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Journal of General-Procedural Dermatology & Venereology Indonesia
Published by Universitas Indonesia
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.
Articles
39
Articles
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Profile of vitiligo patients and distribution of narrowband-UVB therapy at dr. Cipto Mangunkusumo General Hospital

Lis Surachmiati Suseno ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Putu Martha Gerynda Sukma ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Rahadi Rihatmadja ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Triana Agustin ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Githa Rahmayunita ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Endi Novianto ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 3, ##issue.no## 1 (2018): December 2018
Publisher : Universitas Indonesia

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Abstract

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. Method: A retrospective descriptive study, using secondary data obtained from dr. Cipto Mangunkusumo General Hospital medical records during the period of 2015-2017. Result: There were 255 vitiligo patients enrolled. Females were greater in number (55.3%). Most patients were distributed evenly in all age groups, highest number of patients were the 21-30 years age group (18.8%). Most patients received elementary school–high school education (56.9%), worked as private employees (36.9%), resided in Jakarta (47.8%). The common diagnosis were unspecified vitiligo (53.3%). Onset of symptoms were mostly around 2 months prior to diagnosis (38.8%) and most of the patients received other treatments other than narrowband-UVB (N=180, 70.6%). Conclusion: The number of vitiligo cases decreased each year with the average vitiligo cases of 85 cases per year and mostly women whereas the number of unspecified vitiligo were quite high. Therefore, more attention is needed from the physicians to treat the patient starting from the establishment of vitiligo to the decision treating with narrowband-UVB Keywords: patient profile, prevalence, vitiligo

Cumulative exposure to solar ultraviolet A & B increases apoptosis of peripheral blood cutaneous lymphocyte antigen (CLA)+ T-Lymphocytes in outdoor workers

Afif Nurul Hidayati ( Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University/Dr. Soetomo General Hospital/Universitas Airlangga Hospital, Surabaya ) , Saut Sahat Pohan ( Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University/Dr. Soetomo General Hospital/Universitas Airlangga Hospital, Surabaya ) , Widodo J. Pudjirahardjo ( Faculty of Public Health, Universitas Airlangga/Universitas Airlangga Hospital, Surabaya ) , Isaak Effendy ( Department of Dermatology and Allergology, Academic Teaching Hospital Bielefeld - Klinikum Bielefeld )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 3, ##issue.no## 1 (2018): December 2018
Publisher : Universitas Indonesia

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Abstract

  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 skins 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+ T-lymphocytes. Methods: An observational cohort study of 37 male outdoor workers (caddies on the golf course) and 33 indoor workers in Surabaya, aged 20-45 years, with skin phototype IV/V. Measurement of solar UVA-UVB doses received by the subjects was conducted for 2, 4, and 8 weeks. Examination of Bax and Bcl-2 of peripheral blood CLA+ T-lymphocyte was conducted at the beginning of the study, after 4 and 8 weeks. Results: The average dose of solar UVA-UVB for 8 weeks received by outdoor workers was 12450.51±3948.81 (J/m2 ) and that by indoor workers was 1793.97±1518.46 (J/m2 ). Exposure to solar UVAUVB leads to the increase of apoptosis (Bax/Bcl-2 ratio) of peripheral blood CLA+ T-lymphocytes (p=0.003). Conclusion: Cumulative exposure to solar UVA-UVB radiation in high-dose or received within 8 weeks resulted in the increase in apoptosis of peripheral blood CLA+ T-lymphocytes. Keywords: solar UVA-UVB, CLA+ T Lymphocyte, Bax, Bcl-2, apoptotic.  

Eccrine poroma: The prominent mimicker

Nahla Shihab ( Department of Dermatology and Venereology Universitas Indonesia/Cipto Mangunkusumo Hospital ) , Larisa Paramitha ( Department of Dermatology and Venereology Universitas Indonesia/dr. Cipto Mangunkusumo Hospital ) , Adhimukti T. Sampurna ( Department of Dermatology and Venereology Universitas Indonesia/dr. Cipto Mangunkusumo Hospital ) , Inge Ade Krisanti ( Department of Dermatology and Venereology Universitas Indonesia/dr. Cipto Mangunkusumo Hospital )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 3, ##issue.no## 1 (2018): December 2018
Publisher : Universitas Indonesia

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Abstract

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 on extremities. The dermoscopy appearance of the first patient showed two major components, multiple red dots and lacunae mimicking glomerular vessels, and multiple whitish halos-likekeratosis. Red dots with whitish halos can be seen in dermoscopy of verruca vulgaris, while glomerular vessels and keratosis is usually found in Bowen’s disease. The dermoscopy examination of our second patient only showed some loop hemorrhagic and thrombosed vessels, which are quite inconclusive. Diagnoses were made with histopathology examination which revealed similar pattern of eccrine poroma in both cases. Conclusion: EP is a prominent mimicker, often misdiagnosed because it is uncommon in clinical practice, has variable clinical presentations and dermoscopic appearances. Hence, recognizing and diagnosing this disease becomes a challenge for dermatologist. Keywords: adnexal tumor, dermoscopy, eccrine poroma

Efficacy of low level laser therapy in the treatment of postherpetic neuralgia

Lili Legiawati ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Marsha Bianti ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 3, ##issue.no## 1 (2018): December 2018
Publisher : Universitas Indonesia

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Abstract

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 is relatively new and is used with increasing frequency in the management of chronic pain.Aim: To assess the efficacy of low level laser therapy in the treatment of postherpetic neuralgia.Methods: Articles were searched through Pubmed/ MEDLINE, Cochrane, and Google scholar. Two randomized-controlled trials by Kemmotsu et al. and Moore et al. were obtained and critically appraised.Results: Based on the appraisal, studies by Kemmotsu et al. and Moore et al. are considered valid, important, and applicable. The results demonstrated a significant reduction in PHN intensity following a course of LLLT (p< 0.05).Conclusion: There is a statistically significant difference between the involvement of LLLT in PHN patients and without involvement of LLLT. LLLT is a noninvasive, painless, and safe method of treatment and may be recommended as an early intervention for pain therapy of PHN.  Keywords: low level laser therapy, herpes zoster, pain, postherpetic neuralgia, treatment

Diagnostic procedures in pediatric dermatology

Arini Astasari Widodo ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Githa Rahmayunitha ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Triana Agustin ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia ) , Rinadewi Astriningrum ( Dermatology and Venereology Department, Dr. Cipto Mangunkusumo National Hospital - Faculty of Medicine, Universitas Indonesia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 3, ##issue.no## 1 (2018): December 2018
Publisher : Universitas Indonesia

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Abstract

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 of the most commonly performed pediatric dermatology procedures highlighted in this article are potassium hydroxide examination, Gram staining examination, acid fast bacilli examination, skin test for allergies, and skin biopsy for children. We also discuss the process of obtaining a written informed consent from the parents who were involved in decision making process and play a crucial role in assisting physicians to calm their children during the diagnostic procedures.  Keywords: children, dermatology, diagnostic procedures

Elevated homeostatic model assessment of insulin resistance level increases the risk of acne

Stefani Nurhadi ( dermatology resident at medical faculty of Udayana University ) , IGAA Praharsini ( Dermato-Venereology Department Faculty of Medicine of Udayana University/ Sanglah Hospital, Denpasar ) , A. A. Gde Putra Wiraguna ( Dermato-Venereology Department Faculty of Medicine of Udayana University/ Sanglah Hospital, Denpasar )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 3, ##issue.no## 1 (2018): December 2018
Publisher : Universitas Indonesia

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Abstract

Insulin resistance and 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 of the pilosebaceous duct and the production of sebum in acne.   This is a cross sectional observational analytic study involving 38 acne patient and 38 non acne patients. This study aims to determine whether the increase in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) value is a risk factor for acne. HOMA-IR formula was used to determine insulin activity in basal state. High HOMA-IR values ??are expressed from cut-off point ≥2. Sampling by consecutive sampling that meets inclusion and exclusion criteria. Fasting insulin and glucose levels is derived from venous blood examination.   The average age of acne subjects was 23.71 years (10 men and 28 women). The mean value of HOMA-IR in the acne group was higher (2.63 ± 0.29) than those in the non acne group (1.71 ± 0.26) and statistically significant (p value <0.001). The prevalence ratio was 31.58, meaning that patients with high HOMA-IR were 31.6 times more likely to have acne than patients with normal HOMA-IR values. These results were statistically significant with p value <0.001. The conclusion was elevated HOMA-IR is one of the factors that increase the risk of someone developing acne.

The comparison of skin irritation level between topical cajeput oil and telon oil: A pilot study

Sri Esa Ilona ( Departement of DermatoVenereology Dr. Moewardi General Hospital/ Medical Faculty of Sebelas Maret University Surakarta, Indonesia ) , Aris Cahyono ( Departement of DermatoVenereology Dr. Moewardi General Hospital/ Medical Faculty of Sebelas Maret University Surakarta, Indonesia ) , Endra Yustin Ellistasari ( Departement of DermatoVenereology Dr. Moewardi General Hospital/ Medical Faculty of Sebelas Maret University Surakarta, Indonesia ) , Muhammad Eko Irawanto ( Departement of DermatoVenereology Dr. Moewardi General Hospital/ Medical Faculty of Sebelas Maret University Surakarta, Indonesia ) , Harijono Kariosentono ( Departement of DermatoVenereology Dr. Moewardi General Hospital/ Medical Faculty of Sebelas Maret University Surakarta, Indonesia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 2, ##issue.no## 3 (2018): June 2018
Publisher : Universitas Indonesia

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Abstract

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 using Nachitape®, followed by repeated open application test (ROAT) with cajeput oil, telon oil and alcohol (positive control). The skin irritation was examined in 15 minutes after each cycle by measuring transepidermal water loss (TEWL) using Tewameter® TM300 (Courage-Khazaka, Germany) and erythema using Mexameter® MDD4. Data were analyzed using One-way ANOVA with p<0.05 considered significance.Results: The average TEWL and erythema of cajeput oil (15.59; 345.42) were the highest compared to telon oil (12.63; 316.60), alcohol (13.87; 319.06) and negative control (7,48; 296.68).  All treatment groups had significant differences in TEWL (p<0.000) and erythema (p<0.002) when compared to the negative control. However, cajeput oil showed the largest difference.Conclusion: Cajeput oil caused the most irritation compared to alcohol and telon oil. Therefore, it should be used with caution.  Keywords: cajeput oil, essential oil, skin irritation, telon oil

Comparative study of two diagnostic methods of demodicosis in patients with acne and rosacea

Anzhela Kravchenko ( Russian medical academy of continuous professional education of the Ministry of Healthcare of the Russian Federation, Russia 125993, 2/1 Barrikadnaya street, Moscow, Russia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 2, ##issue.no## 3 (2018): June 2018
Publisher : Universitas Indonesia

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Abstract

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 with acne and rosacea not complicated by demodicosis, and 30 healthy volunteers. All patients were examined by scraping of the skin, eyebrow and/or eyelash epilation and confocal laser scanning in vivo microscopy. Results: The specificity of light microscopy of skin scrapings was 65.5%, while the specificity of confocal laser scanning in vivo microscopy for the diagnosis of demodicosis was 68.8%. Conclusion:  The study showed advantages of confocal laser scanning in vivo microscopy compared to the traditional method of investigation.   Keywords: acne, confocal laser scanning in vivo microscopy, Demodex mites, light microscopy, rosacea 

Double-blind randomized trials once a week narrowband ultraviolet B (NB-UVB) phototherapy in vitiligo

Retno Dwi Utami ( Department of Dermatovenereology Dr. Moewardi General Hospital, Surakarta, Indonesia Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia ) , Mira Trisna Murti ( Department of Dermatovenereology Dr. Moewardi General Hospital, Surakarta, Indonesia Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia ) , Muhammad Risman ( Department of Dermatovenereology Dr. Moewardi General Hospital, Surakarta, Indonesia Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia ) , Arie Kusumawardhani ( Department of Dermatovenereology Dr. Moewardi General Hospital, Surakarta, Indonesia Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 2, ##issue.no## 3 (2018): June 2018
Publisher : Universitas Indonesia

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Abstract

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. Group A was scheduled for NB-UVB phototherapy twice a week while Group B was scheduled for once a week. All patients received topical desoxymetasone cream once daily. Re-pigmentation were compared using Vitiligo Area Scoring Index (VASI). VASI was graded as good (≥25%), moderate (10-24%), and poor (<10 %) responses. Evaluation for melanin index for each lesion was assessed by Mexameter® and cumulative doses of phototherapy were compared. Results: Thirty-seven lesions were treated on face and neck, trunk and extremities. Good responses were obtained in 14.29% group A patients and 13.04% group B patients. The mean of cumulative doses phototherapy in group A was 850 mJ/cm2, whereas group B was 800 mJ/cm2. There was no significant differences (p>0.05) between both groups in terms of re-pigmentation, cumulative doses of phototherapy, and melanin index. Conclusion: In vitiligo, once a week NB-UVB phototherapy appears to be as efficacious as twice a week treatment schedule.   Keywords: melanin index, narrowband ultraviolet B, phototherapy, vitiligo, vitiligo area scoring index

Severe kerion celsi effectively treated with skin debridement and antifungals

Ismiralda Oke Putranti ( Department of Dermato-venereology, Faculty of Medicine, Jendral Soedirman University ) , Citra Primanita ( Prof. dr. Margono Soekarjo District General Hospital Jl. Dr. Gumbreg No.1 Purwokerto Central Java Indonesia )

Journal of General-Procedural Dermatology & Venereology Indonesia ##issue.vol## 2, ##issue.no## 3 (2018): June 2018
Publisher : Universitas Indonesia

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Abstract

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 culture showed colony of Trichophyton mentagrophytes. A surgical debridement was performed to remove the thick crust covering the abscess with alopecia and followed by application of normal saline gauze dressing and terbinafine cream on the top of the lesion for 6 weeks. Systemic micronized griseofulvin was also administered for 6 weeks. Combination treatment of debridement-topical and systemic antifungal gave a good result without scarring alopecia.Discussion: Kerion celsi was diagnosed based on clinical findings and mycological examination. From the laboratory examination, a dermatophyte fungal infection was found. Skin debridement was performed to create a good environment for topical antifungal application and wound healing, with 20mg/kg bodyweight of systemic griseofulvin administered as the first line therapy for tinea capitis. A good prognosis was achieved after those treatments combination.Conclusion: In this case, combination between skin debridement with topical and systemic antifungals gave a better result in treating kerion celsi.  Keywords: antifungals, kerion celsi, skin debridement, tinea capitis