addition to its affordability and availability, oral metronidazole also produces fewer adverse effects. This study aimedto determine the efficacy of single-dose versus divided-dose metronidazole for BV among female sex workers (FSWs) in Surakarta.Methods: A single-blind randomized clinical trial was conducted in Surakarta. FSWswith BV (⩾3 Amsel criteria) were enrolled. The subjects were grouped into two, and treated with MTZ either as a single-dose of 2 gr (single-dose group) or 500 mg twice daily for one week (divided-dose group). After two weeks, we performed second vaginal swabs and reassessed the Amsel criteria, complaints and adverse events. Results: Out of 75 FSWs, 30 (42%) were diagnosed with BV. The efficacy between two groups was not significantly different. However, patients in the single-dose group were 2 times more likely to develop recurrent BV (OR = 2.000; 95% CI 0.146 – 27.447), and 1.5 times more likely to have vaginal discharge complaints (OR = 1,500; 95% CI 0,181-12,459) than divided-dose group.Conclusion: Single-dose and divided-dose metronidazole produce similar efficacy for treating BV in sexually active women. Single-dose metronidazole has a higher risk of BV recurrence and vaginal discharge complaint. Divided-dose metronidazole is recommended for treating BV. Keywords:bacterial vaginosis, female sex workers, metronidazole

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INDONESIA