Dermatology Commons^™

Overview Of Stevens-Johnson Syndrome And Toxic Epidermal Necrolysis, Christina Spinaris, Sarah Kradel, Tara Tokar, Zachary Crawford, Michael M. Milks

Pharmacy and Wellness Review

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immunologic reactions that typically present due to drug hypersensitivity. These reactions present with serious mucocutaneous manifestations that can lead to significant morbidity and mortality. The pathogeneses of SJS and TEN have yet to be clearly elucidated, but three potential immunologic mechanisms have been defined in literature: granulysin, Fas-FasL, and perforin and granzyme B. Medications have been immunologically linked as the primary causative agents of SJS/TEN. Corticosteroids, intravenous immunoglobulin administration (IVIG) and cyclosporine have been employed as treatments; however, none have resulted in consistent positive outcomes. Pharmacists have a significant role in …

Ecthyma Gangrenosum In An Immunocompromised Patient Without Detectable Bacteremia, Jonathan Miles, Alex Mari, Matthew Crabtree, Vinod Nambudiri, Jilian Sansbury

Dermatology

Ecthyma gangrenosum (EG) is typically pathognomonic of Pseudomonas aeruginosa bacteremia among immunocompromised patients, particularly with underlying malignancy. Recently, other pathogens and clinical histories have been implicated, challenging the classic picture of patients with EG. The cutaneous findings in patients follow a pattern of lesion progression from indurated pustules and hemorrhagic vesicles evolving to necrotic ulcers with central black eschar and surrounding erythema. While lesions typically occur on the perineum or lower extremities, their presence has also been described elsewhere. Herein, we describe a case of an immunocompromised man with chronic lymphocytic leukemia and multiple myeloma actively undergoing chemotherapy presenting with …

Treatment Of Podoconiosis With Complicating Polyinfections Within Rural African Villages: A Case Study, Amanda R. Beering, Abigail R. Florence, Soon Bahrami Md

Journal of Refugee & Global Health

This case study aims to provide a treatment plan for the treatment of podoconiosis with complicating polyinfections in a resource poor setting. A second objective is to help healthcare providers teach preventive measures to villagers in affected regions.

High-Dose Finasteride Is An Effective Treatment Modality For Androgenic Alopecia In Postmenopausal Women, Joshua T. Gaudette

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Oliveira-Soares R, Silva JE, Correia M, André M. Finasteride 5 mg/day treatment of patterned hair loss in normo-androgenetic postmenopausal women. International Journal of Trichology. 2013;5(1):22-25. doi: 10.4103/0974-7753.114709.

Ulcus Vulvae Acutum - A Rare Case, Irene Dorthy Santoso, Ika Anggraini, Wresti Indriatmi, Yudo Irawan, Hanny Nilasari, Melani Marissa, Sondang P. Sirait, Rahadi Rihatmadja

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Ulcus vulvae acutum, also known as Lipschütz ulcer, is a rare condition characterized by multiple, painful, and acute genital ulceration in young women without venereal infections, associated with systemic symptoms like malaise, fever, and inguinal lymphadenopathy.

Case Illustration: A 24-year-old woman developed multiple and painful vulvar ulcers that recurred for almost a year. The patient was primarily diagnosed and treated as genital herpes in several hospitals with only slight improvement and no complete healing. The patient came to our hospital for examinations to rule out sexually-transmitted infection (STI) (genital herpes, syphilis, HIV, and chancroid) and possibility of …

Recurrent Perianal Wart Therapy With 90% Trichloroacetate (Tca) Solution In Aids Patients, Sri Linuwih Sw Menaldi, Ika Anggraini, Hanny Nilasari

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Being the most commonly found sexually-transmitted infection (STI), anogenital warts are mainly caused by human papilloma virus (HPV) type 6 and 11. These infections are often recurrent, leading to loss of time and medical expenses. Various therapeutic modalities can be chosen singularly or in combination with varying results. Treatments with less responsive results usually occur when acquired comorbidities are present, such as HIV infection.

Case Illustration: A 28-year-old homosexual male was reported to have a recurrent perianal wart for the duration of eight months. He was also diagnosed with AIDS and pulmonary tuberculosis. Initially, patient was treated …

The Effect Of Face Washing Frequency On Acne Vulgaris Patients, Rini Hastuti, Etty Farida Mustifah, Imroatul Ulya, Muhammad Risman, Prasetyadi Mawardi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Patients with acne often wash their faces twice a day, but there are not many studies supporting this practice.

Methods: A single-blind randomized clinical trial was conducted in 38 subjects, divided into three groups based on face washing frequency (once, twice, and thrice a day). All groups used the same cleanser. The acne vulgaris severity and the number of lesions were assessed prior to study. After eight weeks, we re-assessed the acne severity, the number of lesions, the adverse event and patient’s self-evaluation. SPSS 17 was used to analyze the face washing frequency and the number of …

Dapsone Hypersensitivity Syndrome Overlaps Reversal Reaction In Leprosy Patient, Chesia Christiani Liuwan, Medhi Denisa, M Yulianto Listiawan

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Leprosy is a chronic granulomatous infectious disease that primarily involves the skin and peripheral nerve and is caused by Mycobacterium leprae. Clinical features may vary depending on the patient’s immune response. Reversal reaction due to increased immunity is common after treatment in patients with borderline leprosy. Dapsone hypersensitivity syndrome (DHS) is an adverse effect from dapsone therapy that may occur in 5-6 weeks to 6 months after initial treatment.

Case Illustration: A 47-year-old female complained of a spreading red patches on the skin of her trunk and extremities for three weeks duration. She also felt itchiness and …

Clinical Diagnostic Matrix (Cdm) As A Tool To Diagnose Subtypes Of Epidermolysis Bullosa Cases In Children, Suci Widhiati, Benazier Marcella, Susanti Rosmala Dewi, Anggana Rafika Paramitasari, Endra Yustin Ellistari, Indah Julianto

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Epidermolysis bullosa (EB) is a rare genetic skin disease characterized by trauma-induced blisters, which appear shortly after birth. Immunofluorescence antigen mapping and mutational analysis are essential for establishing an accurate diagnosis of EB. However, in limited resource settings like in Indonesia, such techniques are not always readily available, forcing many clinicians to diagnose EB based on clinical features alone that is often inaccurate. Recently, a novel clinical diagnostic matrix (CDM) tool has been developed to improve the diagnostic accuracy of EB in such settings.

Case Illustration: We examined clinical photographs and medical records of patients registered at …

Efficacy And Safety Of 5% Imiquimod Cream Compared To 10% Koh Solution For Elimination Of Molluscum Contagiosum Lesions In Adults, Marsha Bianti, Agung Muhammad Rheza, Arinda Marina, Rizka Farah Hilma, Sarah Mahri, Teffy Nuary, Rahadi Rihatmadja

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Molluscum contagiosum (MC) is a benign infection caused by the Molluscipox virus that most often affects children and sexually active adolescents. Various topical therapeutic options are available, however, no single intervention is convincingly effective. Potassium hydroxide (KOH) solution is widely used but its usefulness is hampered with adverse effects. Newer preparation, 5% imiquimod cream seems to be as, if not more, effective. However, it is not legally available yet in Indonesia.

Aim: To assess the efficacy and safety of 5% imiquimod cream in treating adult molluscum contagiosum.

Methods: Literature search was done through Pubmed, EBSCO, dan …

Efficacy Of Inosine Pranobex As An Adjuvant Oral Therapy In Anogenital Warts: An Evidence-Based Case Report, Benny Nelson, Indina Sastrini, Lidwina Anissa, Patricsia Manalu, Peppy Fourina, Rahmaniar Desianti Kuraga, Wresti Indriatmi

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Human papillomavirus (HPV) causes the most prevalent sexually transmitted infection and is an important etiological factor in genital cancer. HPV infection manifests in broad spectrum, from genital warts to cervical intraepithelial neoplasia and cancers. Genital warts remain a frequent problem in primary care. Current modalities provide unsatisfactory result in curing genital warts completely. To date, there are many convincing studies encouraging oral inosine pranobex as an adjuvant therapy to improve post-conventional therapy cure-rate.

Aim: To assess the efficacy of inosine pranobex as an adjuvant oral therapy in anogenital warts.

Methods: Literature search was performed using Pubmed, …

Influence Of Demodex Mites On Life Quality Of Patients With Acne And Rosacea, Anzhela Kravchenko

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Ulcus vulvae acutum, also known as Lipschütz ulcer, is a rare condition characterized by multiple, painful, and acute genital ulceration in young women without venereal infections, associated with systemic symptoms like malaise, fever, and inguinal lymphadenopathy.

Case Illustration: A 24-year-old woman developed multiple and painful vulvar ulcers that recurred for almost a year. The patient was primarily diagnosed and treated as genital herpes in several hospitals with only slight improvement and no complete healing. The patient came to our hospital for examinations to rule out sexually-transmitted infection (STI) (genital herpes, syphilis, HIV, and chancroid) and possibility of …

Validity Of An Atopic Dermatitis Outcome Measure For Real-World Clinical Practice, Christina Topham, Dylan Haynes, Molly Brazil, Eric Simpson

OHSU-PSU School of Public Health Annual Conference

Introduction: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the United States. AD is associated with reduced quality of life and substantial financial costs, making it burdensome at an individual and population level. Disease severity outcome measures are validated tools to assess severity and therapeutic response. Recent consensus statements have identified gold-standard outcome measures for AD in clinical trials, but further work is needed evaluating outcome measures feasible for clinical practice.

Objective: To investigate the validity and feasibility of the product of investigator global assessment and body surface area (IGA x BSA) as an outcome measure …

Efficacy Of Low Level Laser Therapy In The Treatment Of Postherpetic Neuralgia, Lili Legiawati, Marsha Bianti

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ) and defined as pain that persists for more than 90 days after the onset of HZ rash. The chronic pain of PHN is debilitating and often associated with significant morbidity. It is a neuropathic pain and manifests as allodynia, hyperalgesia, or spontaneous pain. Although it is not considered to be life-threatening, sometime HZ is inadequately treated and may result in more severe PHN. Various treatment protocols for PHN are available; however, the result remains unsatisfactorily. The use of low level laser therapy (LLLT) in pain management …

Eccrine Poroma: The Prominent Mimicker, Nahla Shihab, Inge Ade Kristanti, Adhimukti T. Sampurna, Larisa Paramitha Wibawa

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Eccrine poroma (EP) is an adnexal benign tumor arising from the eccrine duct epithelium. The appearance of EP can mimic benign and malignant skin tumors, thus often making the diagnosis delayed or inaccurate.

Case Illustration: We report two cases of EP, with clinical and dermoscopic features mimicking Bowen’s disease, verruca vulgaris, pyogenic granuloma, skin metastases of breast cancer, and amelanotic melanoma. Both patients were surgically excised and biopsied. Histopathology examination of both cases revealed eccrine poroma.

Discussion: Both cases showed similarity with the theories, that EP is most found in middle age population and its predilection …

Diagnostic Procedures In Pediatric Dermatology, Arini Astasari Widodo, Githa Rahmayunita, Triana Agustin, Rinadewi Astriningrum

Journal of General - Procedural Dermatology and Venereology Indonesia

Diagnostic procedures in pediatric dermatology are different and significantly more challenging than those in adult patients, especially on how to approach the patients. We need to acknowledge that pediatric patients have unique anatomical, physiological, and psychological aspects. Compared to adults, children have smaller procedure area, are less cooperative, and more difficult to understand. For these reasons, we should perform diagnostic procedures on children cautiously. Having extensive knowledge in this field can facilitate us to carry out an ethical, efficient, targeted procedure with less risk. This article reviewed the most appropriate, most comfortable, and least invasive diagnostic procedures for children. Some …

Elevated Homeostatic Model Assessment Of Insulin Resistance Level Increases The Risk Of Acne, Stefani Nurhadi, Igaa Praharsini, Aagp Wiraguna

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Insulin resistance and high carbohydrate diets are currently considered to be influential in acne aetiology. Insulin is a hormone that does not only regulate the concentration of blood glucose but also affects the production of sebum and through the Insulin Growth Factor-1 (IGF-1) receptor stimulates androgen synthesis which will increase the proliferation of keratinocytes duct and the production of sebum in acne of the pilosebaceous.

Methods: This is a cross sectional observational analytic study involving 38 acne patients and 38 controls. This study aims to determine whether the increase in Homeostatic Model Assessment of Insulin Resistance …

Profile Of Vitiligo Patients And Distribution Of Narrowband-Uvb Therapy At Dr. Cipto Mangunkusumo General Hospital, Lis Surachmiati Suseno, Putu Martha Gerynda Sukma, Rahadi Rihatmadja, Triana Agustin, Githa Rahmayunita, Endi Novianto

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Vitiligo is a disease marked by depigmented macules. Prevalence of vitiligo varies between 0.1- 2.3% worldwide. The objectives of this study are to identify the socio-demographic profile of vitiligo patients and distribution of narrowband-UVB given as a treatment modality. However, in Indonesia, including at dr. Cipto Mangunkusumo General Hospital, there has not been any study on the profile of vitiligo patients. Therefore, a preliminary study on the patients’ profile would be very useful for healthcare providers in calculating the need for narrowband-UVB equipment and evaluation of its current use.

Methods: A retrospective descriptive study, using secondary data …

Cumulative Exposure To Solar Ultraviolet A & B Increases Apoptosis Of Peripheral Blood Cutaneous Lymphocyte Antigen (Cla)+ T-Lymphocytes In Outdoor Workers, Afif Nurul Hidayati, Saut Sahat Pohan, Widodo J. Pudjirahardjo, Isaac Effendy

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Exposure to ultraviolet A & B (UVA-UVB) plays a role in the survival of human life, but it may cause negative effects, such as immunosuppression and skin cancer. The effect of solar UVA-UVB exposure on apoptosis (Bax/Bcl-2 ratio) of peripheral blood cutaneous lymphocyte antigen (CLA)+ T-lymphocyte; the immune competent cells in the skin, has not been investigated. Apoptosis of peripheral blood CLA+ Tlymphocyte affects its function; which serves as the skin's resistance and is involved in infectious diseases, skin inflammation, and malignancies. This study observed the effect of solar UVA-UVB to apoptosis (Bax/Bcl2 ratio) of peripheral blood CLA+ …

Dietary Recommendations For Adults With Psoriasis Or Psoriatic Arthritis From The Medical Board Of The National Psoriasis Foundation: A Systematic Review, Adam Ford, Michael Siegel, Jerry Bagel, Kelly M. Cordoro, Amit Garg, Alice Gottlieb, April W. Armstrong

NYMC Faculty Publications

Importance: Psoriasis is a chronic, inflammatory skin disease and has significant associated morbidity and effect on quality of life. It is important to determine whether dietary interventions help reduce disease severity in patients with psoriatic diseases. Objective: To make evidence-based dietary recommendations for adults with psoriasis and/or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation. Evidence Review: We used literature from prior systematic reviews as well as additional primary literature from the MEDLINE database from January 1, 2014, to August 31, 2017, that evaluated the impact of diet on psoriasis. We included observational and interventional studies of …

Non-Standard Patch Test, Astri Adelia, Windy Keumala Budianti, Melani Marissa, Evita Halim Effendi

Journal of General - Procedural Dermatology and Venereology Indonesia

In managing contact dermatitis, identification of the causative agent is essential to prevent recurrent complaints. Patch test is the gold standard to identify the causative agent. Nowadays, there are many patch test standard materials available in the market, but do not include all the materials that potentially cause contact dermatitis. Patch test using patient’s own products or later we refer to as non-standard materials, is very helpful in identifying the causative agents of contact dermatitis. Guidance is needed in producing non-standard patch test materials in order to avoid test results discrepancy.

Comparative Study Of Two Diagnostic Methods Of Demodicosis In Patients With Acne And Rosacea, Anzhela Kravchenko

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Demodicosis is a disease, caused by parasitisation of the opportunistic parasites from the acariasis group – Demodex mites. This article presents a comparative study of two methods (light microscopy of skin scrapings and confocal laser scanning in vivo microscopy) for identification of Demodex mites on the facial skin in acne and rosacea patients. The use of confocal laser scanning in vivo microscopy in dermatology today is considered as one of the most promising methods.

Methods: A total of 90 subjects were included in the study, comprising 30 patients with acne and rosacea complicated by demodicosis, 30 patients …

Darier-White Disease: A Rare Genetic Disorder, Cara Lynn Marie N. Chia, Ma. Teresita G. Gabriel, Leilani R. Senador, Ciara Mae Dela Cruz

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: The clinical manifestation of Darier-White disease, an autosomal dominant genodermatosis, are greasy hyperkeratotic papules in seborrheic regions with nail abnormalities and mucous membrane changes due to a defective sarcoendoplasmic calcium pump. The clinical appearance and unpleasant odor in some sites of the lesions may cause psychosocial disturbances and pose a major morbidity.

Case Illustration: We report a case of a 20-year old female with clinical manifestations of multiple erythematous to hyperpigmented hyperkeratotic papules, multiple flesh-colored keratotic papules with red and white longitudinal bands on dystrophic fingernails, as well as plantar pits. Skin punch biopsy was performed to …

Double-Blind Randomized Trials Once A Week Narrowband Ultraviolet B (Nb-Uvb) Phototherapy In Vitiligo, Retno Dwi Utami, Mira Trisna Murti, Muhammad Risman, Arie Kusumawardhani

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Vitiligo is a skin pigmentation disorder, affecting approximately 1-2% population worldwide. Currently, there are wide varieties of treatment to achieve re-pigmentation, and phototherapy is one of the effective treatments. Narrowband ultraviolet B (NB-UVB) is administered twice a week according to the phototherapy protocol for vitiligo. Some vitiligo patients have difficulty following this schedule, leading to decrease of patient’s compliance. Therefore, we performed study comparing the efficacy of phototherapy frequency, once a week and twice a week NB-UVB in vitiligo.

Methods: This preliminary study divided 10 patients into 2 groups of 5 patients each with randomized, double-blind method. …

The Comparison Of Skin Irritation Level Between Topical Cajeput Oil And Telon Oil: A Pilot Study, Sri Esa Ilona, Aris Cahyono, Endra Yustin Ellistasari, Muh. Eko Irawanto, Harijono Kariosentono

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Cajuputi/Cajeput/Melalueca leucadendron oil is a type of essential oil, widely known and used by Indonesian for infants, children, and elderly. It is also included in telon oil compositions (±42%). Excessive application of cajeput oil and telon oil may lead to skin irritation.

Methods: This randomized single-blind control trial was conducted with 10 subjects who met the inclusion criteria. Four areas with diameter of 10 mm each were made on the flexor surface of the upper arm. Area 1 was designated as negative control. Area 2 to 4 were pre-irritated with tape stripping for 40 ± 10 times …

Severe Kerion Celsi Effectively Treated With Skin Debridement And Antifungals, Ismiralda Oke Putranti, Citra Primanita

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Kerion celsi is a severe inflamed deep abscesses form of tinea capitis which mostly occurs in children population. Despite good regular treatment with antifungals, the prognosis of kerion celsi is poor with scarring alopecia.

Case Illustration: A 5-year-old boy had history of an alopecia with locally large painful oedema on his scalp a month before treatment. From the physical examination, a painful large area with alopecia was found with abscess covered by thick crust. Pull test showed hair breakage and right retro-auricular lymphatic nodes enlargement was also found. Endo-ectothrix spores were positive in potassium-hydroxide examination and the …

Androgenic Alopecia; The Risk–Benefit Ratio Of Finasteride, David L. Rowland, Ion G. Motofei, Ioana Păunică, Petrișor Banu, Mihaela F. Nistor, Stana Păunică, Vlad D. Constantin

Journal of Mind and Medical Sciences

Finasteride is currently approved and largely used as a therapeutic option for androgenetic alopecia. Apparently a safe drug and effective at the onset of its application, several concerns have since appeared over the years regarding the frequency and magnitude of finasteride adverse effects, which in some cases appear irreversible even after drug termination.

This paper discusses the use of finasteride for androgenic alopecia from two distinct perspectives. On the one hand, androgenic alopecia is a condition that especially affects a person’s self-image and esteem, aspects that are subjectively-constructed and thus relative and changeable. On the other hand, this condition involves …

A Case Of Eosinophilic Annular Erythema As A Presenting Sign For Autoimmune Hepatitis, Olabola Awosika, Kristin Totoraitis, Misty Eleryan, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Eosinophilic annular erythema (EAE) is a relatively new entity, clinically presenting as a figurate erythema. The cause of EAE remains obscure, but it has been associated with several chronic conditions and malignancies. We describe an unusual case of EAE developing before the onset of autoimmune hepatitis.

Profile Of Dupilumab And Its Potential In The Treatment Of Inadequately Controlled Moderate-To-Severe Atopic Dermatitis., Olabola Awosika, Lori Kim, Momina Mazhar, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Atopic dermatitis (AD) is a common inflammatory skin disorder that manifests as eczematous lesions, often associated with allergic rhinitis and asthma. Historically, moderate-to-severe disease has been managed with systemic immunosuppression, such as oral corticosteroids, which result in relapse and limiting side effects. Due to recent advancements in the identification of interleukin (IL)-4 and IL-13 as key mediators in AD, new biological agents have been developed for treatment. Dupilumab is a recently approved monoclonal antibody that targets the alpha subunit of the IL-4 receptor and, thus, downregulates activity of IL-4 and IL-13. This review discusses the profile of dupilumab and its …

Shortening The Duration Of Antimicrobial Therapy In Uncomplicated Skin And Soft Tissue Infections, Alicia Daggett, Brandi Missel

Posters

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