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Journal of General Procedural Dermatology and Venereology Indonesia
Published by Universitas Indonesia
ISSN : -     EISSN : 24607991     DOI : https://doi.org/10.19100/jdvi.v1i1.8
Core Subject : Health,
Medicine & Pharmacology
Journal of General-Procedural Dermatology & Venereology Indonesia is an open access and peer-reviewed journal that focuses on dermatology and venereology. This journal publishes original articles, reviews, case reports, and brief communications which contain short features of medicine, current developments in diagnostic procedures, treatments, or other health issues that are relevant and important.
Arjuna Subject : Kedokteran - Dematologi
Articles 164 Documents
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Purpuric lesion in a patient with leprosy: Was it a Lucio’s phenomenon or an epiphenomenon? Menaldi, Sri Linuwih; Marissa, Melani; Chairista, Inadia Putri; Lim, Henry W.; Rihatmadja, Rahadi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Abstract

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.
Reversal reaction with nodules clinical manifestations that initially diagnosed as erythema nodosum leprosum in borderline lepromatous leprosy Tsaqilah, Laila; Achdiat, Pati Aji; Gunawan, Hendra
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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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.
Prevalence of nail changes in patients infected with HIV - A cross sectional study Vellaisamy, Seethalakshmi Ganga; Jeyaraman, Priya; Gopalan, Kannan
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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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.
The management of seborrheic dermatitis 2020 Widaty, Sandra; Bramono, Kusmarinah; Listiawan, Muhammad Yulianto; Yosi, Ariyati; Miranda, Eliza; Rahmayunita, Githa; Brahmanti, Herwinda; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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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.
Impact of scabies on Indonesian public boarding school students’ quality of life: A mixed-method analysis Menaldi, Sri Linuwih SW; Surya, Danny; The, Valensia Vivian; Marissa, Melani
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
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Abstract

Background: Scabies is a neglected tropical disease in which people affected primarily presents with intense pruritus. The disease is often recurrent, especially in people living in close contacts, such as in a community; thus, it negatively impacts their quality of life (QoL).This study analyzes the impact of pruritus in scabies on the QoL of patients living in a public boarding school (PBS) in West Java, Indonesia. Methods: This study is a mixed-method study conducted on 39 subjects. TheQoL was examined using the Indonesian version of the dermatology life quality index (DLQI) questionnaire and in-depth interviews. Results: Most subjects were female, grade 9 students, had a duration of symptoms between six months to one year, had been infected more than twice, and with no family member affected by the same symptoms. We found that sex, duration of symptoms, disease frequency, and affected family members did not significantly affect subjects’ QoL. In-depth interviews revealed that pruritus affected social relationships, quality of learning, and sleeping. Conclusion: Holistic and comprehensive community management is needed to treat and prevent scabies transmission, as its symptoms negatively impact the QoL of students in PBS.
Multisystem Langerhans Cell Histiocytosis in high-risk group: A case series of two infants Yuniaswan, Anggun Putri; Safitri, Putri Rachma; Retnani, Diah Prabawati
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
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Background: Langerhans Cell Histiocytosis (LCH) has diverse manifestations, from asymptomatic to aggressive, which involves many organs. Histopathological examination playsa crucialrole as a basic diagnostic standard for LCH. Writing Group of the Histiocyte Society proposes a guideline for diagnosing LCH, divided into presumptive, designated, and definitive diagnosis. Case Illustration: Two cases of a 14 month-old girl and an 18 month-old girl presented similar clinical manifestation and multi-organ involvement. Dermatological examination revealed red papules and plaques covered by brownish scales and crusts on the scalp and body, erosion in some folds of the body. Histopathological examination of the first case revealed an early purpuric phase. S100 immunostaining just revealed hyperplasia of Langerhans cell but still could not support the diagnosis of LCH. Fine Needle Aspiration Biopsy of the enlarged submandibular lymph node after two months ofobservation suggested LCH. In the second case, histopathological examination revealed proliferation of round-oval nucleated cells, pleomorphic, some reniform nuclei, with amphophilic cytoplasm. S100 and CD1a immunostaining revealed a positive reaction in the proliferative cells. Discussion: Patients aged 14 and 18 monthsoldindicatedalmost similar clinical manifestations leading to LCH diagnosis, with different histopathological pictures. The first patient was presumptively diagnosedas high-risk multisystem LCH, but theinitial histopathology results did not support LCH diagnosis. On the other hand, the second patient was definitively diagnosed with high-risk multisystem LCH. Conclusion: Patientswith clinically suspected LCH without histopathological confirmation should be observed at least six months to reassess the necessity of a follow-up biopsy.
Dermoscopy-guided carbon dioxide laser destruction for nevus sebaceous: two case reports Wibawa, Larisa Paramitha; Ohara, Kuniaki
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
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Background: Nevus sebaceous (NS) is a common hamartoma of the cutaneous adnexal structure, clinically appear as a well demarcated yellow-orange plaque, sometimes with verrucous surface. Dermoscopy may aid the diagnosis of NS and also guide carbon dioxide (CO2) laser therapy. Case Illustration: Two cases of brown and yellowish plaque on the face, with clinical appearance, dermoscopic, and histopathological findings consistent with NS. The patients consented to undergo serial CO­2laser destruction, aimed to reduce recurrences and shorten the duration of the downtime. Dermoscopy aided in locating the area and the depth of each treatment. Discussion: The dermoscopy finding of NS were already reported as milia-like structure and multiple whitish structures (dots) varying in size, with orange background. The dermoscopy findings of these two cases were in accordance with previous reports. CO2laser destruction was reported to produce satisfying results, but with known recurrences. With the knowledge of dermoscopy appearance, we could determine the area and depth of the lesion to prevent reoccurrence. After two years of follow-up, the area where the deep ablation was performed had not reoccurred. Conclusion: Dermoscopy may aid the diagnosis and therapeutic confirmation of NS.
Childhood-onset borderline tuberculoid leprosy with reversal reaction Lubis, Ramona D; Darmi, Mila; Chandra, Rudi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
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Background: Leprosy is a chronic granulomatous infection caused by Mycobacterium lepraethat predominantly affects the skin and peripheral nerves. Leprosy among children is still common in endemic countries. Case Illustration: A 12-year-old girl complained about a hypopigmented anesthetic patch on her face for 11 years, which became larger and spread slowly to her arms and legs. She had a history of close contact with her aunt, who was diagnosed with multibacillary leprosy. On slit-skin-smear test, acid-fast-bacilli (bacteriologic index +1) were found. She was diagnosed with multibacillary leprosy and treated with children’s multidrug therapy-multibacillary (MDT-MB) regimen. After 2 months of MDT-MB treatment, she complained that the hypopigmented patches became reddish and swollen with enlarged peripheral nerves. She underwent a reversal reaction (RR) and was treated with 40 mg prednisone daily and continued the MDT regimen. Discussion: RR is found less frequently in children than the adult.Accurate diagnosis is vital because of its psychosocial impact on the family. One of the most prominent features of borderline tuberculoid leprosy is its susceptibility to RR. It is characterized by rapid changes from existing plaques to edematous lesions with or without abrupt neuritis. Conclusion: We reported a girl with borderline tuberculoid leprosy with developed RR after taking MDT-MB for 2 months. The risk factors for developing RR were being diagnosed with borderline tuberculoid leprosy, female, multiple and disseminated patches involving larger body areas and multiple nerve involvement, large facial patches, and starting treatment. These risk factors were found in our patient.
Basal cell carcinoma in a 14-year-old: A rare case of a common skin cancer Wahyudi, Danang Tri; Parrol, Firman; Hoemardani, Aida Sofiati; Sutarjo, Agassi Suseno
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
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Background: Basal cell carcinoma (BCC) is the most common cutaneous malignancy. It usually arises in sun-exposed areas of the body, with the face and neck being the most common sites for BCC. BCC is typically found in older individuals, but it is becoming more prevalent in people younger than 50. However, such cases in children under 15 are rarely encountered. Pigmented BCC is a common presentation in people of color, while such presentation is relatively unusual in Caucasians. Pediatric cases could be idiopathic, but it is more commonly associated with a genetic defect, such as basal cell nevus syndrome, xeroderma pigmentosum, Bazex syndrome, and albinism. Those cases could also arise from a congenital lesion, e.g., nevus sebaceous, radiotherapy-related, or solid organ transplant. Case Illustration: We present the case of a 14-year-old boy with a chief complaint of growing tumor on the left cheek since he was 8 years old. He was diagnosed with childhood-onset BCC based on the findings of dermoscopy and skin biopsy. The patient underwent surgical excision of the lesion with 3 mm margins and a full-thickness skin graft obtained from the left retroauricular area. Discussion: Removal of the tumor with clear margins remains the gold standard for BCC treatment. This case presentation showed the best practice for BCC cases in the childhood population. Conclusion: The diagnosis of BCC should not be neglected in the childhood population.
Alternative modality in the treatment of acne vulgaris: Low level laser therapy Chandra, Rudi; Jusuf, Nelva K.
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
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Abstract

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit with polymorphic manifestations. The four key elements leading to the formation of acne lesions are alteration of follicular keratinization that leads to comedones, increased and altered sebum production under androgen control, follicular colonization by Propionibacterium acnes, and complex inflammatory mechanisms that involve both innate and acquired immunity. Phototherapy (light, lasers, and photodynamic therapy) has been proposed as an alternative therapeutic modality to treat acne vulgaris and is proposed to have less side effects compared to other treatment options. Recently, low-level laser (light) therapy (LLLT) which refers to the use of red-beam or near-infrared laser with a wave-length between 600 and 1000 nanometers and power from 5 to 500 milliwatts, starts to be used in the treatment of acne. Mechanism of action of LLLT for acne is through photochemical reaction that produces reactive free radicals and singlet oxygen species which in turn lead to bacterial destruction by blue light. Meanwhile, red light can affect the sebum secretion of sebaceous glands, change keratinocytes behavior, and modulate cytokines from macrophages and other cells that reduce inflammation. LLLT is proposed to be effective as an alternative modality for inflammatory type lesions in acne vulgaris.

Page 9 of 17 | Total Record : 164

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