Dermatology Laser In General

Buku ini membahas mengenai prinsip dasar terapi laser pada bidang dermatologi. Buku ini juga membahas secara komprehensif mengenai sejarah laser, mekanisme dan parameter kerja terapi laser pada kulit, indikasi terapi laser pada berbagai jenis kelainan kulit hingga pedoman etik penggunaan laser pada kelainan kulit

Penuaan Dini Kulit Etiopatogenesis dan Implikasi Kinis

Buku ini membahas mengenai penyebab dan proses terjadinya penuaan kulit dini. Buku ini juga membahas secara komprehensif mengenai penyebab penuuan dini pada kulit, gejala klinis penuaan dini kulit dan berbagai pilihan terapi untuk penuaan dini kulit

Retrospective Study: Type 1 Leprosy Reaction

Background: Type 1 reaction (T1R) of leprosy occurs due toaltered balance between cell mediated immunity and M. leprae bacilli in the skin and nerves, with upgrading/reversal or downgrading as final result. Leprosy subpolar types have unstable immunity, this cause them often experience recurrence T1R, especially BB type.Clinical findings of T1R are inflammation in the skin or nerves, and can lead to disability if not treated properly. Aim: To evaluate the distribution, diagnosis, trigger factors, and therapy of T1R. Methods: Retrospective study using medical record of leprosy new patients in Dermatology and Venereology Outpatient Clinic, Dr Soetomo General Hospital, Surabaya, during 2010 – 2013. Database, anamnesis, examination, and T1R therapy were recorded. Results: The total of new leprosy patients with T1R within 2010-2013 were 117 patients (19,7% of all new leprosy  patients). Most of them were men (70,1%), aged between 15–34 years (42,8%), with BB as the most frequent type (70,9%). Skin symptom of T1R could be thickening of old lesion (52,1%). T1R most occurred when patients still consume MDT (71,8%). NSAID (37,6%) andcorticosteroid (38,5%)were prescribed as T1R therapy. Conclusions: T1R diagnosis should established accurately by history taking and physical examination.For recurrent T1R,trigger factors should be considered. Key words: type 1 reaction, CMI, reversal, downgrading

The Use of Thalidomide in Steroid Dependent Continous Erythema Nodosum Leprosum Leprosy Patient: A Case Report

Background: Treatment thalidomide in erythema nodosum leprosum (ENL), can inhibits the transcription repression mediated by tumor necroting factor (TNF). Thalidomide can be used as sparing agents drug to reduce the dependency of steroid. Purpose: To report the effectiveness of thalidomide to treat ENL and of relinquish steroid dependency. Case: A 39 years old patient with leprosy borderline lepromatous type, came with complain bumps on skin accompanied with fever, occurring recurrently since 4 years ago if the steroid’s dose tappered off. He consumed steroid routinely every day for the last 4 years and if the dose was tapered to 4 mg once daily, the painful bumps reappeared often accompanied by fever. Thalidomide 50 mg twice daily and methyl prednisolone 4 mg once daily was given. The constant tapering off of methyl prednisolone done every week. After a month, the patient shown significant improvement. Discussion: Thalidomide is effective in ENL, it is regarded as first line in terms of clinical efficiency because it displays an effect on 90% of ENL patients. In this case, thalidomide was given and steroid dose was reduced slowly while observing the clinical manifestation and patient’s complain. There were no complain of recurrent ENL after discontinuation of steroid and thalidomide, no serious adverse event happened in this patient as well. Conclusion: The effectiveness of thalidomide in ENL is primarily due to its action on TNF but other mechanisms may contribute to its anti-inflammatory effect. Thalidomide is effective in the management of steroid dependent ENL patient.   Key words: thalidomide, steroid dependent, methyl prednisolone, erythema nodosum leprosu

Significant Different Level of Malondialdehyde (MDA) as Oxydative Stress Marker in Severity Groups of Acne Vulgaris

Background: Acne vulgaris (AV) is a common chronic inflammatory disease of sebaceous gland that may decrease patient’s quality of life. Oxidative stress is suggested to play role in the pathogenesis of AV. Purpose: To evaluate the differences of malondialdehyde (MDA) level as oxidative stress marker in AV severity. Method: This is an analytic observational cross sectional research of AV patients in Cosmetic Division of Dermatology and Venereology Outpatient Clinic of Dr. Soetomo hospital Surabaya. Subjects were collected through consecutive sampling since May-August 2015. Total samples were 42 patients, classified into 3 severity groups (mild, moderate, severe).  Samples were taken from blood vein, examined with Enzyme-linked immunosorbent assay (ELISA) then analyzed statistically. Results: There were differences of MDA mean level among AV severity groups: mild 58.371 ng/ml (SD±25.2141); moderate 99.121 ng/ml (SD±8.5172); and severe 171.779 ng/ml (SD±49.9694). Post hoc analytic revealed that there were statistically differences of MDA level in all stages (mild-moderate p=0.002; mild-severe p=0.000; moderate-severe p=0.000). Conclusions: This research revealed that oxidative stress plays a role in AV pathogenesis. Lipid peroxidation process in sebum produced lipid oxidant that could induce inflammatory process in sebaseous gland via Peroxisome Proliferator-Activated Receptor  (PPAR)

Melanocyte Function and Count of Leukotrichia in Vitiligo Using S100 Immunohistochemistry and Microphtalmia Associated Transcription Factor (MITF)

Background: Melanocyte of the hair follicle is one of the major sources of repigmentation in vitiligo. Leukotrichia is complete depigmentation with significant bleaching hair. Leukotrichia in nonsegmental vitiligo may contribute to the lack of response to medical treatment. Leukotrichia is often associated with absent of melanocyte, showing poor prognosis for vitiligo treatment. Purpose: To evaluate melanocyte count and function of leukotrichia’s melanocyte in vitiligo and comparing with other feature. Method: Melanocyte count in each feature of lesional skin in 18 segmental vitiligo patients were evaluated based on vitiligo extent tensity index (VETI). Melanocyte count has been evaluated using immunohistochemistry S100 and microphtalmia associated transcription factor (MITF). Results: Eighteen patients were nonsegmental vitiligo, and five of them had leukotrichia. Two of five leukotrichia patients did not express MITF nor melanocyte. There were no differences of melanocyte and MITF expression between patient with or without leukotrichia. Conclusion: Leukotrichia is a poor indicator for treatment response in vitiligo, but this research showed that leucotrichia may not contribute to the lack of response upon medical treatment

Dermoscopic Features of Alopecia Patient

Backgroud: Alopecia is hair loss of the scalp that occurs in mostly men and about 30% of women during their lifetime. Prevalence of alopecia is increased along with age in both men and women. Using of dermoscope can help the diagnostic accuracy and avoid scalp biopsy for diagnosis. Purpose: Identifying dermoscope examination results and determine the pathophysiology of dermoscope features. Methods: Cross sectional and descriptiove observational study to all of alopecia patients who fulfilled the inclusion criteria at outpatient clinic Dr. Soetomo General Hospital Surabaya in December 2014 through February 2015 performed dermoscope examination Result: There were 20 patients who fulfilled the inclusion criteria, consisted of 3 patients with androgenetic alopecia, 8 alopecia areata, 4 tinea capitis, 2 discoid lupus erythematosus, 1 psoriasis vulgaris, 1 seborheic dermatitis, and 1 trichotilomania. Conclusion: Most of all dermoscope features accordance with the description in the literature, the most diagnosis is androgenetic alopecia. Key words: alopecia, dermoscope, zig-zag hair, black dots

Kadar Hormon 17α-Hydroxyprogesterone (17-Ohp) Serum pada Pasien Pria dengan Akne Vulgaris Sedang-Berat dan Tanpa Akne Vulgaris

Latar Belakang: Akne vulgaris (AV) adalah penyakit kulit kronis pada unit pilosebaceous. Kelebihan androgen dapat menimbulkan akne dengan cara menginduksi kelenjar sebum. AV pada pria mungkin satu-satunya tanda adanya kelebihan androgen. Tujuan: Mengevaluasi kadar 17-OHP serum pada pasien pria AV sedang-berat dan pria tanpa AV di URJ Kesehatan Kulit dan Kelamin RSUD Dr. Soetomo Surabaya. Metode: Sebuah studi kasus kontrol observasional analitik termasuk 15 kasus AV dan 15 kontrol dari klinik Kulit dan Kelamin rawat jalan rumah sakit Dr.Soetomo, berdasarkan kriteria inklusi dan eksklusi. Hasil: Rerata 17-OHP pada kelompok AV adalah 1.58 ±0,25 ng/mL dan pada kelompok kontrol adalah 0,98 ±0,15 ng/mL. Dengan nilai P adalah P = 0,0001 (P <0,05) Kesimpulan: Kadar serum 17-OHP pada kelompok AV signifikan lebih tinggi dibanding kelompok kontrol. Diperlukan penelitian lebih lanjut untuk menyingkirkan faktor perancu untuk mengetahui lebih peran hormonal dalam patogenesis AV

Peningkatan Jumlah Protein S100 pada Vitiligo setelah Terapi Narrowband-Ultraviolet B

Latar Belakang: Vitiligo adalah penyakit depigmentasi yang paling sering dijumpai dengan manifestasi klinis berupa makula berwarna putih susu berbatas tegas, dengan patogenesis kompleks yang belum dipahami dengan baik sehingga evolusi penyakit tidak dapat diprediksi dan hasil terapi seringkali tidak memuaskan. Sampai sekarang Narrowband-Ultraviolet B (NB-UVB) dianggap sebagai pengobatan vitiligo yang paling efektif dan aman. Evaluasi terapi dengan melihat jumlah melanosit melalui pemeriksaan imunohistokimia protein S100 akan menjadi lebih objektif dan akurat. Tujuan: Untuk membandingkan jumlah protein S100 pada pasien vitiligo sebelum dan setelah terapi NB-UVB. Metode: Penelitian ini merupakan penelitian eksperimen analitik komparatif dengan menggunakan metode pre-post test yang membandingkan protein S100 pada pasien vitiligo sebelum dan setelah mendapatkan terapi NB-UVB yang dilakukan di Unit Rawat Jalan, RSUD Dr. Soetomo Surabaya. Dua belas sampel kasus yang didiagnosis vitiligo diobati dengan terapi NB-UVB dua kali seminggu sampai 8 kali terapi. Dosis awal adalah 200 mJ dan secara bertahap meningkat 20% setiap terapi. Dilakukan biopsi sebelum dan setelah terapi dan kemudian protein S100 dibandingkan dengan menggunakan pewarnaan imunohistokimia. Hasil:  Terdapat perbedaan yang bermakna antara jumlah protein S100 pada vitiligo sebelum dan setelah terapi NB-UVB dengan nilai p=0,002 (p=<0,05). Simpulan: Pemeriksaan imunohistokimia protein S100 berguna sebagai indikator keberhasilan terapi pada vitiligo

Hubungan Kadar Antioksidan Superoxide Dismutase (SOD) dengan Indeks Bakterial (IB) pada Pasien Kusta Baru Tipe Multibasiler (MB) tanpa Reaksi

Latar Belakang: Kusta merupakan penyakit infeksi kronik yang disebabkan oleh kuman Mycobacterium leprae (M. leprae).  Tubuh memiliki beberapa mekanisme pertahanan untuk menghadapi infeksi bakteri M. leprae, diantaranya melalui scavenging dari radikal bebas, antioksidan enzimatik merupakan garis pertahanan pertama melawan reactive oxygen species (ROS). Superoxide dismutase (SOD) adalah salah satu enzim antioksidan utama yang menangkal radikal bebas. Terdapat perburukan status antioksidan pada pasien kusta yang berkorelasi dengan indeks bakterial (IB) dan spektrum kusta. Tujuan:  Mengevaluasi hubungan antara kadar SOD dengan IB pada pasien kusta baru tipe multibasiler (MB) tanpa reaksi. Metode: Penelitian ini merupakan rancangan penelitian analitik observasional potong lintang yang bertujuan untuk mengetahui hubungan kadar SOD dengan IB pada pasien kusta baru tipe MB tanpa reaksi. Hasil: Rerata kadar SOD pada semua pasien 86,02±17,89. Kadar SOD pada IB negatif lebih rendah dibandingkan kadar SOD pada IB +1 sampai +3. Kadar SOD tertinggi didapatkan pada IB +1, dengan median IB 0 = 82,20, IB +1 = 92,10, IB +2 = 85,75 dan IB +3 = 82,94. Hasil uji korelasi menunjukkan tingginya kadar SOD tidak disertai dengan rendahnya nilai IB sehingga tidak terdapat hubungan yang signifikan antara kadar SOD dengan berbagai nilai IB dengan p = 0,909 (p>0,05) r= -0,022. Simpulan: Hasil uji korelasi menunjukkan tingginya kadar SOD tidak disertai dengan rendahnya nilai IB dan penelitian ini tidak terdapat hubungan yang signifikan antara kadar SOD dengan nilai IB