Prevention of Contact Dermatitis Due to Hand Hygiene in The Era of COVID-19

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is known to cause COVID-19 (Coronavirus Disease 2019), and it is rapidly spreading throughout the world that it is declared as a global pandemic. Hand hygiene is widely promoted as it is recommended to reduce the risk of COVID-19 transmission. Contact dermatitis is one of the risks of hand hygiene campaign during the COVID-19. Purpose: This study aimed to assess the parents' level of knowledge before and after health education about contact dermatitis due to hand hygiene. Methods: This was a cross-sectional study, and the data was collected via questionnaires. This study involved 53 respondents. Result: There was a significant increase in respondents' knowledge level after being educated (Wilcoxon test, p=0.000), as evidenced in the mean score of pre-test and post-test evaluation. Conclusion: To lower the incidence, education on contact dermatitis prevention due to hand hygiene during the COVID-19 pandemic is required.

The Profile of Psoriasis Vulgaris Patients: A Descriptive Study

Background: Psoriasis is a skin disease that occurs due to proliferation and differentiation disturbances of the epidermis. This chronic condition often reduces the human quality of life. There have been studies investigating psoriatic patient profiles and treatments, but few are conducted in Surabaya. Hence, those studies cannot fully represent the population demographic in Surabaya. Purpose: To investigate the prevalence of psoriasis vulgaris and the sociodemographic profile of the patients in Dr Soetomo General Academic Hospital. Methods: This was a Retrospective study psoriasis vulgaris patients in January 2016–December 2018. The data were collected by retrieving Electronic Medical Records (EMR) as secondary data. Result: The psoriasis vulgaris prevalence of outpatients was 0.46% and 4.59% in inpatients. Most study subjects were adults aged 18 and above (98.1%), most of the patients were obese (46.3%), the most common provoking factor was focal tooth infection (33.8%) and stress (28.8%), and none reported family history of psoriasis. Conclusion: Some results are similar to other studies conducted in Surabaya, which were the obesity and Type 2 Diabetes Mellitus (DM) being strong a factor to psoriasis development. However, the result on psoriasis family history was not in line with other studies.

Chickenpox Mimicking Monkeypox in Adult with Diabetes Mellitus and Acute Kidney Injury: Diagnosis and Management

Background: Chickenpox caused by the varicella-zoster virus (VZV) in diabetes mellitus patients might exhibit similar clinical features with monkeypox, caused by monkeypox virus (MPXV). In May 2019, Singapore notified World Health Organization (WHO) of one laboratory-confirmed case of monkeypox. Considering Singapore is located near Indonesia, awareness about the possibility of an outbreak in Indonesia should be raised. Purpose: To report a case of chickenpox mimicking monkeypox in an adult with diabetes mellitus and acute kidney injury. Case: A 51-year-old male with poorly controlled diabetes mellitus was suspected to have a chickenpox differential diagnosis with monkeypox. His chief complaint was multiple blisters on his body and vomiting. There was a history of feeding a monkey. From dermatological status on facial, trunk, and extremities there were multiple pleomorphic vesicles. Laboratory results showed elevated renal function. Polymerase chain reaction (PCR) examination using VZV as primer revealed a positive result in the range of 810 bp. He was treated with intravenous acyclovir for 3 days and oral acyclovir for 7 days then discharged with improvement in skin lesions and normal renal function. Discussion: Chickenpox in adult and diabetes mellitus patients can give severe clinical manifestation mimicking monkeypox. PCR has a significant role especially when diagnosis could not be established from the physical examination. Acyclovir can be given as the therapy. Conclusion: Adult and poorly controlled diabetes mellitus are important risk factors associated with the severity and complication of chickenpox. A careful diagnostic approach and management are needed.

The Effect of Systemic Methotrexate and Cyclosporine Combination Therapy inPsoriasis Vulgaris Patients in Bandung, Indonesia

Background: Methotrexate (MTX) and cyclosporine have been used as effective systemic mono-therapy for psoriasis. Several factors are considered to switch monotherapy to combination therapy because monotherapy is no longer effective and has higher side effects. Hence,clinicians have avoided systemic therapy combinations due to its toxicity. However, some studies showed that this combination therapy could be usedeffectively for psoriasis patients. Purpose: This study aimed to analyze the efficacy and adverse effects of systemic MTX and cyclosporine combination therapy in Indonesian psoriasis vulgaris patients. Methods: The retrospective study assessed the effectiveness of 3 monthsmono-therapyand combination therapy of systemic MTX and cyclosporine in psoriasisvulgaris patients from 2016–2017 in Dermatology Clinic, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia. Result: Psoriasis area and severity index (PASI) score 90 were achieved in the group MTX (50%) and cyclosporine group (50%), while none in the combination group.However, eight patients (50%) in group MTX and cyclosporine reached the primary endpoint of PASI 50. One patient in cyclosporine group had adverse effects on kidney profiles. Nonetheless, other patients had no biochemical changes. But, there was no significant difference in the change of PASI between each group (p=0.102). Conclusion: We propose that combination therapy of MTX and cyclosporine is relatively safe and efficacious in treating Indonesian psoriasis vulgaris patients. This combination treatment isas effective as MTX or cyclosporinemono-therapy.

The Confusion between Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis as a Cause of Exfoliative Dermatitis: A Case Report

Background: Pustular psoriasis and Acute Generalized Exanthematous Pustulosis (AGEP) are grouped under pustular diseases, in which their clinical manifestations are similar. Those diseases can lead to exfoliative dermatitis. Purpose:To evaluate a specific histopathological examination in differentiating Pustular Psoriasis and AGEP. Case: A 55-year-old woman presented with sudden redness and diffused scaly skin with multiple pustules and also fever. She had taken Cefadroxil 2 days before the scales and pustules appeared. Leukocytosis and histopathological examination results from biopsy supported the diagnosis of AGEP. The patient was then hospitalized and received steroid therapy. Within the first week of tapering off, the scales disappeared but the pustules increased. After such clinical findings, the histopathological examination results were revisited and reassessed. Thus, we considered changing the diagnosis to Pustular Psoriasis, and the therapy was switched to Methotrexate. The patient had a better outcome, and the pustules slowly disappeared entirely. Discussion: It is often difficult to differentiate between the pustules in pustular psoriasis and AGEP unless by thorough history-taking and physical examinations. AGEP is characterized by a widespread of pustules with an acute febrile onset; while pustular psoriasis is an acute variant of psoriasis where pustules are spread over erythematous skin and accompanied by high fever and leukocytosis. Conclusion: Histopathological examination is the gold standard for the establishment of pustular psoriasis diagnosis. The histopathological characteristics of pustular psoriasis and AGEP are difficult to differentiate. Therefore, we need detailed history-taking and physical examination to establish the diagnosis.

Mucocutaneous Manifestations in HIV/AIDS Patients

Background: The main target of human immunodeficiency virus (HIV) is cluster of differentiation 4 (CD4) T lymphocytes and several other immune cells that have CD4 receptors. They are also present in skin and mucosa, such as Langerhans cells (LC). Mucocutaneous lesions are one of the first clinical presentations of immunosuppression in HIV seropositive patients that manifest at different stages of the infection and require early diagnosis and prompt treatment. Purpose: To determine the clinical characteristics and the pattern of various mucocutaneous manifestations in Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS) patients at Intermediate Care and Infectious Diseases Dr. Soetomo General Academic Hospital Surabaya. Methods: This is a descriptive retrospective study with a cross-sectional design. The study subject was classified as all HIV-AIDS patients with mucocutaneous manifestations treated in Intermediate Care and Infectious Diseases Dr. Soetomo General Academic Hospital Surabaya in 2019. Result: Out of the 614 patients who participated in the study, 72.1% were males. The majority of patients were in the age group 25–49 years (75.4%). The most common risk factor was heterosexuality (41.7%). Based on the distribution of mucocutaneous manifestations, the most common mucocutaneous manifestation was candidiasis mucocutan 387 patients (49.4%) followed by the pruritic papular eruption (PPE) 118 patients (15.1%) and human papillomavirus infection 57 patients (7.3%). Conclusion: Mucocutaneous manifestations occur throughout the course of HIV infection, and they can be considered as good clinical indicators for the progression of the disease and underlying immune status in resource-poor settings.

The Effect of Corncob (Zea mays) Extract Cream on the Number of Melanin Pigments of Guinea Pig Exposed to Ultraviolet

Background: Exposure to Ultraviolet B (UVB) rays on the skin causesmany problems, including pigmentation and aging effect. Hence, protection against it is needed. Purpose: The study aimedto determine the effect of corncob extract cream on the number of melanin pigments in guinea pig skins exposed to UVB rays. Methods: Anexperimental post-test-only control group study was conducted on the 25 guinea pigs. The guinea pigs were divided randomly into five groups: group I without cream, group II cream base, group III hydroquinone cream, group IV 30% corncob extract cream, and group V 40% corncob extract cream. The cream was given daily for 20 minutes before UVB exposure and 4 hours after UVB exposure. The total dose of UVB exposure was 780 mJ / cm2 for 28 days. The amount of melanin pigment was calculated using the CX21 image J. Result: The number of melanin pigment in groups I, II, III, IV, and V were 22.8±0.4 cells, 18±0.3 cells, 6.3±3.1 cells, 13.8±0.2 cells, and 9.4±0.5 cells, respectively. Asignificantlydifferent value of One way ANOVA test was <0.05. Thus, there was a difference in the number of melanin pigments between the five groups. LSD post-hoc test showed differences in each group (p <0.05). Conclusion: 40% corn cobs extract cream effectively decreased the number of melanin pigment in guinea pigs exposed to UVB rays.

A Five-Year Review of Adverse Cutaneous Drug Reaction in a Tertiary Care Hospital in Yogyakarta, Indonesia

Background: The prevalence of adverse drug reactions is likely to increase, and it is associated with increased usage of various drugs. Adverse Cutaneous Drug Reaction (ACDR) is the most frequent adverse drug reaction (30–45%). In Indonesia, the study on the prevalence of ACDR is still limited. Purpose: This study investigated the prevalence, clinical features, causative agents, and mortality rate of ACDR with a type-IV hypersensitivity reaction among patients attending the Department of Dermatology and Venereology in Dr. Sardjito Hospital, Yogyakarta. Methods: This retrospective study was conducted examining medical records undertaken for five years (2011–2015). Of 68,375 patients medicated in the Department of Dermatology and Venereology, 397 patients were diagnosed as ACDR with a type-IV hypersensitivity reaction. Detailed history, including age, sex, past history, and family history of drug reaction taken by the patient, were obtained. Patch testing was done wherever feasible. Result: Of 68,375 patients, 397 patients were included in ACDR with type-IV hypersensitivity (0.58%), giving a 5% of mortality rate. The mean age of the patients was 40.42 years (±16.30; range 18 to 89 years). The female to male ratio was 1.1: 1. The Maculopapular rash was the most common ACDR manifestation (50.88%), followed by Stevens-Johnson Syndrome (13.85%), Fixed Drug Eruption (12.85%), and Drug Reaction with Eosinophilia and Systemic Symptoms (10.08%). The most common causative agents were beta-lactam (16.55%), NSAIDs (12.18%), and acetaminophen (8.62%). Conclusion: Prescription of those drugs should be considered carefully so the incidence of ACDR can be reduced.

Phototherapy in Pediatric Dermatology

Background: Phototherapy is a safe and effective treatment modality for skin diseases in children such as psoriasis, atopic dermatitis, pityriasis lichenoides, vitiligo, cutaneous cell lymphoma, pityriasis rubra pilaris, and other skin disorders. It is reported to be effective with less side effects compare to the administration of systemic medicine. Short and long term side effects should be taken into account when applying this model of therapy, especially in children. Purpose: To identify special considerations regarding the use of phototherapy modalities in the field of dermatology in children. Review: Phototherapy is the use of ultraviolet (UV) radiation for therapeutic purposes. The various wavelengths of UV radiation used for phototherapy have their own respective photochemical and photobiological properties. There are modality choices that have been proven to provide benefits in treating various skin diseases, including broadband UVB and narrowband UVB, psoralen UVA photochemotherapy (PUVA), ultraviolet A 1 (UVA1), and targeting phototherapy. Special considerations regarding the use of this treatment modality in the pediatric population increase with safety and treatment tolerance. Conclusion: Special considerations should be taken when providing phototherapy treatment options to children with skin disorders requiring phototherapy. The therapies are generally well tolerated and mostly have minor adverse side effects, such as sunburn.

Susbstance P Levels in Children with Atopic Dermatitis

Background: Atopic dermatitis (AD) is the most common skin disease in infants and children. AD is influenced by hereditary and environmental factors, and it is characterized by an inflammatory reaction in the skin. In developing countries, children suffering from AD are estimated around 10–20%, of which 60% of the cases persist into adulthood. Substance P is a cutaneous neuropeptide that contributes to the pathogenesis of AD. Substance P promotes the production of nerve growth factors from keratinocytes, and the release of histamine, leukotriene, or tumor necrosis factor from mast cells, which cause the growth of sensory nerve fibers, augmentation of skin inflammation, and are considered pruritogenic factors. Purpose: This study aims to determine the description of substance P in children with atopic dermatitis using a descriptive observational study with a cross-sectional approach. Methods: This is a destructive observational study with a crossectional approach samples were selected from AD patients at the Universitas Sumatera Utara Hospital. Result: The largest group of subjects were childhood (2–12 years old), there was 60%, followed by the adolescent group (12–18 years old) and the infant group (<2 years old). In the childhood group, the highest level of substance P was found in girls with a mean of 349.03 ± 146.7. On the other hand, the highest levels of substance P in the adolescent were found in males with a mean of 243.73 ± 64.57 ng/L. Conclusion: In this study, we found that the level of substance p was higher in the childhood group.