The Correlation between Interleukin-10 Serum with Bacterial Index in Multidrug Therapy-treated Leprosy Patients

Background: Immune respons disturbance oftenly found in leprosy patient, mainly in various T cell subset and cytokine immune system arranger. Interleukin-10 produced by Th 2 cell, Th3 cell, monocyte, dendritic cell, eosinophil, mast cell, and keratinocyte. Interleukin 10 (IL-10) works in active macrophage to end the respons to microbe and restore the system to the resting state after the microbes are destroyed. Purpose: To analyze correlation between IL-10 level with Bacterial Index (BI)  in Multidrug Therapy (MDT)-treared leprosy patient. Methods: Cross sectional analytical observational study of 43 subjects, consisting of 38 males (88.4%) and 5 females (11.6%). The IL-10 examination used quantitative sandwich enzyme immunoassay, human IL-10 Quantikine® ELISA methods from R & D systems® Result: There was positive correlation between IL-10 and BI of MDT-treated leprosy patient (r = 0,504; p=0,001). Conclusion: The increasing of IL-0 correlated with high BI. Interleukin-10 level is higher in MB type than PB type of leprosy patients. Key words: Interleukin-10 (IL-10), bacterial index (BI)

The Characteristic of Anti dsDNA and Organ System Involved in Systemic Lupus Erythematosus Patient at Hasan Sadikin General Hospital, Bandung

Background : Clinical manifestation of Systemic Lupus Erythematosus (SLE) may be varies in attacking various body tissue and organ system. Anti-dsDNA is the important antibody indetermining diagnosis and prognosis of SLE. This study was conducted to explain the characteristics of antidsDNA and organ system involved in SLE patients.Method:  We used quantitative descriptive analysis methods. Data were collected from medical records of SLE patients who came to Dr. Hasan Sadikin Bandung General Hospital Rheumatology Clinic from September to November 2016. Using categorical descriptive research equation, we found that total minimum samples were 67 subjects. Data observed included the level of anti-dsDNA antibody and clinical manifestation of organ systeminvolved.Result: From 67 samples, there were 65 females which accounted for 97% of the research subjects. Distribution of organ system involved in our subjects was musculoskeletal (29%), mucocutaneous (27%), hematologic (21%), kidney (15%), neuropsychiatry (4%),lung involvement (4%) and cardiovascular (0%). Organ system involved related with strong positive anti-dsDNA were mucocutaneous (21,6%), hematologic (25%), musculoskeletal (12,5%), kidney (14,3%) and lungs (20%).Conclusion:  The most frequent organ system involved in SLE patients at our setting was musculoskeletal. The common organ involvement related with strong positive antidsDNA were mucocutaneous, musculoskeletal, and hematologic. Keywords: anti-dsDNA, involvement of organ system, clinical manifestation, systemic lupus erythematosu

The Effect of Systemic Methotrexate and Cyclosporine Combination Therapy inPsoriasis Vulgaris Patients in Bandung, Indonesia

Background: Methotrexate (MTX) and cyclosporine have been used as effective systemic mono-therapy for psoriasis. Several factors are considered to switch monotherapy to combination therapy because monotherapy is no longer effective and has higher side effects. Hence,clinicians have avoided systemic therapy combinations due to its toxicity. However, some studies showed that this combination therapy could be usedeffectively for psoriasis patients. Purpose: This study aimed to analyze the efficacy and adverse effects of systemic MTX and cyclosporine combination therapy in Indonesian psoriasis vulgaris patients. Methods: The retrospective study assessed the effectiveness of 3 monthsmono-therapyand combination therapy of systemic MTX and cyclosporine in psoriasisvulgaris patients from 2016–2017 in Dermatology Clinic, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia. Result: Psoriasis area and severity index (PASI) score 90 were achieved in the group MTX (50%) and cyclosporine group (50%), while none in the combination group.However, eight patients (50%) in group MTX and cyclosporine reached the primary endpoint of PASI 50. One patient in cyclosporine group had adverse effects on kidney profiles. Nonetheless, other patients had no biochemical changes. But, there was no significant difference in the change of PASI between each group (p=0.102). Conclusion: We propose that combination therapy of MTX and cyclosporine is relatively safe and efficacious in treating Indonesian psoriasis vulgaris patients. This combination treatment isas effective as MTX or cyclosporinemono-therapy

Mucocutaneous Manifestation of Systemic Lupus Erythematosus Patients At Rheumatology Outpatient Clinic In Dr. Hasan Sadikin General Hospital

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune systemic disease which symptoms induced by Ultraviolet rays exposure. It commonly affects women and causes wide range of symptoms. One of the organs affected is mucocutaneous. Our study aims to determine mucocutaneous manifestations of SLE patients in Rheumatology Outpatient Clinic in Dr.Hasan Sadikin General Hospital, Bandung.Methods: A descriptive study with prospective crosssectional design conducted. Data were obtained by interviewing SLE patients as primary data and accessing medical record as secondary data. Ninety-six SLE patients met the inclusion and exclusion criteria wereincluded.Results: From ninety-six subjects, 94.8% subjects are working indoors. Mucocutaneous manifestation were found in most patients. Based on American College of Rheumatology (ACR) criteria, we found mucocutaneous manifestations, such as: oral ulcers in 67 patients(69.8%); malar rash in 63 patients (65.6%); photosensitivity rash in 51 patients (53.1%), and discoid rash erythematous in 21 patients (21.9%). Specific SLE cutanoeus manifestation based on Gilliam classification were found in our study subjects, such as papulosquamous/ psoriasisform (19.5%) , morbilliform (17.7%), vesicobullous annular SCLE (13.5%), annular SCLE (6.3%), and TEN-like LE (1%). Non-specific LE cutaneousmanifestations based on Gilliam classification were also found in our study subjects, such as oral ulcers (69.8%), photosensitivity rash (53.1%), alopecia (86.5%), Raynaud’s Phenomenon (39.6%), nail abnormalities (24.0%), periungual telangiectasia patients (13.5%), vasculitic lesions (12.5%), thrombophlebitis (44.8%), bullous lesion (5.2%) and erythema multiforme (5.2%).Conclusion: Mucocutaneous manifestations in SLE patients based on ACR criteria found most in this study is oral ulcers. Based on Gilliam classification specific LE cutanoeus manifestation was not found in all SLE patients, while non-specific LE mucocutaneous manifestations mostly found is alopecia. Keywords: American College of Rheumatology (ACR) criteria, Gilliam classification, Mucocutaneous manifestations, Systemic Lupus Erythematosu

Keberhasilan Terapi Kombinasi Menggunakan Metotreksat Injeksi dan Siklosporin pada Psoriasis Pustulosa Generalisata

Psoriasis pustulosa generalisata (PPG) adalah bentuk khusus dari psoriasis yang bersifat akut dan berat. Etiologi yang belum diketahui secara pasti menyebabkan pengobatan PPG masih menjadi suatu tantangan. Terapi kombinasi dapat diberikan pada PPG yang berat maupun yang tidak memberikan respons terhadap terapi sistemik tunggal, selain itu terapi kombinasi juga dapat meningkatkan efektivitas dari obat tunggal. Dilaporkan satu kasus PPG pada seorang wanita yang diterapi dengan menggunakan kombinasi metotreksat (MTX)  injeksi dan siklosporin. Dari anamnesis dan pemeriksaan fisis didapatkan pustula berkelompok pada dasar makula eritem yang bergabung membentuk lake of pus, disertai gejala sistemik demam dan leukositosis. Keluhan tersebut sudah berulang sejak 13 tahun yang lalu. Pasien diberikan terapi kombinasi injeksi MTX dan siklosporin. Pustula pada pasien menghilang setelah tujuh hari pemberian obat. Terapi kombinasi dengan MTX injeksi dan siklosporin ini baru pertama kali dilakukan 19 Mei–26 Mei 2017 di Departemen Ilmu Kesehatan Kulit dan Kelamin Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung dan memberikan hasil yang baik. [MKB. 2017;49(3):208–12] Kata kunci: Metotreksat, metotreksat injeksi, psoriasis pustulosa generalisata, siklosporin   Succesful Treatment of Generalized Pustular Psoriasis with a Combination of Methotrexate Injection and Cyclosporine Generalized pustular psoriasis (GPP) is a special form of acute and severe psoriasis. The definite etiology of GPP remains a challenge. Combination therapy may be given to severe GPP or GPP that does not respond to a single systemic therapy sincecombination therapy may also improve the effectiveness of a monotherapy drug. A GPP case was reported in a woman treated with a combination of methotrexate (MTX) and cyclosporine. From anamnesis and physical examination it was revealed that there were clustered  pustules on the base of erythematous macules that form a lake of pus accompanied by systemic symptoms of fever and leukocytosis. This was a recurrent complaint since 13 years ago. Patients were given combination therapy of MTX injection and cyclosporine. Pustules disappeared after seven days of drug administration. This case was the first combination therapy with MTX injection and cyclosporine used during the period of 19 May to 26 May 2017 at the Department of Dermatology and Venereology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, resulting in good results. [MKB. 2017;49(3):208–12] Key words: Cyclosporine, generalized pustular psoriasis, methotrexate, methotrexate injectio

A clinician's reference guide for the management of atopic dermatitis in Asians

Background Atopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD. Objective The Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians. Methods Electronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017. Results The Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included. Conclusion The management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability