Mid-Borderline Leprosy with Mild Type 1 Reaction in Children: A Case Report

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Cases of leprosy in children are rarely found because of the long incubation period of Mycobacterium leprae. Purpose: To report a case of mid-borderline leprosy with a mild type 1 reaction in a seven-years-old girl patient. Case: A 7-years-old girl patient presented with multiple red and white patches on her face, body, arms, legs, and buttocks since 6 months before. There was no itching, numbness, painr fever. There was no thickening of peripheral nerves and no nerve function impairment. Her grandmother was suspected to have leprosy, but she had never been treated and had already passed away. From the acid fast bacilli (AFB) examination, the bacterial index (BI) was 1+ and the morphological index (MI) was 2%. A serologic test examination was also performed and the result were Immunoglobulin (Ig) G  3716 u/ml and IgG 284 u/ml. The patient got multidrugs therapy for 12 months and after 9 months of treatment, the pre-existing patches became erythematous, thickened, and felt pain when touched, but there was no fever. In the presence of pain, oral ibuprofen was then administered and the patches began to improveDiscussion: Due to the possibility of leprosy reaction, it is important to immediately give prompt treatment to children with type 1 leprosy reaction that is associated with neuritis and leads to deformities. Conclusion: Early diagnosis and therapy for a type 1 leprosy reaction are very important to prevent deformities

Facial Rejuvenation in Indonesian Skin With a Picosecond 755-nm Laser

Background: Skin aging is a natural process that occurs as people age, affected by various factors, ultraviolet irradiation is a major factor, leading to appear wrinkles, pigmentations, and textural irregularities. Laser had gained popularity for facial rejuvenation in the Asian population, but melanin rick skin type like Asian are more susceptible to pigmentary alterations. Majority of Indonesians have brown skin color and the rest have lighter skin color. The aim of this study is to know the efficacy and safety of the picosecond 755 nm laser on facial rejuvenation in Indonesian skin. Methods: This is a retrospective analysis of 20 healthy subjects with Fitzpatrick skin type III-V presenting with facial photoaging from 36 to 55 years old. Assessments were conducted at the baseline and 4 weeks after the second session of the treatment. Standardized photographs were taken from the front and side of both cheeks using VISIA. Clinical improvement was categorized as mild - excellent. Patients were also asked and examined about the presence of adverse event. Results: Patients were predominantly female with a mean age of 44 years old. Sixty percent of patients had a good improvement and 40% of patients had a moderate improvement. The VISIA analysis showed significant improvement in wrinkles, pigments, and textures (p < 0.001). Only mild anticipated adverse events were observed, there were no post-inflammatory hyperpigmentation or hypopigmentation. Conclusion: Picosecond 755 nm laser is effective and safe for facial rejuvenation in Indonesian skin without significantadverse event

Long Term Effects of Combination of Metabolite Product Amniotic Membrane Stem Cell (MP-AMSC) and Vitamin C after Fractional CO2 Laser for Photoaging Treatment

Background: Metabolite Products Amniotic Membrane Stem Cell (MP-AMSC) originating from the amniotic membrane has a skin rejuvenation effect by stimulating collagen synthesis. Vitamin C functions as an antioxidant in photoaging treatment. It is expected that the application of a combination of MP-AMSC and vitamin C after fractional CO2 laser treatment as Laser-Assisted Drug Delivery (LADD) to provide better long-term effects on clinical improvement of photoaged skin. As the drug penetration reaching the target, long-term effects and no side effects are expected. This promises as an option for photoaging therapy in the future. Purpose: This study aimed to evaluate the long-term effects of a combination of topical MP-AMSC mixtures and vitamin C after fractional CO2 laser treatment on wrinkles, spots, pores, and skin tones. Methods: Thirty adult women with photoaged skins were selected as samples, and were observed for wrinkles, spots, pores, and skin tones examination. The observation involved computer-simulated photographic devices, Facial Skin Scope System Janus-II for three months after the topical administration of MP-AMSC mixture and vitamin C, three times fractional CO2 laser, tretinoin 0.025% cream, and sun protection factor (SPF) 30 sunscreen as maintenance therapy. Result: The data analysis result was not statistically significant (p>0.05). Conclusion: There was a long-term effect of the application of a mixture of topical MP-AMSC and vitamin C after fractional CO2 laser treatment, and no side effect was observed

The Analysis of Serum Vitamin D (25[OH]D) Level in Psoriasis Patients Comparing with Control Subjects

Background: Vitamin D has been shown to have an immunomodulatory effect, and previous studies have proven that vitamin D deficiency contributed to several autoimmune diseases, including psoriasis. Purpose: The purpose of this study was to determine serum vitamin D levels in psoriasis vulgaris patients and compare them with control subjects. Methods: The research samples were sixteen adults with psoriasis vulgaris and 16 control subjects. Blood samples were taken, and the serum 25 (OH) D levels were measured using the Chemiluminescent Microparticle Immunoassay method. Result: The mean serum vitamin D in psoriasis vulgaris patients and controls were 14.36 ± 6.36 and 19.92 ± 7.59 ng/mL, respectively. No psoriasis vulgaris were observed in patients with normal 25(OH)D levels, and only 3 control subjects with normal serum 25(OH)D levels. These results were not statistically significant (p = 0.09). Conclusion: Most patients with psoriasis vulgaris were observed having vitamin D deficiency. However, the prevalence of vitamin D deficiency in the control subjects was high as well. Therefore, there were no differences in serum 25(OH)D levels between psoriasis vulgaris and control patients

The Role of Stem Cell Metabolites Derived From Placenta for Skin Regeneration An In Vitro Study

Background: The role of stem cells in skin aging is to repair injured tissue or replace other cells in programmed cell death. Stem cell metabolites are rich in growth factors including IL-10, IL-4, EGF, GM-CSF, and TGF-β that can induce the skin production of protein and elastic fbers, leading to the improvement of skin appearance. Aim: This study aimed to assess the characteristics of stem cell metabolites in vitro. Methods: Cytotoxicity assay was performed using MTT reagents and optical cell densities were determined using ELISA reader to fnd the percentage of living cells. Cytokine detection assay was performed by analyzing the cytokine levels in the peripheral blood mononuclear cell (PBMC) and mesenchymal stem cell (MSC) using ELISA. Apoptosis assay was performed using the double staining method with the markers identifed were Hsp70, p53, and caspase-3. Results: All samples showed the percentage of living cells that exceed 70%. Cytokine detection assay showed a decrease of IL- 12 and IFN-γ in both PBMC and MSC groups. The apoptosis assay of human adipose mesenchymal stem cells using a fluorescence microscope showed most of the green light was lost in control cells without metabolites. We found that the expressions of Hsp70 were increased while the expression of p53 and caspase-3 were decreased in the stem cell metabolites samples. Conclusion: These results showed that stem cell metabolites are non-toxic, do not cause a systemic immune response to surrounding tissue, and able to inhibit the occurrence of apoptosis

Toxic Epidermal Necrolysis Induced by Carbamazepine: A Case Report

Background: Toxic epidermal necrolysis (TEN) is an uncommon but potentially fatal condition. TEN is distinguished by apoptosis of keratinocytes, which results in erosion of the mucous membrane and epidermal detachment. Case: A man, 20-year-old, came to hospital with skin sore and blisters in almost over his body, accompanied by swollen eyes, sore on the lips and genital. Dermatological examination on the regio trunk showed erythematous and hyperpigmented macules, irregularly shaped, multiple flaccid bullae, and epidermal detachment. The suspected drug, carbamazepine was discontinued immediately, then the patient was given appropriate supportive treatment with intravenous fluid drop (IVFD), systemic corticosteroid, antibiotic, and topical treatment. After 10 days, skin recovery and reepithelialization mucosal was stabilized. The patient was discharged after 12 days if admission. Drug patch testing was performed resulting in positive result for carbamazepine. Conclusion: The accurate diagnosis, avoidance of the use causative drug and rapid treatment may improve the prognosis. Drug patch testing with positive reactions have high predictive value to avoid using that drug in the future

A successfully treated Basal Cell Carcinoma using elliptical excision surgery

 Basal cell carcinoma (BCC) is a non-keratinization cell-derived neoplasm. Surgical excision is the most common way to remove a tumor. The excision depends on the tumor type, size, and location. This paper reported a 44- years-old woman presented with the chief complaint of a single bump that bleeds easily in the facial region that began one year ago. Dermatology examination revealed hyperpigmented plaque with an ulcer in central, solitary, oval, 2 cm x 1 cm in size, covered with blackish crust on top. A Dermoscopy examination showed blue dots and globules, arborizing vessels, and ulceration. Histopathology examination findings were in concordance with BCC. The patient was treated with elliptical surgical excision. The lesion was successfully removed and showed good results with minimal scarring. BCC occurs in 75% of all skin cancers. Elliptical surgical excision on the left cheek was performed after considering the location anatomy, defect size, age, and general condition patient and postoperative cosmetic estimates. The minimal scar that occurs is planned to be performed with a fractional laser. The prognosis is generally good. There is no recurrence until one year later. In conclusion, elliptical surgical excision is an effective standard treatment if performed with a safe margin. In this case, we used 5 mm safe outer margin

The Efficacy of Topical Vitamin C and Microneedling for Photoaging

Background: Photoaging is premature skin aging caused by exposure to ultraviolet (UV) radiation. Vitamin C is an antioxidant that inhibits the tyrosinase enzyme that can reduce pigmentation. Microneedling procedure can improve the penetration of topical vitamin C, and it has skin rejuvenating effects to reduce wrinkles and minimize pore size. Purpose: The main purpose of this study was to evaluate the efficacy of topical vitamin C application after microneedling intervention for the clinical improvement of photoaging. Methods: Twenty-four women with photoaged skin participated in this randomization study, and they were divided into control and intervention groups. Solution of 0.9% NaCl and microneedling were performed to control group, and topical vitamin C and microneedling were performed to intervention group. Three intervention sessions were repeated at a 2 week interval. Signs of photoaging such as pigmentation, wrinkles, and pores were evaluated using Metis DBQ3-1, and the data were obtained numerically. Result: The data analysis revealed a significant improvement in pigmentation in the intervention group compared to control group (p<0.05). Wrinkles and pores evaluation revealed no significant difference between the control and intervention groups. Conclusion: Topical vitamin C after microneedling procedure has provided a significant improvement in pigmentation compared to NaCl 0.9% after microneedling

Long - Term Effects of Topical Amniotic Membrane Stem Cell Metabolite Product (AMSC-MP) and Fractional CO2 Laser in Photoaging

Background: Photoaging causes wrinkles, lentigines, keratoses, dyspigmentation, telangiectasia, decreased elasticity, rough texture, and pale color. Facial wrinkles and mottled skin can negatively affect perceived attractiveness, self-esteem, personality, and level of acceptance. Stem cells are important cells in the skin, and they are the source for continuous regeneration of the epidermis. It can be extracted from many sources, including amnion. Amnion membrane stem cell (AMSC) can be cultured and secretes metabolite product, and it can rejuvenate aging skin. Laser-Assisted Drug Delivery (LADD) involves selective destruction of the layers of the epidermis and dermis to allow penetration and absorption of topical drugs as well as large molecular weight drugs such as stem cells. Purpose: To evaluate the long-term effects of topical administration of AMSC metabolite products (AMSC -MP) and fractional CO2 laser on the clinical improvement of photoaging compared to previous skin conditions. Methods: This was an observational study which was aimed to evaluate the long-term effects of clinical improvement after topical therapy of AMSC-MP and fractional CO2 laser in patients with photoaging. Results: The results of the analysis showed a decrease in wrinkles, dark spots, skin tone, and pores. Conclusion: Based on Janus-II® assessment, there was improvement degrees of wrinkles, dark spots, and pores in patients with photoaging who received fractional CO2laser fractional for 12 weeks. There were no side effects found in this study

Efficacy of 5% Tea Tree Oil Hydrogel on Healing Morbus Hansen's Chronic Plantar Ulcer

Background: The damage of the peripheral nerves that occurs in Morbus Hansen (MH) patients can cause disability due to loss of sensory, motor and autonomic functions can cause wounds, infections, ulcers and disability. Ulcers are the most common cause of disability complications in MH patients and requires a certain time of healing. As many as 10-20% of MH patients experience ulcers on the soles. Tea Tree Oil (TTO) is extracted from steam distillation of the leaves and twigs of the Australian native shrub Melaleuca Alternifolia. In ulcers, TTO can work as an antimicrobial, anti-inflammatory, and antioxidant. TTO preparation in the form of hydrogel is believed to help the wound healing process. Purpose: To investigate the effect of TTO hydrogel 5% on the healing of Chronic Plantar Ulcer of Leprosy (CPUL). Methods: Tea tree oil hydrogel 5% was applied every 3 days for up to 8 weeks in 22 subjects with chronic MH plantar ulcers. Ulcer size, side effects, and possible side effects are evaluated weekly. Result: There were significant clinical and statistical differences in ulcer size (p = 0.000) and in ulcer depth (p = 0.000) after TTO hydrogel 5%. No side effects occurred in this study. The ulcer healed was 59%, the ulcer improved by 36.4%, the persistent ulcer was 4.6%, and there was no ulcer that got worse. Conclusion: TTO hydrogel 5% is effective in the healing process of chronic MH plantar pedis ulcers