Retrospective Study: Management of Atopic Dermatitis

Background: Atopic dermatitis (AD) is a chronic skin inflammatory disease, characterized with mild to severe itching, relapses, and mostly appears in infants and children. Although there has been current advances in the management of AD but satisfactory treatment has not been obtained. Purpose: To evaluate the treatment of patients with AD, hence better management can be provided. Methods: Retrospective study of newly diagnosed AD patients in Allergy Immunology Division of Dermatology and Venereology Outpatient Clinic Dr. Soetomo General Hospital Surabaya during 2012-2014. Result: Antihistamine is the most widely prescribed medication, as many as 234 (36.3%) of all patients visits and cetirizine was the most given antihistamine in 142 (58%) of the patients. Emollients still used minimally, such as urea 10% cream in 71 (11%) patients, ambiphilic cream (biocream®) in 52 (8.1%) patients, and vaseline album in 11 (1.7%) patients. Conclusion: Emollients therapy is important in the management of AD and hence its usage should be adequate. Key words: atopic dermatitis, management, retrospective

Allergic Contact Dermatitis due to Henna Tattoo with Secondary Infection

Background: Recently henna tattoo become popular. Incidence of allergic contact dermatitis due to henna tattoo is increasing. Para-phenylenediamine (PPD) is suspected as a contact sensitizer because it is often added to henna tattoo to make a darker color. Patch test is needed to determine the allergen. Case: A 18 year-old woman with chief complaint itchy redness patches, burning sensation, and blisters containing pus on her lower left arm after she applied henna tattoo on those site 3 days before. It was the second time applying henna and the reaction was appeared. The patient was treated with oral antibiotic for 5 days, oral antihistamine, and wet dressing with NaCL 0.9% for 3 days. Three days after wet dressing, topical corticosteroid was applied, and the lesion resolved. Patch test was performed 10 months later and showed positive reaction to PPD and toluenesulfonamide formaldehyde resin (TSFR). The previous history, patient had allergy to nail polish which TSFR was suspected as a contact sensitizer. Discussion: Allergic contact dermatitis is a hypersensitivity reaction caused by skin contact with an environmental allergen. Prior sensitization is required for allergy to develop. Patch test is the gold standard to determine the allergen. Based on history and physical examination, clinical relevance of patch test showed positive current relevance (possible) for PPD, and past relevance for TSFR. Conclusion: Avoiding the allergens are important in the management of contact dermatitis. Key words: Allergic contact dermatitis, henna tattoo, para-phenylenediamine (PPD), patch test

Topical Therapy in Atopic Dermatitis Patient

Background: Atopic dermatitis (AD) is an inflammation skin disorder characterized by itchy, chronic, residif, can occur in infant, child, and adult. The therapy for AD are divided into systemic and topical therapy. Topical therapy is the first line therapy for mild and moderate AD which are the most common type AD. Purpose: To evaluate the pattern of topical therapy in new AD patients. Methods: Retrospective study methods was performed by evaluating medical records of new AD patients who received topical therapy in Allergy Immunology Division, Department of Dermatology and Venereology, Dr. Soetomo General Hospital from 2013 until 2015. The evaluated data included the patient's visitation, age, gender, time visit, patient's complaint, periode of illness, history of atopy, physical examination, management, and follow up. Results: There were 272 patients (83.2%) of 327 new AD patients who received topical therapy. Topical therapies were provided in form of corticosteroid topical  for 187 patients (23.6%), emolient for 183 patients (23.1%), and topical antibiotic for 40 patients (5.1%). Patients who did not return to the hospital after first visitation were 174 patients (53.2%). Conclusion: Corticosteroid topical is the first line therapy for atopic dermatitis, but emolient is important to improve skin barrier

Dermatitis Kontak Alergi terhadap Tato Hena dengan Infeksi Sekunder

Latar Belakang: Tato hena menjadi populer akhir-akhir ini. Insidensi Dermatitis Kontak Alergi (DKA) karena tato hena meningkat. Para-phenylenediamine (PPD) diduga sebagai penyebab sensitisasi karena sering ditambahkan dalam hena untuk menghasilkan warna lebih gelap. Uji tempel kulit diperlukan untuk menentukan alergen penyebab DKA. Kasus: Wanita, 18 tahun dengan keluhan bercak merah gatal, rasa terbakar dan lepuhan berisi nanah di lengan kiri bawah setelah pasien menggunakan tato hena 3 hari sebelumnya. Kejadian ini adalah kedua kalinya pasien menggunakan tato henna dan timbul reaksi. Pasien mendapat pengobatan antibiotik oral selama 5 hari, antihistamin oral, dan kompres NaCL 0,9% selama 3 hari. Tiga hari kemudian kortikosteroid topikal diberikan, dan lesi membaik. Uji tempel kulit dilakukan 10 bulan kemudian dan hasilnya positif terhadap PPD dan toluenesulfonamide formaldehyde resin (TSFR). Pasien mempunyai riwayat alergi terhadap cat kuku, TSFR diduga sebagai bahan kontak terjadinya sensitisasi. Pembahasan: Dermatitis kontak alergi adalah reaksi hipersensitifitas yang disebabkan kulit kontak dengan alergen lingkungan. Proses sensitisasi diperlukan untuk terjadinya alergi. Uji tempel kulit adalah baku emas untuk menentukan alergen penyebab. Relevansi klinis hasil uji tempel kulit pasien, berdasarkan riwayat pasien dan pemeriksaan fisik, menunjukkan positive current relevance (possible) terhadap PPD, dan past relevance terhadap TSFR. Simpulan: Menghindari alergen penyebab adalah penting dalam tatalaksana dermatitis kontak. Kata kunci: Dermatitis kontak alergi, tato hena, para-phenylenediamine (PPD), uji tempel kulit

Salivary Cortisol Levels Representing Serum Cortisol Levels in Atopic Dermatitis Patients

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder, recurrent lesion with a distinctive and specific distribution of lesions according phases. Patients with allergic diseases have been known to have a variety of patterns of cortisol. Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and the role of cortisol has been studied in patients with DA. Free cortisol adrenal cortex is considered biologically active, which passively diffuses into all body fluids including saliva. Another advantage is the saliva examination is non-invasive, stress free and easy to do anywhere. Purpose: To analyze the correlation between levels of serum cortisol and salivary cortisol in patients with AD. Methods: Analytical, observational, cross-sectional study of the 29 AD patients who underwent blood and saliva samples by the method of "passive drooling" conducted on the hour 8:00 to 9:00 to see the levels of serum cortisol and salivary cortisol. Results: Twenty-nine subjects revealed mean serum cortisol levels 6,703,82g/dL, mean salivary cortisol levels was 1,430,96g/dL. Equation of salivary cortisol = 0,471+0,142*serum cortisol 2 (R=28,5%). Conclusions: The increasing of serum cortisol level of AD patients will result in increased levels of cortisol in saliva. Saliva collection methods by “passive drooling” were able to describe the serum cortisol levels at 28,5%. Key words: atopic dermatitis, serum cortisol, salivary cortisol

Severe Cutaneous Adverse Drug Reaction

Background: Cutaneous adverse drug eruption (CADR) are frequently found. A systematic review showed, the incidence of severe CADR (SCADR) ranging from 0-8%. Few studies have assessed the severe form of CADR, which has high mortality rate. The epidemiological study was needed to show the profile of SCADR, especially in the setting of general hospital. Purpose: To evaluate clinical and epidemiological profile of SCADR in Dermatology and Venereology Ward Dr. Soetomo Hospital Surabaya. Methods: All SCADR patients in the period of January 2015–January 2016 was evaluated clinically and epidemiologically. Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic reaction (DRESS) cases were included in the study. Results: There were 14 patients in this study, consist of 10 SJS cases (71.4%), 2 TEN patients, and 2 AGEP patients. The highest frequency of age group was 25-29 years old (57.1%). Man to woman ratio was 3:4. The most common offending drug was paracetamol (50%), followed by amoxicillin (28.6%). Antibiotic was the highest frequent offending drug-group (64.3%), followed by antipiretics (50%). In this study, all patients got systemic corticosteroid and the mortality was 0%. Conclusion: The most common type of SCADR was SJS. The most common offending drug was paracetamol, and antibiotic was the highest frequent offending drug-group. Systemic corticosteroid therapy showed good result in severe CADR management

Clinicoepidemiological Profile of Severe Cutaneous Adverse Drug Reaction: A Retrospective Study

Background: Drug eruption were varied from mild to severe reaction. Few studies have assessed the severe cutaneous adverse drug reaction (SCADR), especially in the setting of general hospital. Purpose: To evaluate clinicoepidemiological profile of SCADR at Dermatology and Venereology Ward Dr. Soetomo Hospital, Surabaya, Indonesia. Methods: All SCADR patients at Dr. Soetomo Hospital, Surabaya, Indonesia in the period of January 2016 – June 2017 was evaluated. Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), Acute Generalized Exanthematous Pustulosis (AGEP), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) and exfoliative dermatitis cases were included in the study. Results: There were 24 patients in this study, consisted of 11 SJS cases, 1 TEN case, 2 SJS/TEN-overlap cases, 10 exfoliative dermatitis cases. The mean of latent period between drug intake and onset of symptoms was 15.8 days. The most common offending drug was mefenamic acid (20.9%), followed by cefadroxil and phenytoin (each 16.7%). Antibiotics was the highest frequent offending drug-groups (62.5%), followed by non-steroid anti-inflammatory drugs (NSAIDs). Prompt withdrawal of the offending drugs, systemic corticosteroid, and supported therapy were given to all patients, which gave good results in 21/24 patients (87.5%). Conclusion: Antibiotics were the most common offending drug-groups. SCADR might give high mortality rate, but early diagnosis, prompt withdrawal of the suspected drugs, closed monitoring to evaluate complications can improve the prognosis of SCADR