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All Journal Berkala Ilmu Kesehatan Kulit dan Kelamin Indian Journal of Forensic Medicine & Toxicology MEDICINUS
Wibisono Nugraha
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Hemorrhagic Varicella in a 41-Year-Old Woman with Evans Syndrome : Case Report Alfina Rahma; Eka Devinta Novi Diana; Frieda; Wibisono Nugraha; Muhammad Eko Irawanto; Moerbono Mochtar
Indian Journal of Forensic Medicine & Toxicology Vol. 16 No. 1 (2022): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v16i1.17445

Abstract

Background: Varicella is an infection caused by the varicella-zoster virus (VZV) with symptomsof an exanthematous vesicular rash and systemic symptoms. Hemorrhagic varicella commonlyseen in immunocompromised patients. Evans syndrome (ES) is an autoimmune with two or morecytopenias,including autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP).Case: 41-year-old woman complains of swelling filled with reddish fluid almost all over herbody,sometimes painful and accompanied by fever. Patient also experienced vaginal bleeding resultingin anemia (Hb 8.8 g/DL) and thrombocytopenia (platelets 34,000/uL). Dermatological status of thegeneralized,multiple hemorrhagic vesicles with an erythematous base,partially ruptured. Tzank testrevealed multinucleated giant cells. Patient suffered AIHA and received therapy with methylprednisolone4 mg/day and mycophenolic acid 2x500 mg/day.Conclusion: We report a case of hemorrhagic varicella in a 41-year-old woman with Evan’s syndromewith concurrent features of AIHA and ITP. Dermatological status of the generalized, multiplehemorrhagic vesicles with an erythematous base,some of ruptured with erosions. Tzank test revealedmultinucleated giant cells. Patient was treated with acyclovir 5x800 mg for 7 days,2% salicylic acid and0.5% menthol applied every 12 hours and mupirocin 2% ointment applied twice a day on the erosionarea and clinical improvement was found after 17 days of therapy.
Secondary Syphilis in the Second Trimester Pregnancy : Case Report Wibisono Nugraha; Eka Devinta Novi Diana; Frieda; Alfina Rahma; Prasetyadi Mawardi
Indian Journal of Forensic Medicine & Toxicology Vol. 16 No. 1 (2022): Indian Journal of Forensic Medicine & Toxicology
Publisher : Institute of Medico-legal Publications Pvt Ltd

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37506/ijfmt.v16i1.17670

Abstract

Background: Syphilis is a sexually transmitted disease caused by Treponema pallidum, which is transmitted through sexual contact, blood transfusion and transplacental from an infected mother to the fetus. Syphilis in pregnancy can cause complications including abortion, low birth weight, premature birth, neonatal death or congenital syphilis infection.Case: A 39-year-old woman, 16 weeks pregnant, presented with a complaint of a small lump on the genitals accompanied by red patches on the palms of the hands and feet. Serological tests showed a reactive VDRL of 1:512 and a reactive TPHA of 1:640. Based on the history, physical examination and serological tests the patient was diagnosed with secondary syphilis in pregnancy. The management of this patient was given a single dose of Benzathine Penicillin G injection of 2.4 million units intramuscularly.Conclusion: Early screening for syphilis in pregnancy isvery important to prevent complications in the fetus. VDRL serological test examination 3 months after therapy was carried out to determine the success of therapy. In this case, there was a decrease in the VDRL titer to 1:4 in the absence of skin lesions 3 months after therapy with benzathine penicillin G 2.4 million units intramuscularly single dose.
The Association of Keloid Site with its Histopathological Features: an Analytical Observational Study Wibisono Nugraha; Muhammad Eko Irawanto; Moerbono Mochtar; Nur Rachmat Mulianto; Novan Adi Setyawan; Nugrohoaji Dharmawan
Berkala Ilmu Kesehatan Kulit dan Kelamin Vol. 36 No. 1 (2024): APRIL
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bikk.V36.1.2024.47-52

Abstract

Background: Keloid is a growth of fibrous tissue in the wound tissue of susceptible individuals. This tissue extends beyond the boundaries of the previous wound. The site of keloids commonly appears on a high-tension area, such as the chest, shoulders, and neck. Histopathologically keloids show thickened the epidermis and the vascularization and infiltration of inflammatory cells in the dermis. Purpose: This study aims to determine the relationship between the site of keloids and the histopathological appearance of keloids. Methods: An analytical observational study was conducted on keloid patients visiting the Dermatovenereology outpatient clinic of Dr.Moewardi Hospital. The sample collection used consecutive sampling techniques Result: The majority of keloid patients are >30 years old (46.4%). Most patients with keloids were female (53.6%). Keloids were mostly found on the chest (25.0%). Tounge-like appearance of the epidermis at the edges of the lesions was mostly on the shoulders and chest (33.3% each, p=0.048); flattened appearance was found on the middle epidermis of the lesions, which were mostly on the ears, shoulders, and upper extremities (22.7% each, p=0.011). Increased vascularity was found in the dermis at the edges of the lesions, especially in the ear and chest areas (31.3% each, p=0.046). Moderate-severe inflammatory infiltrates in the dermis at the edges of the lesions were commonly found on the chest (p=0.04). Conclusion: There is a significant relationship between the site of the lesion and the histopathological appearance of the keloid in epidermal as well as dermal layers.
Korelasi Kadar Serum Nitric Oxide (NO) dengan Tipe dan Derajat Keparahan Psoriasis Fiska Rosita; Bobby Febrianto; Ambar Aliwardani; Putti Fatiharani; Wibisono Nugraha; Muhammad Eko Irawanto; Nurrachmat Mulianto
MEDICINUS Vol. 34 No. 2 (2021): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (103.767 KB) | DOI: 10.56951/medicinus.v34i2.61

Abstract

Psoriasis is a chronic, immune-mediated disorder that results from a polygenic predisposition. Nitric oxide (NO) has been considered as important factors in the pathogenesis of psoriasis. This study aims to determine the correlation of serum NO levels with the type and severity of psoriasis. This cross-sectional study was conducted from May to September 2018. Difference in the average of serum NO levels in psoriasis patients with control groups is analyzed using t-test. The Spearman correlation test was used to see the correlation of serum NO levels with type and severity of psoriasis measured by Psoriasis Area and Severity Index (PASI) score. There was significant difference between serum NO level in the control group compared to the group of psoriasis patients (p=0.037). Patient with generalized pustular psoriasis has the highest mean of NO level (59.07 µmol/L). There was no significant correlation between serum NO level with type (r=0.008, p=0.9710 and severity (r=0.157, p=0.486) of psoriasis. Nitric oxide levels are elevated in psoriasis patients, which indicate that oxidative stress plays an important role in the etiopathogenesis of psoriasis.
Prosedur Pembedahan pada Hiperhidrosis Aksilaris dengan Teknik Tumesen Liposuction-Curettage Danu Yuliarto; Wibisono Nugraha; Moerbono Mochtar; Ammarilis Murastami
MEDICINUS Vol. 35 No. 1 (2022): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (179.739 KB) | DOI: 10.56951/medicinus.v35i1.86

Abstract

Hyperhidrosis is an excessive sweat production due to autonomic nerve dysfunction that occurs in areas with higher concentration of eccrine gland such as palms, soles of the feet, and axilla. Management of hyperhidrosis includes pharmacological and nonpharmacological approach. Patients with severe focal hyperhidrosis should consider surgical treatment or botulinum toxin injection. Tumescent liposuction with curettage is one of surgical technique option for the treatment of axillary hyperhidrosis. Case: A 32-year-old woman with complaint of excessive sweating, especially in the axillary area. The patient had received oral therapy from a dermatologist prior, but there was no improvement, so the patient was advised to undergo a surgical procedure. In this patient the tumescent liposuction-curettage procedure was performed. Discussion: Treatment of hyperhidrosis with both topical and systemic agents generally provides only temporary suppression of hyperhidrosis. In severe, disturbing cases, the treatment of choice for axillary hyperhidrosis is the surgical procedure. Combination of liposuction-curettage surgical method using tumescent anesthesia is relatively simple and safe. Reduction of apocrine gland secretion after liposuction-curettage takes a relatively long time. This surgical technique has many advantages, such as relatively minimal injury dan short recovery period. Follow-up after this combined liposuction-curettage procedure should be performed subjectively and objectively at 3, 6, and 12 months postoperative.
Tinjauan Histopatologi pada Pyoderma Gangrenosum dengan Infeksi Sekunder Wibisono Nugraha; Danu Yuliarto; Eka Devinta Novi Diana; Alfina Rahma; Prasetyadi Mawardi; Frieda; Ambar Mudigdo
MEDICINUS Vol. 36 No. 2 (2023): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/medicinus.v36i2.123

Abstract

Background: Pyoderma gangrenosum (PG) is a complex neutrophilic dermatosis, characterized by sterile, painful, necrotic ulcer, and is associated with systemic conditions. PG manifests as papules and vesicles that evolve into painful ulcers. Incidence of PG is relatively rare in Dr. Moewardi Hospital, so it is important to identify and correctly diagnose PG based on its’ histopathological features. Case A 54-year-old man complained of painful scab on several body parts. Hematoxylin and eosin staining in the epidermal layer showed a basket-weave orthokeratosis with necrotic tissue, acanthosis, and basal cell hypermelanosis. In the dermis layer there is a lymphocyte and neutrophil cell infiltrate with slight appearance of leukocytoclastic. Discussion: Pyoderma gangrenosum is a reactive, non-infectious inflammatory dermatosis (neutrophilic dermatoses). In this case, PG occurs in 54-year-old man as painful scab on back and legs. Classical PG characterized by papules, pustules, crusted or necrotic plaque, which typically have undermined, overhanging, dusky purple edges with surrounding induration and erythema. In this patient, the epidermal layer showed ulceration and slight appearance of leukocytoclastic vasculitis in the dermis area and lymphocyte infiltrate with slight neutrophil in the perivascular accompanied by erythrocyte extravasation, which support the diagnosis of PG.
Fototerapi pada Dermatologi Anak Wibisono Nugraha; Endra Yustin Ellistasari
MEDICINUS Vol. 36 No. 3 (2023): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/b5jqva33

Abstract

Phototherapy is a non-ionizing ultraviolet (UV) radiation therapy used as a treatment for several medical conditions. The mechanism of action of phototherapy is to act as antiproliferative, induce apoptotic, and provide immunosuppressive effect. Several therapeutic modalities that can be used as alternative therapy in children include NB-UVB, BB-UVB, ultraviolet A, PUVA, and excimer laser. Phototherapy in children is indicated especially in diseases such as psoriasis, atopic dermatitis, vitiligo, pityriasis lichenoides, and mycoses fungoides. The use of phototherapy has indications, contraindications, dose, and side effects that should be considered when choosing appropriate phototherapy in children. Common side effects are erythema, xerosis, burning sensation, and itching. Several groups of patients with refractory complaints are advised to use additional phototherapy modalities, either as monotherapy or in combination with topical and systemic therapy.
Co-Authors Alfina Rahma Ambar Aliwardani Ambar Mudigdo Ammarilis Murastami Bobby Febrianto Danu Yuliarto Dharmawan, Nugrohoaji Eka Devinta Novi Diana Endra Yustin Ellistasari Fiska Rosita Frieda Moerbono Mochtar Muhammad Eko Irawanto Novan Adi Setyawan Nur Rachmat Mulianto Nurrachmat Mulianto Prasetyadi Mawardi Putti Fatiharani