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Atypical mycobacterial infection resembles sporotrichosis in elderly patient Siti Nurani Fauziah; Lili Legiawati; Sri Adi Sularsito; Shannaz Nadia Yusharyahya; Rahadi Rihatmadja; Sondang P Sirait; Fifi Mifta Huda; Indah Widyasari
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 2 (2016): June
Publisher : Universitas Indonesia

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Atypical mycobacterial (AM) infection is caused by Mycobacterium species other than M.tuberculosis. AM skin infection has clinical manifestations that resemble M. tuberculosis infection and deep fungal infection. Laboratory workup is necessary to confirm the diagnosis. An 83-year old female came with a painful lump and swelling on her right lower extremity since three months before admission. Physical examination revealed a plaque consisting, of multiple erythematous and hyperpigmented papules and nodules, diffuse erythematous lesion, and shallow ulcers partially covered with pus and crust. Histopathological features showed tuberculoid granuloma. Direct test and periodic acid-Schiff (PAS) staining of the skin biopsy found no fungal element nor acid-fast bacilli (AFB). Culture and polymerase chain reaction (PCR)of M. tuberculosis were negative. The working diagnosis was atypical mycobacterial infection and treatment with 450 mg rifampicin and 100 mg minocycline daily were administered accordingly. In two months observation following the treatment, the pain was no longer exist, the ulcers were completely healed, and some nodules were in the process of healing Among other Mycobacterium spp, M.marinum is the most common cause of AM infrections. Clinical manifestation of M. marinum infection may present as solitary or multiple nodules on the hands, feet, elbows and knees with sporotrichoid spreading patern. The diagnosis of AM was established based on clinical and laboratory examination. The diagnosis was also confirmed by good clinical response to minocycline and rifampicin. Keywords: atypical, mycobacterium, minocycline, rifampicin

Atopic dermatitis in the elderly Yudo Irawan; Rahadi Rihatmadja; Lili Legiawati; Shannaz Nadia Yusharyahya; Sri Adi Sularsito
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 2 (2016): June
Publisher : Universitas Indonesia

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Atopic dermatitis (AD) is a recurrent skin inflammation accompanied by itching. The incidence of AD is increasing worldwide. AD, which persists until elderly or with an onset during elderly, is known as senile AD. It has different prevalence and clinical features from other AD stages. Senile atopic dermatitis affects males more than females, which is different from other stages of AD. Skin manifestation of senile AD is similar with the adult stage of Hanifin-Rajka criteria, but can be atypical. The typical feature of senile AD is eczematous dermatitis around a free-lesion fossa. Other common clinical manifestations are erythroderma and non-specific chronic dermatitis. In the management of senile AD, changes related to aging process should be considered. Management of senile AD is complex, involves combined pharmacological treatment consists of topical and systemic agents, and nonpharmacological aspects. Appropriate treatment considering effectiveness and safety will improve the quality of life of patients with senile AD. Keywords: atopic dermatitis, elderly, clinical feature, senilis, atypical

Narrowband ultraviolet B phototherapy combined with topical treatment for vitiligo in 2 geriatric patients Rinadewi Astriningrum; Lili Legiawati; Vivianne Chandrakesuma; Shannaz Nadia Yusharyahya
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 4, No 2 (2020): June 2020
Publisher : Universitas Indonesia

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Background: Narrowband ultraviolet B (NB-UVB) become the mainstay of widespread vitiligo therapy due to its great efficacy and safety compared with other modalities. The use of NB-UVB for vitiligo has been widely studied in adult patients, while studies on geriatric patients specifically are still very limited. This report aims to show the immediate response after the initial treatment, side effects of therapy, and other problems that were encountered during therapy in two geriatric patients with vitiligo who have been followed up for more than 12 months.Case Illustration: We reported two geriatric patients with vitiligo treated with NB-UVB phototherapy combined with topical treatment for more than 12 months. The first patient was 68-year-old woman, with Fitzpatrick skin type IV, who had vitiligo on her face, both lower arms and hands, and both legs and feet. The second patient was a 61-year-old man with Fitzpatrick skin type IV who had generalized vitiligo. The first repigmentation occurred on the 5th session in the first patient and on the 6th session in the second patient, using a cumulative dose of 1223 mJ/cm2 and 1541 mJ/cm2, respectively.Discussion: After NB-UVB phototherapy, there was a great improvement on the face in both patients, followed by the trunk and legs. However, the duration of treatment needed to achieve homogeneous repigmentation is longer in geriatric patients than in the general population.Conclusion: NB-UVB was well tolerated and showed good clinical response to treat vitiligo in the elderly. However, little is known about the safety and efficacy of phototherapy in elderly patients with vitiligo. Keywords: Geriatric, narrowband, phototherapy, therapy, vitiligo

Atypical mycobacterial infection mimicking carbuncle in an elderly patient: A case report Terlinda Barros; Lili Legiawati; Shannaz Nadia Yusharyahya; Sri Adi Sularsito; Imelda Wihadi
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 1 (2015): August
Publisher : Universitas Indonesia

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Background: Atypical mycobacterium infection occurs under certain skin conditions, namely the disruption of skin integrity and mucous membranes accompanied by the reduction of cellular immunity. However, atypical mycobacterial infection in elderly patients is rarely reported. Case: A 64 years old male patient, complained of red lumps on the upper-backfor a month, accompanied by mild fever and minimal pain. Three months before, the patient had accupuncture on the neck and upper back. Physical examination showed multiple miliar to lenticular sized papules and pustules on an erythematous-violaceus base with hard and immobile palpable nodes and infiltrate. After clinical and laboratory workup, the patient was diagnosed withcarbuncle with Candida spp colonization. The treatment consisted of systemicantibiotics and topical antifungals. There was no clinical improvement after 3 weeks. Histopathology and laboratory results suggested atypical mycobacterium infection. Discussion: Atypical mycobacterium infection should be considered in elderly patients with skin and soft tissue infections that show no clinical improvement tostandard therapy. Keywords: skin and soft tissue infection, atypical mycobacterium, geriatric patients

Efficacy of Topical Estradiol Compared to Topical Glycolic Acid for Skin Aging Treatment in Postmenopausal Women Shannaz Nadia Yusharyahya; Marsha Bianti
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 2, No 2 (2017): December 2017
Publisher : Universitas Indonesia

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Skin aging is a complex biological process in human being, as a result from intrinsic factors (genetic, hormonal, metabolism) and extrinsic factors (UV exposure, pollution, smoking, life style). In postmenopausal women, physiologically, the amount of estrogen are decreased, causing deterioration of their skin’s appearance. Along with the changes that occur, skin care require more attention. A holistic approach can increase epidermal thickness, therefore, reducing the depth of wrinkles, as well as improving skin texture and moisture. There are various treatments available to improve skin appearance due to aging. This EBCR is aimed to compare the efficacy of topical estradiol and topical glycolic acid as skin treatment in postmenopausal women. Articles were searched through Pubmed/MEDLINE, EBSCO, and Cochrane. One randomized-controlled trial by Fuchs KO, et al was obtained and critically appraised. Based on the appraisal, study by Fuchs KO, et al is considered valid, important, and applicable. Both estradiol and glycolic acid show good efficacy and safety for postmenopausal women with signs of skin aging, however estradiol is not considered to have better efficacy than glycolic acid. Keywords: aging, efficacy, postmenopausal, topical estradiol, topical glycolic acid

Case series of primary psychiatric skin disorders with multi-disciplinary approach Lusiana Lusiana; Rizky Lendl Prayogo; Shannaz Nadia Yusharyahya; Irma Bernadette S. Sitohang; Kusmarinah Bramono
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 4, No 2 (2020): June 2020
Publisher : Universitas Indonesia

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Background: The incidence of psychodermatologic diseases, a group of skin abnormalities associated with psychosomatic factor, are increasing recently. About 20-40% patients with skin symptoms have concurrent psychiatric problems which are often difficult to diagnose and treat. The new classification of primary psychiatric skin disorders are delusional disorders, obsessive-compulsive and related disorders, and factitious disorders. This classification could be used for effective treatment in each patient which involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Illustration: The first case was a 39-year-old unmarried female, with anemia and dermatitis artefacta occurred as wound due to blade cuts. Patient was with schizoaffective depressive type and was not under regular treatment. The second case was a 61-year-old male referred with unresolved prurigo nodularis for the past 30 years. After in-depth assessment, there were delusional parasitosis and neurotic excoriations disorders. The third patient was a 50-year-old female admitted with recurrent ulcer on her face. She was aware that the lesions were intentionally manipulated by her own fingers when she was depressed. Discussion: All patients were classified as primary psychiatric skin disorders with varied skin manifestations. Symptoms usually occurred when the patient was in the depression state or low compliance for the psychotropic drugs. Patients generally had poor insight and refused to be associated with psychiatric factors. Dermato-venereologists are expected to conduct early detection and treat this disease. Conclusion: It is important to approach psychocutaneous disease in multi-disciplinary manner, especially with the psychiatrist. Keywords: psychodermatologic, dermatitis artefacta, neurotic excoriations, delusion of parasitosis

Vaginal microbiota in menopause Martinus Tarina; Larisa Paramitha; Evita Halim Effendi; Shannaz Nadia Yusharyahya; Hanny Nilasari; Wresti Indriatmi
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 1, No 3 (2016): December
Publisher : Universitas Indonesia

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The human vagina together with its resident, microbiota, comprise a dynamic ecosystem. Normal microbiota is dominated by Lactobacillus species, and pathogen microbiota such as Gardnerella species and Bacteroides species can occur due to decrease in Lactobacillus domination. Lactobacillus plays an essential role in keeping normal vaginal microbiota in balance. Vaginal microbiota adapts to pH change and hormonal value. Changes in the vaginal microbiota over a woman’s lifespan will influence the colonization of pathogenic microbes. They include changes in child, puberty, reproductive state, menopause, and postmenopause. Estrogen levels change will affect the colonization of pathogenic microbium, leading to genitourinary syndrome of menopause. Vulvovaginal atrophy is often found in postmenopausal women, and dominated by L. iners, Anaerococcus sp, Peptoniphilus sp, Prevotella sp, and Streptococcus sp. The normal vaginal microbiota’s imbalance in menopause will cause diseases such as bacterial vaginosis, and recurrent vulvovaginal candidiasis due to hormonal therapies. Changes in the vaginal microbiota due to bacterial vaginosis are characterized by decrease in H2O2-producing Lactobacillus. They are also caused by the increase in numbers and concentration of Gardnerella vaginalis, Mycoplasma hominis, and other anaerob species such as Peptostreptococci, Prevotella spp, and Mobiluncus spp. Keywords: vagina, microbiota, menopause, Lactobacillus, bacterial vaginosis

Venous Ulcer Irene Dorthy Santoso; Hanny Nilasari; Shannaz Nadia Yusharyahya
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 2, No 2 (2017): December 2017
Publisher : Universitas Indonesia

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Leg ulcers one common problem in the adult population to geriatric with a prevalence about 1-2%. The pattern of life which tends to be sedentary, less activity, obesity, increased the incidence of leg ulcers. The duration of healing and recurrence occurs in majority of patients contributed the decline in quality of life for patients with venous ulcers. Diagnosis, latest treatment and prevention are essential to discuss. Keywords: venous ulcer, geriatric, diagnosis, management, prevention

Atypical mycobacterial infection mimicking carbuncle in an elderly patient: A case report Barros, Terlinda; Legiawati, Lili; Yusharyahya, Shannaz Nadia; Sularsito, Sri Adi; Wihadi, Imelda
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 1
Publisher : UI Scholars Hub

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Background: Atypical mycobacterium infection occurs under certain skin conditions, namely the disruption of skin integrity and mucous membranes accompanied by the reduction of cellular immunity. However, atypical mycobacterial infection in elderly patients is rarely reported. Case: A 64 years old male patient, complained of red lumps on the upper-backfor a month, accompanied by mild fever and minimal pain. Three months before, the patient had accupuncture on the neck and upper back. Physical examination showed multiple miliar to lenticular sized papules and pustules on an erythematous-violaceus base with hard and immobile palpable nodes and infiltrate. After clinical and laboratory workup, the patient was diagnosed withcarbuncle with Candida spp colonization. The treatment consisted of systemicantibiotics and topical antifungals. There was no clinical improvement after 3 weeks. Histopathology and laboratory results suggested atypical mycobacterium infection. Discussion: Atypical mycobacterium infection should be considered in elderly patients with skin and soft tissue infections that show no clinical improvement tostandard therapy.

Atopic dermatitis in the elderly Irawan, Yudo; Rihatmadja, Rahadi; Legiawati, Lili; Yusharyahya, Shannaz Nadia; Sularsito, Sri Adi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
Publisher : UI Scholars Hub

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Atopic dermatitis (AD) is a recurrent skin inflammation accompanied by itching. The incidence of AD is increasing worldwide. AD, which persists until elderly or with an onset during elderly, is known as senile AD. It has different prevalence and clinical features from other AD stages. Senile atopic dermatitis affects males more than females, which is different from other stages of AD. Skin manifestation of senile AD is similar with the adult stage of Hanifin-Rajka criteria, but can be atypical. The typical feature of senile AD is eczematous dermatitis around a free-lesion fossa. Other common clinical manifestations are erythroderma and non- specific chronic dermatitis. In the management of senile AD, changes related to aging process should be considered. Management of senile AD is complex, involves combined pharmacological treatment consists of topical and systemic agents, and non pharmacological aspects. Appropriate treatment considering effectiveness and safety will improve the quality of life of patients with senile AD.

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