Human Papillomavirus High-risk Type Infection on Perianal Giant Condyloma Acuminatum

Background: Giant condyloma acuminatum (GCA) is a large form of condyloma acuminatum that become locally invasive, destructive, but non-metastasizing, caused by human papillomavirus (HPV). Giant condyloma is a rare disease, with only 0.1% incidence in the general population. Most commonly caused by HPV type 6 and 11 infections, in this case, reported HPV high-risk type. Case presentation: A 20-years-old man, the main complaint is enlarging, easy bleeding perianal tumor with pruritus and constipation for 2 months. Physical examination found skin-colored, verrucous surface. Some have smooth surface, cauliflower-like tumor on perianal region, size 7x4x2cm. Syphilis and HIV Serology laboratory tests are non-reactive. Koilocytes appear on histopathologic examination. High-risk HPV type detected on HPV genotyping. This patient was diagnosed as GCA. Topical agent 25% podophyllin tincture applied to the lesions once a week. Improvement appears after eighth-time therapy. Discussion: High-risk type HPV infection, detected in the patient, have an important role in GCA development. Decreased immune system and other risk factors also have a role in GCA

The Role of Topical Vitamin D in Vitiligo: A Narrative Literature Review

Vitamin D plays a role in the process of melanogenesis, namely increasing L-Dopa cells, inducing differentiation of immature melanocytes, and increasing melanocyte activity. The use of vitamin D in dermatology is in the treatment of vitiligo, psoriasis vulgaris, atopic dermatitis, verruca vulgaris, and alopecia. Vitiligo is an autoimmune disease of the skin in the form of depigmentation due to the destruction of melanocytes by T cells. The clinical manifestations of vitiligo are white macular lesions and no scale, asymptomatic, and symmetrical. Vitiligo can affect the patient's quality of life, so accurate therapy is needed. Standard therapy in vitiligo needs further research to find accurate therapy with minimal side effects. Topical vitamin D is a vitiligo therapy with minimal side effects. Several types of topical vitamin D with therapeutic effects in the field of dermatology are calcipotriol, calcitriol, tacalcitol, maxacalcitol, and hexafluoro-1,25 dihydroxyvitamin D3 with various dosages and preparations. The role of vitamin D in melanogenesis and immunomodulators as monotherapy or in combination with topical corticosteroids has been shown to be effective in the treatment of vitiligo. This literature review was on the role of topical vitamin D in the treatment of vitiligo

Efficacy of Calcipotriol 0.005% Ointment for Uremic Xerosis with Pruritus in Chronic Kidney Diseases Undergoing Hemodialysis Patients: Randomized Double Blind Clinical Trial

Introduction: Uremic xerosis with pruritus (UXP) is a chronic cutaneous complication among patients undergoing maintenance renal dialysis. Uremic xerosis level is directly related with pruritus severity or vice versa. Uremic xerosis with pruritus may lead to discomfort and negative psychological effect. The ethiopathogenesis still unknown, Most of treatments are empirical, and there is no effective and safe therapy. Emollient has not been effective enough to improve quality of life. There is some report about efficacy of topical vitamin D in xerosis and chronic pruritus. Objective: We evaluate the efficacy of calcipotriol 0.005% ointment for uremic xerosis and uremic pruritus in chronic kidney disease patients undergoing hemodialysis. Material & methode: Sixty two patients with UXP were enrolled, randomized double blind study. Patients were divided to two group, calcipotriol 0.005% ointment group or placebo. In baseline, patients were instructed to apply twice daily for four weeks. We assesesment the efficacy and safety of calcipotriol 0.005% ointment and placebo after 2nd and 4th weeks treatment using overall dry skin score (ODSS), visual analog scale (VAS), corneometer and sebumeter. We also assessed adverse effect and tolerance this drugs using visual assessment scale. Results: Overall dry skin score (ODSS) and visual analog scale (VAS) significantly decreased in calcipotriol 0.005% ointment group than in placebo group (p <0.05). Skin hydration level based on Corneometer score and skin surface lipid based on Sebumeter score was significantly increased in calcipotriol 0.005% ointment group than in placebo group (p <0.05). Cure rate and clinical improvement for calcipotriol 0.005% ointment group was significantly higher than placebo group. There was no adverse effect between two groups after treatment. Conclusion: calcipotriol 0.005% ointment is effective than placebo and can be used as alternative or adjuctive treatment and safe and tolerance for UXP

Latent Syphilis Unresponsive to Doxycycline and Azithromycin

Background. Syphilis management is based on the syphilis stage classification. The main treatment for syphilis is currently benzathine penicillin. However, patients allergic to penicillin antibiotics or who are not willing to be injected can be given doxycycline or erythromycin antibiotics. Case presentation. We present a case of a female with latent syphilis. Patient was previously treated with oral antibiotics, such as doxycycline for 30 days and followed by azithromycin for 30 consecutive days. Clinical laboratory examinations show increase of TPHA and VDRL, and the case was considered as unresponsive case. Later, the patients received benzathine penicillin G for three weeks and showed clinical improvement. Conclusion. For patient who refuse to be treated with penicillin injection, the alternative treatments are oral antibiotics. However, there is a reduced number of successful treatments for patients treated with oral antibiotics

Laboratory Examination of Syphilis

Syphilis, is sexually transmitted disease caused by spirochete Treponema pallidum subsp.pallidum. It have many diverse clinical manifestations that occur in distinct stages. Early diagnosis and management are the main things to prevent transmission and complication. Direct test or morphological observation is the definitive diagnosis of syphilis. This can be done through animal inoculation test, dark field microscopy, direct fluorescence antibody (DFA), and nucleid acid amplification test (NAAT). While the indirect test is a nontreponemal serologic test consist of Wasserman test, venereal disease research laboratory (VDRL), toluidine red unheated serum test (TRUST), unheated serum reagin (USR), rapid plasma reagin (RPR) and treponemal serologic test, such as T. pallidum passive particle agglutination (TPPA), T. pallidum haemagglutination assay (TPHA), fluorescent treponemal antibody absorption (FTA-Abs), enzyme immunoassay (EIA) and rapid test. The algorithm of serologic test can be divided into traditional or reverse