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All Journal Medical Journal of Indonesia Media Dermato-Venereologica Indonesiana Journal of General-Procedural Dermatology & Venereology Indonesia Jurnal Kedokteran Meditek
Windy Keumala Budianti
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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TORCH Re-activation Concomitant with Drug-induced Hypersensitivity Syndrome Shows Erythema Multiforme-like and Vasculitis Clinical Features Budianti, Windy Keumala; Rihatmadja, Rahadi; Aulia, Izzah; Effendy, Isaak
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 6, No. 2
Publisher : UI Scholars Hub

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Background: Drug-induced hypersensitivity syndrome (DIHS) can be associated with cytomegalovirus (CMV) infection, besides induced by drugs. We report a case of DIHS with prolonged atypical clinical features and vasculitis precipitated by drug allergy, CMV, and other viral infections. Case illustration: A 54-year-old female presented with generalized follicular erythematous papules and waxy palmoplantar keratoderma since one month before admission. The symptoms started as a purpuric lesion on the upper extremities, spreading as erythematous papules on the trunk with facial edema, accompanied by fever and chronic cough. She had been previously treated with ambroxol and cephalosporin. Cutaneous drug allergy reaction was assessed. Although in therapy with systemic corticosteroids, lesions still appeared and became confluent, with new palpable purpura on the extremities. Histopathology showed interface dermatitis, consisting of lymphocytes and plasma cells but lacking eosinophils, leukocytoclastic vasculitis, and numerous dyskeratotic keratinocytes. The possibility of systemic infection was sought, and TORCH examination suggested acute and latent infection. The patient had a positive PCR for CMV. Intravenous ganciclovir 500 mg/day for three weeks and a low dose of systemic corticosteroids led to complete cessation of skin and pulmonary symptoms. Discussion: The clinical and histopathological examination was consistent with erythema multiforme. Therefore, high titer of IgM and IgG anti-CMV, and excellent response to ganciclovir supported our suspicion of an infection-induced process. The infection might be precipitated by a drug allergy. Conclusion: CMV-associated skin lesion could be precipitated by drug hypersensitivity, resulting in erythema multiforme-like clinical features with vasculitis. Severe systemic involvement related to CMV reactivation. Early anti-CMV therapy showed good improvement and reduce risk of mortality.
Systemic contact dermatitis due to nickel Olivia, Taruli; Budianti, Windy Keumala; Agustina, Fitria
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 1
Publisher : UI Scholars Hub

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Introduction: Systemic contact dermatitis (SCD) is a systemic reactivation of a previous allergic contact dermatitis. The initial exposure may usually be topical, followed by oral, intravenous or inhalation exposure leading to a systemic hypersensitivity reaction. A case of a 27 year-old male with SCD due to nickel is reported Case Report: A 27 year-old male presented with recurrent pruritic eruption consist of deep seated vesicles on both palmar and left plantar since 6 months before admission. This complaint began after patient consumed excessive amounts of chocolate, canned food, and beans. The patient worked as a technician in a food factory. History of allergy due to nickel was acknowledged since childhood. The clinical presentation was diffuse deep seated vesicles, and multiple erythematous macules to plaques, with collarette scale. Patch test using the European standard showed a +3 result to nickel. The patient was diagnosed as systemic contact dermatitis due to nickel. The treatments were topical corticosteroid and patient education of avoidance of both contact and systemic exposure to nickel. The patient showed clinical improvement after 2 weeks. Discussion: SCD was diagnosed due to the history of massive consumption of food containing nickel in a patient who had initial sensitization to nickel, with clinical features and the patch test result. Advice to be aware of nickel and its avoidance is important in SCD management.
Non-standard patch test Adelia, Astri; Budianti, Windy Keumala; Marissa, Melani; Effendi, Evita Halim
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 2, No. 3
Publisher : UI Scholars Hub

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In managing contact dermatitis, identification of the causative agent is essential to prevent recurrent complaints. Patch test is the gold standard to identify the causative agent. Nowadays, there are many patch test standard materials available in the market, but do not include all the materials that potentially cause contact dermatitis. Patch test using patient’s own products or later we refer to as non-standard materials, is very helpful in identifying the causative agents of contact dermatitis. Guidance is needed in producing non-standard patch test materials in order to avoid test results discrepancy.
Clinical characteristics and treatment regimen of pemphigus patients: A retrospective study Budianti, Windy Keumala; Fitri, Eyleny Meisyah; Meilinda, Puti Rineska; Novianto, Endi; Anindya, Shafira; Debinta, Arlha Aporia
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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Background: Pemphigus is a potentially life-threatening autoimmune bullous disease. In pemphigus, the therapeutic options are based on the clinical characteristics of each patient. However, other than corticosteroids, most therapeutic options for pemphigus are currently limited. Steroid-sparing agents might be considered since the initiation of therapy to prevent the side effects of corticosteroid. The objective of this study is to identify the clinical characteristics and therapy of choice in patients with pemphigus at Dr. Cipto Mangunkusumo General Hospital. Method: All cases of pemphigus from 2016 to 2018 at Dermato-Allergo-Immunology Clinic, Department of Dermatology and Venerology Dr. Cipto Mangunkusumo General Hospital were included in this study. Data were collected from medical records, including patient’s demographics, clinical data, and therapy. Data were analyzed using SPSS 20. Results: There were 24 new pemphigus cases from 2016 to 2018. Female to male ratio was 3.8:1 with median age of onset of 37.5 (16-73)years old. Pemphigus vulgaris was the most common subtype of pemphigus (75%), followed by pemphigus foliaceus. Number of patients with oropharyngeal mucosal involvement was found higher in pemphigus vulgaris compared to pemphigus foliaceus (p=0.012). Systemic steroid was given in 86.9% patients while the rest were treated with topical corticosteroid only. Steroid-sparing agents were given in 58.3% patients. Remission was achieved in 42.3% cases in average 5 (2-28) months. Conclusion: Pemphigus vulgaris is the most common subtype of pemphigus and corticosteroid remains to be its treatment of choice. The steroid-sparing agents most commonly used in this study are mycophenolate mofetil and azathioprine.
Low-calorie diet improves PASI score in psoriasis patients with obesity: An evidence-based case report Kuniawan, Kristian; Fahira, Alessa; Ramadan, Edwin Ti; Budianti, Windy Keumala
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 3
Publisher : UI Scholars Hub

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Background: The association between psoriasis and metabolic syndrome is appealing as the two may share a similar cross-linking systemic inflammation process. The inflammation processes occurring in obesity and psoriasis may aggravate one another. This raised the question of whether a low-calorie diet would possibly reverse the aforementioned process. This study aims to determine whether calorie restriction reduces psoriasis area and severity index (PASI) in obese patients with moderate-to-severe psoriasis receiving conventional treatment compared to no calorie restriction.Methods: We searched Pubmed/Pubmed Central, ScienceDirect, Cochrane library, EBSCOhost, and Scopus databases using keywords derived from our clinical question. The inclusion criteria were randomized clinical trial (RCT) or systematic review, published in English, and available in full-text.Results: We obtained 2 systematic reviews with meta-analyses by Ko et al. and Upala et al. Ko et al. included 6 RCTs which found that the inclusion of a low-calorie diet shows significant improvement in PASI 75 compared to standard therapy (RR 1.66; 95%CI 1.07, 2.58). Upala et al. also found significant improvement in PASI 75 in a meta-analysis of 7 RCTs (Pooled OR 2.92; 95%CI 1.39, 6.13), but shows moderately high heterogeneity between studies. Other secondary outcomes have also shown significant improvements, such as quality of life and metabolic parameters.Conclusion: The intervention of a low-calorie diet may significantly reduce PASI, improve quality of life and reduce comorbidities in obese patients with moderate-to-severe psoriasis, and thus can be recommended in psoriasis management.
Non-pustular annular psoriasis with signs of high disease activity Yasnova, Nevi; Budianti, Windy Keumala; Andardewi, Melody Febriana
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 6, No. 2
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Background: Non-pustular annular psoriasis is a rare condition in which a type of plaque psoriasis appears with ring-like lesions and a clearer central appearance. The disease activities in psoriasis may be evaluated clinically. It is essential to provide a more meaningful approach to treatment management. Case illustration: A 33-year-old woman complained of a one-year history of multiple erythematous, scaly, and annular plaques with central clearing. Some lesions were surrounded by discrete pinpoint papules on several parts of her body. The lesions worsened during seven weeks of topical and systemic therapy. Discussion: Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. High disease activity or unstable psoriasis was defined as recent exacerbations showing pinpoint papules developing around established and erythematous borders of the lesions. The active severe disease may present with systemic involvement due to the production of pro-inflammatory chemokines and cytokines in the skin lesions and circulation. Conclusion: A complete clinical history and physical examination can help the clinician diagnose non- pustular annular psoriasis. Several factors may cause worsening disease activity in a patient with psoriasis. Distinguishing between stable and unstable plaque psoriasis is essential to obtain information on psoriasis pathomechanism related to systemic involvement and managing therapeutic strategies. A multidisciplinary approach must be conducted in the management of a patient with high disease activity.
Perkembangan Terapi Sistemik Pada Pruritus Melody Febriana Andardewi; Windy Keumala Budianti; Lili Legiawati; Yudo Irawan
Jurnal Kedokteran Meditek Vol 28 No 1 (2022): JANUARI-APRIL
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v28i1.2203

Abstract

Pruritus merupakan sensasi tidak nyaman yang mencetuskan keinginan untuk menggaruk. Sensasi tersebut disebabkan oleh berbagai hal, misalnya penyakit kulit, penyakit sistemik, atau idiopatik, gangguan psikiatri, serta penyakit neurologis. Pruritus menjadi masalah kesehatan karena dapat memberi dampak negatif terhadap kualitas hidup pasien. Pendekatan tata laksana pruritus diberikan secara bertingkat mulai dari terapi dasar, terapi target, dan terapi simtomatik. Pada kasus pruritus kronik yang refrakter maupun pruritus tanpa sebab yang diketahui, terapi simtomatik berperan besar dan dapat diberikan pada pasien tersebut. Tata laksana pada pruritus kronik saat ini banyak diteliti seiring dengan ditemukan berbagai mekanisme yang mendasari terjadinya pruritus. Sesuai dengan patofisiologi dari pruritus, terapi sistemik yang dikembangkan menargetkan pada reseptor spesifik di sistem saraf dan sistem imunitas yang berperan pada jalur sinyal pruritus. Berbagai terapi terbaru yang masih diteliti dalam uji klinis menunjukkan hasil yang menjanjikan dan berpotensi menjadi pilihan terapi pada pasien dengan pruritus kronik.
Faktor Risiko Prediktor Bakteremia pada Pasien Nekrolisis Epidermal Evidence Based Case Report Shafira Anindya; Parikesit Muhammad; Windy Keumala Budianti
Jurnal Kedokteran Meditek Vol 28 No 1 (2022): JANUARI-APRIL
Publisher : Fakultas Kedokteran Universitas Kristen Krida Wacana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36452/jkdoktmeditek.v28i1.2240

Abstract

Nekrolisis epidermal (NE) yang terbagi atas Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan reaksi simpang obat berat dengan mortalitas tinggi. Penyebab kematian terbanyak pada NE adalah sepsis, namun gejala sepsis tidak spesifik pada NE dan hasil kultur darah membutuhkan waktu lama. Oleh karena itu penting mengetahui prediktor yang berpengaruh terhadap peningkatan risiko bakteremia pada pasien dengan NE. Evidence-based case report ini bertujuan mengetahui faktor prediktor terjadinya bakteremia pada pasien NE berdasarkan literatur. Pencarian artikel menggunakan basis data PubMed, Cochrane, dan Scopus yang relevan dengan pertanyaan klinis untuk kemudian ditelaah. Didapatkan dua artikel kohort yang sesuai. Studi Koh dkk. mendapatkan tiga prediktor yang berpengaruh terhadap kejadian bakteremia pada pasien NE; yaitu hemoglobin ≤ 10 g/dL (odds ratio [OR] 2,4; interval kepercayaan [IK] 95% 2,2-2,6), luas epidermolisis ≥ 10% (OR 14,3; IK 95% 13,4-15,2) dan penyakit komorbid kardiovaskular (OR 2,1; IK 95% 2,0-2,3). Studi De Prost dkk. mendapatkan tiga prediktor yaitu usia > 40 tahun (hazard ratio [HR] 2,5; IK 95% 1,35-4,63), leukosit > 10.000/mm3 (HR 1,9; IK 95% 0,96-3,61), serta LPB ≥ 30% (HR 2,5; IK 95% 1,13-5,47). Epidermolisis yang lebih luas merupakan faktor prediktor terjadinya bakteremia pada NE di kedua studi. Faktor risiko lainnya memerlukan penelitian lebih lanjut.
TATA LAKSANA TERKINI PENYAKIT SINDROM STEVENS-JOHNSON (SSJ)/ NEKROLISIS EPIDERMAL TOKSIK (NET) Dina Kusumawardhani; Eyleny Meisyah Fitri; Windy Keumala Budianti; Endi Novianto; Evita Halim Effendi
Media Dermato-Venereologica Indonesiana Vol 50 No 1 (2023): Media Dermato-Venereologica Indonesiana
Publisher : Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33820/mdvi.v50i1.291

Abstract

Sindrom Stevens-Johnson (SSJ) dan nekrolisis epidermal toksik (NET) merupakan penyakit yang mengancam nyawa, ditandai oleh adanya ruam dan lepuh yang nyeri, disertai lepasnya lapisan epidermis, atau ulkus pada mukosa mulut, mata, dan genital. SSJ/NET merupakan spektrum terberat dari reaksi efek simpang obat yang dimediasi imun, terutama oleh sel T, dan termasuk reaksi hipersensitivitas tipe IVc. SSJ dan NET adalah penyakit yang sama, dibedakan berdasarkan persentase permukaan kulit yang terlibat yaitu SSJ (<10%), SSJ/NET overlap (10%-30%), dan NET (>30%). SSJ/NET sering disertai keterlibatan multiorgan dengan rerata mortalitas 1-5% pada SSJ dan 25-35% pada NET. Tata laksana optimal SSJ/NET meliputi diagnosis dini, identifikasi dan penghentian obat tersangka, mempertimbangkan kemungkinan adanya infeksi sebagai pencetus, serta terapi suportif sedini mungkin. Terapi suportif yang dilakukan oleh tim multidisipilin merupakan tata laksana utama. Terapi suportif yang baik terbukti dapat memperbaiki kondisi klinis pasien. Rekomendasi penggunaan terapi sistemik berupa kortikosteroid, siklosporin, intravenous immunoglobulin (IVIg), plasmaferesis, dan terapi target, hingga saat ini sangat bervariasi karena belum terdapat bukti efikasi berdasarkan penelitian randomized controlled trial.
Cotton swabs for the measurement of NF-ĸB, IFN-γ, and FOXP3+Treg from lesions of anogenital wart patients Hutabarat, Hernayati; Bramono, Kusmarinah; Indriatmi, Wresti; Wibowo, Heri; Budianti, Windy Keumala; Suyatna, Fransiscus Dhyanagiri; Prihartono, Joedo; Mawardi, Prasetya
Medical Journal of Indonesia Vol. 33 No. 3 (2024): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.247496

Abstract

BACKGROUND Local tissue immunity plays a significant role in anogenital warts’ (AGW) pathomechanism and persistence. Assessing biomarkers from lesions instead of serum is recommended to evaluate therapeutic response. Since biopsy is invasive, it is necessary to find less invasive and more comfortable methods. This study aimed to assess the reliability of cotton swabs and tape stripping for evaluating AGW’s lesions biomarkers. METHODS We compared cotton swab versus tape stripping method to quantify nuclear factor-κappaB (NF-ĸB), interferon-gamma (IFN-γ), and FOXP3+regulatory T cell (FOXP3+Treg) from 3 patients with AGW in the preliminary study. The method was selected based on contamination possibility, side effects, and a simpler approach. The main study examined 48 patients with AGW for reliability and reproducibility using the best sampling method from preliminary result and Spearman’s Rho analysis, while considering the HIV status and CD4+ counts. RESULTS Both cotton swabs and tape stripping obtained adequate protein content for biomarkers examination. However, the tape stripping method was causing serum contamination and painful for patients due to the stripping. The total lesion volume in cotton swab method was positively correlated with all patients’ NF-ĸB (p = 0.001). IFN-γ had a negative correlation in all reactive HIV patients (p = 0.012). FOXP3+Treg and CD4+ counts were negatively correlated with total volume in reactive HIV patients (p = 0.046 and 0.017, respectively). CONCLUSIONS The cotton swab method was reliable in examining NF-ĸB, IFN-γ, and FOXP3+Treg due to its convenience and lack of serum contamination from AGW lesions, potentially improving patient comfort and practical benefits.
Co-Authors Aldri Frinaldi Andardewi, Melody Febriana Astri Adelia, Astri Aulia, Izzah Debinta, Arlha Aporia Dina Kusumawardhani Effendy, Isaak Endi Novianto Evita Halim Effendi Evita Halim Effendi Eyleny Meisyah Fitri Fahira, Alessa Fitri, Eyleny Meisyah Fitria Agustina Gifani, Fathya Nabila Halim, P. Anthony Hamdali, Christie Heri Wibowo Hutabarat, Hernayati Indrawati, Luh Ari Joedo Prihartono Kuniawan, Kristian Kusmarinah Bramono Lili Legiawati Lili Legiawati Ling, Michael Sie Shun Marissa, Melani Mawardi, Prasetya Meilinda, Puti Rineska Melody Febriana Andardewi Noerfani, Rahma Rafina Olivia, Taruli Parikesit Muhammad Permatasari, Nadya Aninditha Pranathania, Andravina Rahadi Rihatmadja Ramadan, Edwin Ti Ramadhani, Reinanda Marizki Shafira Anindya Shafira Anindya, Shafira Suyatna, Fransiscus Dhyanagiri Windy Atika Hapsari, Windy Atika Wresti Indriatmi B. Makes Yasnova, Nevi Yudo Irawan