Focus on the dabrafenib, vemurafenib, and trametinib in clinical outcome of melanoma: a systematic review and meta-analysis

Background: Melanoma is the most serious lethal skin cancer, affects the melanin producer cells (melanocytes). Surgery is the most common treatment, whereas for the advance stage the development of a treatment is recommended. BRAF (Dabrafenib and Vemurafenib) inhibitor or MEK inhibitor (Trametinib) is used as the most frequently targeted therapy of melanoma due to more than 80% patient with positive BRAF mutation. In this review, those treatments will be investigated systematically to identify their clinical outcome.Method: This systematic literature review (SLR) was performed from Cochrane, Science Direct, Google Scholar, and Pubmed. Cochrane Risk-of-Bias Tool RoB2 is used to assess RCT studies and New-castle Ottawa Scale Assessment to assess cohort studies by 3 different assessors. Data analysis was carried out by using Review Manager (RevMan 5.4). Heterogenicity test was assessed by I2 Â and Chi2 statisticResult: There are 20 studies used in this article (13 RCT and 7 cohorts). The overall survival (OS) and progression-free survival (PFS) of study that using targeted therapy (vemurafenib, trametinib, or dabrafenib) compare other therapies (chemotherapy, immunotherapy,etc) showed risk ratio (RR) was 1.12 (95%CI 1.07,1.17;Â I2=100%; p<0,00001). The OS and PFS with monotherapy compare of vemurafenib, trametinib, or dabrafenib with combination therapy showed RR was 1.09 (95%CI.06,1.13;I2=99%; p<0,00001). Conclusion: BRAF and MEK targeted therapy has a good prognosis for a patient with a positive BRAF gene mutation and could be combined with other therapy for a better clinical outcome rather than monotherapy.Keyword: melanoma, dabrafenib, vemurafenib, and trametinib

Systematic review of melasma treatments: advantages and disadvantages

Background: Melasma is an acquired chronic hyperpigmentation mostly affecting women. The pathogenesis of melasma is uncertain but it predominant related to ultraviolet (UV) exposure. Due to chronic and relapsing nature, melasma is challenging to treat. The current available treatment often has undesirable side effects and suboptimal results. The principal of treatment includes protect from UV radiation, inhibit melanin synthesize and increase pathway to remove melanin. Objectives: To define available treatments for melasma and determine advantages and disadvantages including topical, oral and procedural. Method: Medline, Cochrane library and PubMed database were searched for articles from January 2011 to June 2020. Only RCTs, comparative, prospective, retrospective and systematic reviews focusing on melasma treatments were extracted, analyzed and discussed. Results: We found 197 studies that met the inclusion and exclusion criteria with 2314 participants included in this review. The treatments included topical, oral and procedural. In several studies, hydroquinone alone or combination remains the most effective treatment for melasma. Oral and topical tranexamic acid have been found to be a useful adjuvant treatment in refractory melasma with minimal adverse effects. Procedural treatment such as chemical peels, laser and light-based therapies, and microneedling have a mixed and unpredictable result. Overall, the side effects tend to be mild and affect few of the subject.Conclusions: The current state of the evidence suggests that some treatments with multiple modalities have their respective advantages and disadvantages. The choice of treatment modality must be adjusted according to the type of melasma such as its severity, extent and location. A better understanding of melasma through the further research may improve the therapy options with the least adverse effects.

Incidence and characteristic of psoriasis patients at Sanjiwani Gianyar Regional Hospital 2018-2019

Introduction: psoriasis is a chronic inflammatory skin disease that is characterized by firmly demarcated red plaque covered by a thick squama as a result of impaired proliferation and differentiation of the epidermis. Diagnosis of psoriasis is based on history taking and clinical features. Treatment is determined based on the patient's clinical characteristics and the severity of the disease. Purpose: this retrospective study aims to determine the incidence, characteristics and treatment options of psoriasis patients in the dermatovenereology polyclinic of Sanjiwani Gianyar Regional Hospital in 2018-2019. Methods: retrospective study of psoriasis patients at Sanjiwani Gianyar Regional Hospital in 2018-2019. Data collected from medical records includes sociodemographic data, clinical data and patient treatment history. Results: Within two years, there were 53 new cases of psoriasis. The dominance of psoriasis cases were found in men with a ratio of women and men 1:2,31. From total 53 patients, 37 were male (69,81%)and 16 female patients (30,19%). The most common type was psoriasis vulgaris (73,58%). The most age group was 31-45 years. The most commonly given regimen of therapy was topical corticosteroids plus oral antihistamines (45,28%). The most widely given systemic therapy was methotrexate. Accompanying skin infections were found in 6 cases of psoriasis (11,32%). Conclusion: Based on the results of the study, there were 53 new cases of psoriasis in 2018-2019, psoriasis vulgaris was the most common, the most age group was 31-45 years old, topical corticosteroids plus antihistamines were still the main treatment options for psoriasis patients in Sanjiwani Gianyar Regional Hospital.

Dermatology in COVID-19 pandemic: a review of manifestation, prevention, and treatment of personal protective equipment adverse skin reactions

Since declared as a global pandemic by World Health Organizations on 11th March 2020, per early July 2020, COVID-19 total confirmed cases count had surpassed 11 million cases. COVID-19 poses a new challenge to healthcare workers with a new standard of care and managing COVID-19 patients. Healthcare workers must adhere to stricter hand hygiene, and the new Personal Protective Equipment (PPE) protocol brings forth new problems for healthcare workers. Skin problems have become the most common and preventable adverse effects of the daily and prolonged use of PPE. This could inadvertently cause protocol breaches, such as mask touching, scratching, or off-protocol PPE adjustment. Damage in the skin could also cause discomfort, and skin exposure may serve as a new port of entry for a secondary infection. In this study, we review various studies regarding the adverse effects, prevention, and therapy of the skin problems related to COVID-19 PPE use.

Vulvovaginal candidiasis (VVC) : A review of the literature

Vulvovaginal Candidiasis (VVC) is the second most common cause of vaginitis after bacterial vaginosis. VVC often occurs in women of reproductive age (20-40 years). Risk factors for VVC can be divided into two, such as host factors (pregnancy, hormone replacement, uncontrolled diabetes mellitus, immunosuppression, antibiotics, use of glucocorticoids, genetic influences) and behavioral factors (oral  contraceptives, cotraceptives and also some sexual habits, hygiene, and clothes that are used). To diagnose VVC in a person, evaluation from anamnesis and clinical manifestation can be conducted. It can also be confirmed by laboratory examination. The management based on the classification. Uncomplicated VVC is most effectively treated with topical azoles, but a single dose of fluconazole can also be given orally. Treatment of VVC with complications can be given fluconazole 150 mg for 3 days or topical azole for 7 days. However, when the VVC case that caused by Candida non-albicans not responding to conventional treatment such as antimycotics, the   amphotericin B can be given to cure the disease. VVC caused by Candida glabrata can be given topical boric acid or flucytosine. This article consists of several theoretical references that has been viewed to have a better understanding regarding candidiasis vulvovaginitis.Â

Buschke-Löwenstein tumour (BLT)/giant condyloma acuminatum (GCA): An immunopathogenesis insight

Buschke Löwenstein tumor (BLT)/giant condyloma acuminatum is a rare variant of sexually transmitted infection caused by human papillomavirus (HPV) type 6 and 11. HPV has its viral factors that exist to avoid immune surveillance and control through 1) infecting only the basal layer of the epithelium, 2) downregulation of host immunity, 3) suppression of proinflammatory proteins essential for viral clearance. The incidence of BLT/GCA is estimated to be 0.1% in the general population, with males having 2.7 times increased risk than females. BLT/GCA is characterized by verrucous tumor or palpable cauliflower-likemass, exophytic growth, flesh-colored, and uneven surface. The definitive diagnosis of BLT/GCA is typical morphology along with histopathological examination, and/or viral serotyping. Treatment of BLT/GCA requires a multidisciplinary approach, determined based on age, the extent of the lesion, organ involvement, and organ location.

Negative correlation between interleukin-2 (IL-2) serum with bacterial index in leprosy

Background: Leprosy is strongly influenced by the host immunity response. One of the cytokines that play a role in cellular immunity is IL-2. IL-2 will stimulate macrophages to activate phagocytosis and form granulomas, and this occurs in the tuberculoid type of leprosy.Objective: Aim of this study was to verify the IL-2 serum levels are negatively correlated or not with bacterial index in leprosy.Methods: This study was a cross-sectional observational analytic study involving 50 leprosy subjects (41 MB and 9 PB types). Study was conducted at Dermatolovenerology Polyclinic of Sanglah General Hospital from December 2019 to March 2020. Sample was taken using a consecutive sampling method. IL-2 serum levels were measured by ELISA. Result: The mean of IL-2 serum in PB was 75.53±10.32 pg/mL and in MB was 37.59±17.13 pg/mL. Strong negative correlation (r= -0.67; p<0.001) between serum IL-2 levels with bacterial index (CI 95%= 25.96–49.93; p<0.001) was found. Every 1 pg/mL increase in IL-2 serum levels will be accompanied by a decrease in the bacterial index of 0.039 and vice versa. Determinant coefficient shows that 42.2% of bacterial index affected by the IL-2 serum levels. Low IL-2 serum levels were the risk factor of high bacterial index 2.8 times (PR= 2.8; CI 95%= 1.444–5.519; p<0.001).Conclusion: IL-2 serum levels were found to be higher in PB than MB. There was a negative correlation between IL-2 serum levels with bacterial index. Low IL-2 serum levels were the risk factor of a high bacterial index in leprosy patients.

Buschke-Löwenstein tumour (BLT)/giant condyloma acuminatum (GCA): An immunopathogenesis insight

Buschke Löwenstein tumor (BLT)/giant condyloma acuminatum is a rare variant of sexually transmitted infection caused by human papillomavirus (HPV) type 6 and 11. HPV has its viral factors that exist to avoid immune surveillance and control through 1) infecting only the basal layer of the epithelium, 2) downregulation of host immunity, 3) suppression of proinflammatory proteins essential for viral clearance. The incidence of BLT/GCA is estimated to be 0.1% in the general population, with males having 2.7 times increased risk than females. BLT/GCA is characterized by verrucous tumor or palpable cauliflower-likemass, exophytic growth, flesh-colored, and uneven surface. The definitive diagnosis of BLT/GCA is typical morphology along with histopathological examination, and/or viral serotyping. Treatment of BLT/GCA requires a multidisciplinary approach, determined based on age, the extent of the lesion, organ involvement, and organ location.

Trends in diagnostic approach of scabies as a neglected tropical disease

Scabies is a parasitic disease of the skin that is difficult to enforce if the clinical symptoms are not typical. The diagnosis relies on clinical symptoms to be less efficient and only has a sensitivity of less than 50% because it is difficult to distinguish active infestations, residual skin reactions, or reinfestations. Misdiagnosis results in wrong treatment and causes the patient to not recover and continues to be a source of infection for the environment. The exact diagnosis of scabies is determined by finding mites or eggs on laboratory tests, but mites are difficult to find because only a few mites infest sufferers. For this reason, various studies in the world have tried to develop diagnostic methods in the enforcement of scabies. This article will describe the trend of establishing a diagnosis of scabies, as well as the advantages and disadvantages in its application.

Urticarial manifestation in COVID-19 infection: A case report

Background: The COVID-19 pandemic outbreak causes a worldwide health concern. As the epidemic progressed, several cutaneous manifestations are increasingly noticed; therefore, the authors hope this report will provide additional information that may benefit fellow healthcare professionals. Case report: A 45 years old Javanese female patient complained of fatigue, dry cough, dyspepsia, and reddish pruritic swelling on her face for one day. There was no fever, dyspnea, anosmia, diarrhea, or uvula, tongue, vocal cords, and the airway problem. She had no history of food or drug allergy, urticaria, other comorbidities, or any medicine consumption in the last 15 days. Facial dermatological status showed circumscribed, raised, erythematous areas of edema, slightly pruritic. Normal vital signs. Blood laboratory results: leucocyte 5.760/mL, decreased ALC 818/mL, increased NLR 5.0. Chest X-ray showed an increase in bronchovascular pattern and slight opacity on the peripheral, basal part of both hemithorax. COVID-19 rapid test was positive for IgM, and her PCR of upper-airway secretions revealed positive COVID-19 infection. The diagnoses were COVID-19 infection, dyspepsia, and urticaria. The treatments were levofloxacin, isoprinosine, chloroquine sulfate, omeprazole, fluimucyl, vitamin C, and diphenhydramine. Within three days of treatment, the urticaria started to fade off, and her overall condition improved. Conclusion: The COVID-19 poses a global challenge in the health sector, and one of its various manifestations is cutaneous symptoms. Further research is necessary to elucidate how COVID-19 triggers dermatological symptoms.