Association between atopy and allergic contact dermatitis in Dr. Sardjito General Hospital Yogyakarta

Association between atopy and development of allergic contact dermatitis (ACD) remains controversial. T cell disfunctions in a patient with atopy complicate the process of nickel sensitization. On the other, the decrease of the skin barrier function and overexpression of Langerhans cells in the patient facilitate the sensitization.  This study aimed to evaluate the association between atopy and incidence of nickel ACD. A case-control study was carried out in Allergic and Immunology Sub Department of Dermato-Venereology Policlinic, Dr. Sardjito General Hospital, Yogyakarta, involving 54 nickel ACD patients as case group and 74 healthy subjects as control group. All subjects underwent prick test allergens i.e. house dust, dust mite, cockroach, mixed fungi, nuts and egg white. The skin reaction was considered as a positive result if a wheal diameter of at least 3 mm larger than the negative control or a minimum of half of the positive control. The relationship between atopy and the nickel ACD incidence was analyzed using Chi-Square test with confidence interval (CI) of 95%. A significant association between atopy and the nickel ACD incidence was observed in this study. Subjects with atopy to  ≥1 allergen had risk of nickel ACD 3.74 higher than subjects without atopy (odds ratio/OR=3.74; 95%CI = 1.64-8.53).  Furtheremore, subjects with atopy to  ≥2 allergens had risk of nickel ACD 3.74 higher than subjects without atopy (OR=2.08; 95%CI = 1.01-4.29). In conclusion, atopy is a risk factor of nickel ACD

Phacomatosis pigmentokeratotica: two cases series of a neurocutaneous rarity from Indonesia

Phacomatosis pigmentokeratotica (PPK) is a distinct epidermal naevus syndrome. The syndrome is characterized by the coexistence of an organoid naevus with sebaceous differentiation arranged along Blaschko's lines, a papular naevus spilus arranged in a checkerboard pattern, in association with other extracutaneous anomalies. We report on two cases of PPK. The first case was an 11-year-old girl with sebaceous naevus on the right side of the body following the lines of Blaschko present since birth, whereas a papular naevus spilus involving the dorsal area of the neck was noted at 8 years of age. The second case was a 15-year old girl presented with sebaceous naevus on her face and neck and papular naevus spilus involving left side of her chest. Electroencephalography (EEG) of both cases revealed abnormal irritative epileptiform waves, and brain mapping showed symmetrical structures and no focus. The diagnoses of our two cases were based on clinical pictures of the coexistence of sebaceous naevus arranged along Blaschko's lines, a papular naevus spilus arranged in a checkerboard pattern, and EEG anomalies. To our knowledge, these cases were first reported in Indonesia. The association with various extracutaneous manifestation is often, as well as the possibility of malignant transformation.Hence a close follow-up of PPK patients is important, which may help in early recognition of the development of extracutaneous anomalies and the possibility of malignant transformation

Sexual dysfunction in psoriasis patients: study on the relationship between disease severity and degree of stress due to prosiasis

Psoriasis is a chronic, systemic, and immune-mediated skin disease that can affect physical,psychological and social functions of patients leading to a significant impact on sexualdysfunction. The aim of study was to evaluate the relationship between disease severity anddegree of stress with sexual dysfunction in psoriasis patients. This was an observational studyusing case control design. Subjects were psoriasis vulgaris patients who visited SquamousDivision, Polyclinic of Department of Dermato-Venereology, Dr. Sardjito General Hospital/Facultyof Medicine Universitas Gadjah Mada, Yogyakarta. Disease severity was assessed using psoriasisarea severity index (PASI), whereas sexual dysfunction was evaluated using arizona sexualexperience scale (ASEX) and Psoriasis-related psychological stress was assessed using psoriasislife stress inventory (PLSI). Among 93 patients of psoriasis, 38 patients (40.8%) suffered fromsexual dysfunction. Factors that influence the occurrence of sexual dysfunction in psoriasispatients were disease severity (p=0.00), psoriasis-related stress (p=0.00), disease onset (p=0.03),age (p=0.04) and joint pain (p=0.04). In conclusion, disease severity and degree of stress areassociated with sexual dysfunction on psoriasis patients

The effect povidone-iodine on the wound healing process: A study on fibroblast populated collagen lattice (FPCL) model

Povidone-iodine (PI) 10% solution is an effective antiseptic. However, it appears to be toxic tothe cells involved in wound healing. The aim of this study is to evaluate the toxicity of PI oncultured human fibroblast using fibroblast populated collagen lattice (FPCL) model. The culturedhuman fibroblast was divided into 6 groups i.e. 5 groups were exposed by PI 1, 0.1, 0.01, 0.001and 0.0001%, and 1 group was exposed by phosphate-buffered-saline (PBS). Twenty-four hourslater, the media was washed using PBS. The size of the FPCL media on each group wasobserved over time by serial photographs, which then were measured by Image-J computerprogram. Exposure of 0.1, 0.01, 0.001 and 0.0001 PI caused an obvious reduction of fibroblast’scontraction capability on FPCL media, which described temporary fibroblast injury, that showinga concentration-dependent recovery phenomenon after 48th hour. Furthermore, 1% PI exposureleads to a permanent fibroblast injury. In conclusion, PI exposure in concentration more than0.1% has a permanent toxic effect on fibroblast that clearly observed using a simple FPCLmodel

Association between environmental allergen sensitization with severity of atopic dermatitis in children and young adult at Dr. Sardjito General Hospital, Yogyakarta

The important role of aeroallergens and food allergens as the most common environmental allergens in exacerbation of atopic dermatitis (AD) is well known. Sensitization is an essential process which correlates with clinical manifestation of AD. The study of AD in Indonesia, especially in Yogyakarta, has not been reported, yet. The aim of study is to evaluate the association between sensitization of environmental allergens with clinical severity of AD in children and young adult at Dr. Sardjito General Hospital, Yogyakarta. An analytic observational cross sectional study was performed on 33 children and young adult with AD. The severity of disease was determined by SCORing Atopic Dermatitis (SCORAD). Assessment of sensitization was performed using specific IgE serum, atopy patch test, and prick test. Data were analyzed using chi-square or Fisher exact test and prevalence ratio (PR) with significance value of

Akantosis Nigrikans pada Anak

Latar Belakang: Akantosis nigrikans (AN) merupakan kelainan kulit yang ditandai dengan patch atau plak hiperpigmentasi dengan permukaan kasar dan struktur seperti beludru yang biasanya terdistribusi simetris pada daerah lipatan. Selain merupakan tanda klinis yang kuat adanya resistensi insulin dan sindrom metabolik, AN berhubungan pula dengan keganasan, penggunaan obat-obatan, serta dapat menjadi salah satu manifestasi yang menyertai sindrom. Tujuan: Menjelaskan patofisiologi, manifestasi klinis, diagnosis, serta klasifikasi AN. Telaah Kepustakaan: Klasifikasi AN yang ada seringkali tidak konsisten, tumpang tindih dan membingungkan. Hal terpenting dari diagnosis AN adalah membedakan apakah lesi yang ada termasuk ke dalam lesi jinak atau ganas, yang akan memengaruhi pemberian terapi dan prognosis penyakit. Terapi AN tergantung dari penyebab yang mendasari dan ditujukan untuk memperbaiki penampilan dari segi kosmetik. Simpulan: Kewaspadaan klinisi harus ditingkatkan pada kasus AN untuk memberikan penatalaksanaan yang tepat sejak dini

Association between environmental allergen sensitization with severity of atopic dermatitis in children and young adult at Dr. Sardjito General Hospital, Yogyakarta

The important role of aeroallergens and food allergens as the most common environmental allergens in exacerbationof atopic dermatitis (AD) iswell known. Sensitization is an essential processwhich correlateswith clinicalmanifestationof AD. The study of AD in Indonesia, especially in Yogyakarta, has not been reported, yet. The aim of study is toevaluate the association between sensitization of environmental allergens with clinical severity of AD in children andyoung adult at Dr. Sardjito General Hospital, Yogyakarta. An analytic observational cross sectional study wasperformed on 33 children and young adult with AD. The severity of disease was determined by SCORing AtopicDermatitis (SCORAD). Assessment of sensitization was performed using specific IgE serum, atopy patch test, andprick test. Data were analyzed using chi-square or Fisher exact test and prevalence ratio (PR) with significancevalue of p<0.05 and 95%confidence interval (CI). The results showed that specific IgE positivity was associatedwith severity of AD. Percentage of specific IgE positivity to house dust mite was significantly higher in subject withmoderate/severe AD compared to those of mild AD (p=0.049; PR 1.13; 95% CI 1.01-1.59). The result was alsosimilar for cat dander (p=0.041; PR 1.1; 95%CI 1.09-4.98), cow’s milk (p=0.038; PR 1.21; 95% CI 1.02-2.2),and egg white (p=0.027; PR 1.23; 95% CI 1.15-2.97). Whereas specific IgE positivity to fish allergen was notstatistically different in subject with moderate/severe AD compared to those with mild AD (p=0.061; PR 0.8; 95%CI 0.76-2.8). According to atopy patch test and prick test result, no association was found between allergensensitization and severity of AD. If allmethodswere combined to increase the sensitivity of sensitizationmeasurement,then the association was found for all allergens. It could be concluded that environmental allergens sensitization isassociated with severity of AD in children and young adult at Dr. Sardjito General Hospital, Yogyakarta.Key words: atopic dermatitis-disease severity-sensitization-aeroallergen-food allerge

FACTORIAL DESIGN AS THE METHOD IN THE OPTIMIZATION OF TIMOLOL MALEATE-LOADED NANOPARTICLE PREPARED BY IONIC GELATION TECHNIQUE

Objective: This study aims to optimize the timolol maleate (TM) nanoparticle prepared by ionic gelation method using the factors of pectin (PC), calcium chloride (CC), and chitosan (CS) concentrations with the responses of entrapment efficiency, particle size, and polydispersity index using 23 factorial design. Methods: TM nanoparticle suspensions were obtained by mixing of PC (0,4-0,6% (w/v)), CC (0,2-0,4% (w/v)), and CS (0,01-0,02% (w/v)) with TM concentration of 0,02% w/v. Each mixture was then tested for entrapment efficiency, particle size, and polydispersity index. The test results were analyzed with 23 factorial design using Design-Expert software in order to determine the optimum formula. Results: The optimization study showed that all of the factors influenced the responses significantly (p&lt;0.05) based on the analysis of variance (ANOVA) of the suggested models. The R2value and the adequate precision value of the three models were more than 0.7 and 4, respectively. The difference between Adjusted R-Squared and Predicted R-Squared value were less than 0.200. The optimum condition of TM nanoparticle was suggested at the desirability value of 0.839 with the concentration of PC, CC, and CS of 0,4% (w/v), 0,2% (w/v), and 0,01% (w/v), respectively. The entrapment efficiency, particle size, and polydispersity index of the optimum condition were 24.791±2.84%, 274.867±14.45 nm, and 0.634±0.066, respectively. Conclusion: The 23factorial design has been proved as the suitable method to determine the optimum condition that yields the good results of the entrapment efficiency, particle size, and polydispersity index of the TM-loaded nanoparticle prepared by ionic gelation method

FORMULATION AND CHARACTERIZATION OF TIMOLOL MALEATE-LOADED NANOPARTICLES GEL BY IONIC GELATION METHOD USING CHITOSAN AND SODIUM ALGINATE

Objective: The objectives of this study were to formulate and characterize nanoparticles gel of timolol maleate (TM) by ionic gelation method using chitosan (CS) and sodium alginate (SA). Methods: Optimization was carried out by factorial design using Design Expert®10.0.1 software to obtain the concentration of CS, SA, and calcium chloride (CaCl2) to produce the optimum formula of TM nanoparticles. The optimum formula was characterized for particle size, polydispersity index, entrapment efficiency, Zeta potential, and molecular structure. Hydroxy Propyl Methyl Cellulose (HPMC) K15 was incorporated into optimum formula to form nanoparticles gel of TM and carried out in vivo release study using the Franz Diffusion Cell. Results: TM nanoparticles was successfully prepared with concentration of CS, SA, and CaCl2 of 0.01 % (w/v), 0.1 % (w/v), and 0.25 % (w/v), respectively. The particle size, polydispersity index, entrapment efficiency, and Zeta potential were found to be 200.47±4.20 nm, 0.27±0.0154, 35.23±4.55 %, and-5.68±1.80 mV, respectively. The result of FTIR spectra indicated TM-loaded in the nanoparticles system. In vitro release profile of TM-loaded nanoparticles gel showed controlled release and the Korsmeyer-Peppas model was found to be the best fit for drug release kinetics. Conclusion: TM-loaded CS/SA nanoparticles gel was successfully prepared and could be considered as a promising candidate for controlled TM delivery of infantile hemangioma treatment