Miranda, Eliza
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The evidence-based topical therapies for management of minor burns in outpatient clinic Dien, Siphora; Miranda, Eliza; Pusponegoro, Erdina Hardiono D; Wardhana, Aditya
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 1
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Burns are often seen in clinics or hospitals. Majority of burns are minor burns, which can be managed in outpatient setting with satisfactory result. The healing outcome depends on physician’s knowledge and competencies in burn pathogenesis and basic principles of burn care. Initial treatment of burns consists of emergency evaluation, assessment of depth and severity of burns and considerations for referral. The principles of minor wound therapy include cooling, cleansing, pain management, and topical therapy. Recently, many topical agents are available and indicated for first to second degree burn. Silver sulfadiazine (SSD) is the standard treatment; however, it has some limitations. Scientific evidences showed that topical antibiotics do not reduce the incidence of local infection, invasive infection, and mortality of infection. Burns heal faster with hydrogel dressings and some other dressings compared to SSD. There are insufficient evidences to support the use of aloe vera, honey, and negative pressure wound therapy in burns. Moist exposed burn ointment (MEBO®) has been demonstrated to have equal efficacy to SSD.
Subcutaneous mycosis at the Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital, Jakarta, 1989-2013 Yahya, Sammy; Widaty, Sandra; Miranda, Eliza; Bramono, Kusmarinah; Islami, Artini Wijayanti
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
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Introduction: Subcutaneous mycosis (SM) is a fungal infection involving dermis and subcutaneous tissue, which can disseminate slowly through systemic blood or lymphatic circulation. The subacute or chronic infection usually found in workers of rural tropical and subtropical area. SM occurs due to trauma along with other predisposing factors such as sex, genetic and occupation.Aim: To identify the types of SM, its clinical findings, laboratory work-up and the treatment at the Dermatomycology Division, Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital between the year 1989 and 2013.Method: This retrospective study collected data from medical records and case reports of patients with SM who came at Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital (1989-2013).Results: We found 16 cases of SM, i.e. subcutaneous mucormycosis (5 cases), eumycetoma (4 cases), actinomycetoma (4 cases) and chromoblastomycosis (3 cases). There was a greater number of male than female patients ratio (3:1) and mostly were in the age group of 25-44 years. The direct microscopic examination did not reveal any fungal element, except for black spora in chromoblastomycosis (1 case). The culture revealed Basidiobolus ranarum in subcutaneous mucormycosis (5 cases), Nocardia transvalensis in actinomycetoma (1 case) and Phialophora sp. in 1 case of chromoblastomycosis. On histopathological examination, we found fine granules of actinomycetoma, sulphuric granules of actinomycetoma, coenocytic hyphae of subcutaneous mucormycosis, eosinophilic granule in 1 case of mycetoma and hyphae with black spore in chromoblastomycosis.Conclusion: SM is still a rare disease, comprehensive management of SM needs supporting laboratory work-up, particularly the histopathological examination.
Correlation between clinical and histopathological findings of five puzzling cases of cutaneous tuberculosis Miranda, Eliza; Widaty, Sandra; Sirait, Sondang Pandjaitan; Rizky, Luddwi Achmad; Menaldi, Sri Linuwih; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings. Case Illustration: Five cases of cutaneous tuberculosis, which include two cases of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris were presented in this article. Four of the five cases demonstrated significant improvement after initiation of an antituberculosis drug regimen. Discussion: Diagnosis of cutaneous tuberculosis in these cases was confirmed through clinical findings and histopathological and microbiological examination. Conclusion: A negative result following microbiological examination does not completely exclude the diagnosis of cutaneous tuberculosis. Investigating the pathognomonic findings of cutaneous tuberculosis through histopathological examination is important to differentiate among its types correctly. Therefore, correlations between clinical and histopathological results are essential to establish a diagnosis of cutaneous tuberculosis.
The management of seborrheic dermatitis 2020 Widaty, Sandra; Bramono, Kusmarinah; Listiawan, Muhammad Yulianto; Yosi, Ariyati; Miranda, Eliza; Rahmayunita, Githa; Brahmanti, Herwinda; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Background: Seborrheic dermatitis (SD) is a chronic relapsing dermatitis manifesting in the seborrheic area, affecting infants or adults. In Indonesia, the prevalence of SD is 0.99–5.8% of all dermatology cases from 2013 to 2015. SD has been known to be a prominent manifestation among HIV patients, but there is an increasing trend in the general population. Therefore, in 2017, the Indonesian Society for Dermatology and Venereology proposed a consensus for the management of SD in Indonesia based on the discussion from 12 dermatological centers. Concurrent with the development of new drugs, this study aims to evaluate and develop a guideline for the treatment of seborrheic dermatitis in Indonesia to update the previous guidelines in 2017. Methods: Systematic review was based on evidence-based methods, and scientific evidences were acquired through systematic search. Evidence analysis was in accordance with the level of evidence. The available evidences were evaluated, and conclusion was based on the grade of recommendation. Critical appraisal was conducted by experts in dermatology and venereology. Results: Severity of SD can be determined by using the Seborrheic Dermatitis Area Severity Index. The principle of scalp SD management is controlling the scalp condition in a cost-effective manner to make patients comfortable. The recommendations for treatment of adult SD are topical agents, such as antifungals, nonsteroidal anti-inflammatory agents with antifungal properties, corticosteroids, and calcineurin inhibitors. Conclusion: We have updated and added newer agents for the treatment of SD. The approach is divided into scalp or nonscalp and also adult or infantile SD.
The effects of vitamin D on chronic wounds Priyanto, Mufqi Handaru; Miranda, Eliza; Yusharyahya, Shannaz Nadia; Legiawati, Lili; Novianto, Endi; Bramono, Kusmarinah; Krisanti, Roro Inge Ade
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 8, No. 1
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Background: Wounds that fail to proceed through the normal healing process are referred to as chronic wounds, also known as ulcers. Chronic wounds have immeasurable biological, psychological, social, and economic effects, bringing tremendous challenges for patients, doctors, healthcare providers, and healthcare systems. Discussion: This condition is associated with a variety of comorbidities and complex etiologies. The global incidence of chronic wounds is expected to increase with longer life expectancy. Thus, a holistic approach is necessary, such as proper wound management, proper control of comorbidities, and provision of adequate nutrition, including vitamin D supplementation. Vitamin D is an essential pro-hormone for cell differentiation, proliferation, and growth. It affects the skin’s immune response, and is therefore thought to promote wound healing and tissue repair. Many studies have been published on the association between low vitamin D levels and chronic wounds. However, whether or not vitamin D supplementation directly contributes to wound healing still needs to be elucidated. Conclusion: Despite the many reports on vitamin D as an adjuvant treatment for chronic wounds, further large-scale clinical studies are needed to cement the role of vitamin D as an effective standard therapy for chronic wound healing.