INTRODUCTION: Leprosy is a chronic granulomatous infectious disease, mainly affecting the skin and peripheral nerves, caused by the obligate intracellular bacteria Mycobacterium leprae. The disease has been discussed in several review articles in recent research, but as far as we know, only a few have addressed the effects of leprosy on nails, especially those who examine the dermoscopic features of nails in leprosy patients. PURPOSES: We aimed to document nail changes in leprosy patients and identify any particular findings through dermoscopic examination. METHOD: This was an observational study conducted in the Dermatology and Venereology Clinic of Hasan Sadikin Hospital, West Java, Indonesia, from March 2023 through May 2023. All patients have established cases of leprosy, and the diagnosis is based on clinical and bacteriological examinations. Recruitment was done through total sampling. Dermoscopic examination of all fingernails and toenails was performed at 10x magnification using a handheld dermatoscope (Heine DELTA 20 T Dermatoscope) in polarized mode without the linkage fluid to document the dermoscopic features. RESULT: Of a total of 19 patients, 15 had nail changes due to leprosy. Out of 15 patients, 13 patients were male. Patients below 25 years old had more nail changes. Most of the patients had a duration of disease greater than two years. Both fingers and toes were involved in nine patients. In this study, the most common dermoscopic feature found was the longitudinal ridge. Other dermoscopic features found in this study were transverse lines, onycholysis, longitudinal melanonychia, leukonychia, subungual hemorrhage, subungual hyperkeratosis, anonychia, and onychorrexis. CONCLUSION: Nail changes are found in leprosy patients and have a wide variety of clinical appearances. A dermoscopy should be performed to assess nail changes in leprosy.
Leprosy , Nail Diseases , Humans , Male , Adult , Female , Nails , Indonesia , Tertiary Care Centers , Nail Diseases/etiology , Leprosy/diagnosis
Introduction: Vitiligo is an acquired depigmenting skin disorder due to the loss of melanocyte function in the epidermis and hair follicles. The pathogenesis of vitiligo is multifactorial, with genetics being a predisposing factor. Previous studies had varying results regarding whether or not polymorphisms of vitamin D receptor (VDR) gene are associated with the risk of vitiligo in specific populations. This study investigated the association between three frequently analyzed VDR gene polymorphisms (ApaI, BsmI, TaqI) and susceptibility to vitiligo in Indonesian population. Methods: Thirty-four vitiligo patients and 34 age- and sex-matched healthy subjects aged ≥18 years old were recruited in the Dermatology and Venereology Outpatient Clinic of Dr. Hasan Sadikin General Hospital, Bandung, Indonesia. Genomic deoxyribonucleic acid (DNA) was extracted from the peripheral blood using a DNA isolation kit. VDR gene polymorphisms (ApaI, BsmI, and TaqI) were investigated using the polymerase chain reaction-restriction-fragment length polymorphism method. The differences of genotype distributions and allele frequencies were statistically compared between case and control groups using Chi-square test. Results: VDR gene polymorphisms were identified in 68 participants, consisting of Aa (n = 14), aa (n = 20), Bb (n = 15), bb (n = 19), and TT (n = 34) genotypes in the case group. In the control group, Aa (n = 6), aa (n = 28), Bb (n = 17), bb (n = 17), and TT (n = 34) genotypes were identified. However, only subjects with ApaI Aa genotype polymorphism had a 3.267-fold increased risk of developing vitiligo. Conclusion: This study showed that ApaI Aa genotype polymorphism of the VDR gene increases the risk of vitiligo in Indonesian population.
Introduction: Indonesia is the most populous Muslim-majority country, where some women wear hijab covering their scalp and neck. Some hijab-wearing women complain of scalp problems eg, itch, dandruff, and hair loss, which might be related to severe and chronic skin barrier impairment due to occlusion. Excessive water accumulation in the occluded stratum corneum might result in increased permeability, followed by increased skin pH values. This study aimed to evaluate scalp hydration and pH values in hijab-wearing and non-hijab-wearing women. Material and Methods: This was a cross-sectional comparative analytical study using stratified random sampling methods conducted on 63 subjects, who were divided into two groups, consisting of 33 hijab-wearing and 30 non-hijab-wearing women. Both groups underwent physical examination and their medical history recorded. Scalp hydration was measured using a Corneometer (Courage + Khazaka, Koln, Germany), and scalp pH value was measured using a Skin & Scalp pH Tester (Hanna Instruments® HI981037, Rumania). This study was conducted at the Dermatology and Venereology Clinic of Hasan Sadikin General Hospital Bandung. Results: The mean scalp hydration and pH values were 18.34 ± 2.91 AU and 4.93 ± 0.17, respectively, in hijab-wearing women. Meanwhile, the mean scalp hydration and pH values were 17.71 ± 3.35 AU and 4.91 ± 0.16, respectively, in non-hijab-wearing women. The difference of scalp hydration and pH values between the groups was not statistically significant based on the independent t-test, with p-values of 0.430 and 0.597, respectively. Conclusion: Scalp hydration and pH values in hijab-wearing and non-hijab-wearing women did not differ significantly. Hijab-wearing women should not worry about scalp barrier impairment as long as they do not have any history of underlying scalp and skin disorders, and do not wear hijab in wet condition.
Background: Interleukin 17 (IL-17) and interferon gamma (IFN-γ) play a role in the pathogenesis of psoriasis vulgaris (PV). Topical corticosteroids are still utilised as first-line therapy for mild to moderate PV. However, long-term use of corticosteroid is associated with various side effects. Physalis angulata Linn. (Ciplukan) possesses anti-inflammatory properties that could serve as a potential alternative topical therapy for PV. Objective: To assess the efficacy of topical ciplukan as an anti-inflammatory agent targeting the expression of IL-17 and IFN-γ. Methods: Psoriasis was induced using imiquimod cream, therefore divided into five groups. Group I, the psoriasis control group, received only imiquimod cream. Groups C1 and C2 received imiquimod cream followed by a mixture of Ciplukan and vaseline in a 1:2 and 1:4 ratio, respectively. Group M, the standard therapy group, received imiquimod cream, followed by mometasone furoate cream. Lastly, group V, the vehicle group, received imiquimod cream followed by vaseline album. Expression of IL-17 and IFN-γ in mice's skin tissue was analysed using reverse transcription polymerase chain reaction (RT-PCR) after seven days of treatment. Results: The mean expression of IL-17 in Group C1 (22.60) was significantly lower (p = 0.012) than in the psoriasis control group (23.60), and there was no significant difference (p = 0.613) in Group M (22.41). The mean expression of IFN-γ in Group C1 (26.97) and Group C2 (27.03) was also significantly lower (p = 0.026 and p = 0.026, respectively) than Group I (28.80), and there was no significant difference (p = 0.180 and p = 0.093, respectively) than Group M (26.03). Conclusion: Expression of IL-17 and IFN-γ in the ciplukan group is lower than in the psoriasis control group, and there is no significant difference compared to the standard therapy group.
Introduction: Acne vulgaris (AV) is a common and chronic disorder of the pilosebaceous unit and has a multifactorial pathology, including activities of Cutibacterium acnes (C. acnes) and Staphylococcus epidermidis (S. epidermidis). Antibiotic resistance has become a major concern in dermatology daily practice, and the ability of biofilm formation by both bacteria is suggested to increase antibiotic resistance in acne. Purpose: Our aim was to analyze the comparison of antibiotic resistance between biofilm-forming (BF) and non-biofilm-forming (NBF) strains of C. acnes and S. epidermidis towards seven antibiotics commonly used for acne. Methods: This is a cross-sectional analytical study involving 60 patients with AV. Samples were obtained from closed comedones on the forehead using the standardized skin surface biopsy (SSSB) method at the Cosmetic Dermatology Clinic Dr. Hasan Sadikin in Bandung, Indonesia. Isolates were cultured and identified before undergoing the biofilm-forming test using the tissue culture plate method. Antibiotic susceptibility testing for each antibiotic was then performed using the disc diffusion method. Results: The incidence of antibiotic resistance to clindamycin in BF and NBF C. acnes isolates was 54.5% (p=1.00), while in BF and NBF S. epidermidis isolates, it was 54.5% and 45.5% respectively (p=0.67). The incidence of antibiotic resistance to erythromycin and azithromycin in BF and NBF C. acnes isolates was 54.5% and 63.6% respectively (p=1.00), whereas for S. epidermidis BF and NBF isolates, it was 54.5% (p=1.00). There was no resistance observed to tetracycline, doxycycline, levofloxacin, and cotrimoxazole in all groups. Conclusion: There were no significant differences in resistance against seven antibiotics between the C. acnes and S. epidermidis in BF and NBF groups. Furthermore, although statistically not significant, some resistances were observed against clindamycin, erythromycin, and azithromycin. Consequently, the use of these three antibiotics should be judiciously regulated.
Background: Leprosy, a chronic infectious peripheral neuropathy, is caused by Mycobacterium leprae. This bacterium produces triacylated lipopeptides that can induce the immune system via the Toll-like receptor 2/1 (TLR 2/1) complex. Activation of TLR 2/1 produces proinflammatory cytokines and antimicrobial peptides (AMPs), including human beta-defensin-3 (HBD-3) and cathelicidin. Purpose: To analyze differences in gene expression of HBD-3 and cathelicidin in the skin of leprosy patients, household contacts, and healthy individuals. Patients and Methods: An analytic observational study was conducted at the Outpatient Clinic of Dermatology and Venereology of Dr Mohammad Hoesin General Hospital, Palembang, Indonesia, from January 2021 to June 2022. In each group of 18 subjects, 72 samples were collected, including skin lesion in leprosy patients, normal skin in leprosy patients, household contacts, and healthy individuals. A comparison of HBD-3 and cathelicidin gene expression between the four groups was analyzed using Pearson Chi Square, Kruskal-Wallis, and Mann-Whitney Test. Results: The median value of HBD-3 gene expression on skin lesion in leprosy patients was 260.61 (0.19-3734.10); normal skin in leprosy patients was 1.91 (0.01-151.17); household contacts skin was 7.93 (0.27-121.10); and healthy individuals' skin was 1.00 (1.00-1.00) is highly significant difference (p < 0.0001). The median value of cathelicidin gene expression on skin lesion in leprosy patients was 38.72 (0.28-1852.17); normal skin in leprosy patients was 0.48 (0.01-15.83); household contacts skin was 9.8 (0.04-128.0); and healthy individual skin was 1.00 (1.00-1.00), also highly significant difference (p < 0.0001). Conclusion: Gene expression of HBD-3 and cathelicidin increased in skin lesions of leprosy patients and household contacts.
Background: Epidermolysis bullosa (EB) is a genodermatosis disease with bullae and erosions of the skin and mucous membrane that can last for a lifetime and decrease quality of life. Oral and gastrointestinal disorders inhibit the patients' ability to achieve optimal nutrition, making the patients prone to infection, leading to prolonged wound healing, and delayed growth and developmental process. However, there has been no research on the clinical, laboratory, and nutritional status of pediatric EB patients in Indonesia. Purpose: This study aims to describe the clinical, laboratory, and nutritional characteristics of pediatric EB patients treated in Dr. Hasan Sadikin General Hospital Bandung, Indonesia. Patients and Methods: This was a retrospective descriptive study of pediatric EB patient records in Dermatology and Venereology Outpatient of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from April 2018-March 2020. Results: Study results showed 12 pediatric EB patients consisting of 7 dystrophic EB (DEB) (4 recessive dystrophic EB [RDEB] patients and 3 dominant dystrophic EB [DDEB]), 3 junctional EB (JEB), and 2 EB simplex (EBS). The most extensive EB wounds was found affecting 10-20% of the body surface area with a <10% infected wound area. Pain was found in all patients. The most frequent abnormalities in laboratory examination were anemia and low zinc levels. Severe malnutrition was found in almost half of the patients. Conclusion: RDEB is the most commonly found type of pediatric EB. Wounds on the skin, tooth decay, hand deformity, pain when changing dressings, low zinc levels, and low hemoglobin levels are the clinical features and laboratory findings that contribute to the development of moderate and severe malnutrition in RDEB patients.
Scabies is a parasitic skin disease caused by Sarcoptes scabiei var. hominis. Crusted scabies, also known as Norwegian scabies, is a rare and severe form of scabies that occurs more frequently in immunocompromised, elderly, disabled, and debilitated patients. The present study reports a case of crusted scabies combined with bullous scabies. A 44-year-old man was admitted with the chief complaint of red, thick, scaly patches of skin accompanied by crusting that felt itchy and worsened at night. The lesions had appeared all over his body intermittently for the last 10 years; however, the complaints worsened in the last 2 months. From dermatological status, the anterior and posterior thoracic regions and between the fingers of both hands showed generalized distribution of erythematous, yellowish, hyperkeratotic plaques with clear boundaries, pustules, and blisters on an erythematous base with multiple erosions and excoriations. S. scabiei were found on skin scraping examination, and histopathological examination supported the diagnosis of bullous scabies. The patient received 5% permethrin lotion topical therapy and systemic ivermectin therapy. In addition, the patient was given systemic antibiotics. The lesions improved after 2 weeks of therapy, and no S. scabiei were found on the subsequent microscopic examination. Treatment with a combination of topical and systemic scabicidal agents produced a favorable outcome in this patient.
Anogenital Warts (AGWs) are benign proliferations caused by Human Papillomavirus (HPV) infection on the genital or anal areas. Various therapeutic options are available for the treatment of AGWs but there is no best or ideal therapy, and the recurrence of AGWs is significantly high. A promising new therapy that is currently being evaluated is immunotherapy with the intralesional Bacillus Calmette-Guérin (BCG) vaccine. Two cases of a 23-year-old woman and a 41-year-old man were presented with manifestations of condyloma acuminata type AGWs. The patients were immunocompetent and received single dose intralesional BCG vaccine on the largest lesion. Clinical improvements of AGWs lesions were noted starting on the 14th day after receiving therapy by the disappearance of some lesions with no recurrence and side effects. Intralesional BCG vaccine activates the immune system, treats other AGWs lesions that do not receive an intralesional injection, and also prevents recurrence. Although the intralesional BCG vaccine is effective for treating AGWs, further evaluation is still needed for its recurrence.
Condylomata Acuminata , Papillomavirus Infections , Tuberculosis , Male , Female , Humans , Young Adult , Adult , BCG Vaccine/therapeutic use , Condylomata Acuminata/therapy , Condylomata Acuminata/epidemiology , Immunotherapy
Background: Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin disease that can be triggered by various precipitating factors, including colonization by Staphylococcus aureus (S. aureus). The toll-like receptor (TLR), which belongs to the family of pattern recognition receptors (PRR), can recognize components of S. aureus, such as staphylococcal enterotoxin B (SEB). This receptor is known to be expressed on monocytes. However, the understanding of the role of SEB in the pathogenesis of AD through the TLR pathway, especially TLR2 and TLR6, is not widely known. Purpose: To investigate the expression of TLR2 and TLR6 on peripheral blood monocytes induced by SEB during AD exacerbations. Patients and Methods: Twenty AD patients and 20 healthy subjects as a control group were selected. A 5 mL blood sample from each subject was taken for monocyte culture, which was induced by SEB for three days, and the outcomes were assessed by flow cytometry to evaluate TLR2 and TLR6 expression. Results: The expression of TLR2 on peripheral blood monocytes in AD patients was increased compared to healthy controls (p = 0.000), but not for the expression of TLR6 (p = 0.304). In the AD group, TLR2 and TLR6 expression on peripheral blood monocytes after being induced by SEB was significantly increased compared to before induction (p = 0.025 and p = 0.023, respectively), but not in the control group (p = 0.737 and p = 0.100, respectively). Conclusion: There is significantly increased expression of TLR2 and TLR6 on peripheral blood monocytes induced by SEB during exacerbation in AD patients.
OBJECTIVE: This study aimed to compare cathelicidin levels in the skin of leprae patients and leprae contacts. PATIENTS AND METHODS: This research is an analytic observational study with a cross-sectional approach. Fifty-four research subjects participated in this study. They consisted of leprae patients, household contacts, and healthy individuals. Cathelicidin levels were measured using the ELISA method. Data analysis was carried out with the help of SPSS software, and univariate and bivariate analysis was conducted. RESULTS: Cathelicidin levels in the leprae group (256.8±22.9 pg/ml) were higher than in the contact group (25.9±2.7 pg/ml). Likewise, the contact group had higher cathelicidin levels than healthy controls (1.4±0.1 pg/ml). Statistically, there were differences in cathelicidin levels between groups, P<0.050. CONCLUSION: Cathelicidin levels in leprae patients were higher than those in household contacts.
Cathelicidins , Leprosy , Humans , Skin
Objective: To evaluate the correlation between melatonin levels and sleep quality, based on the Children's Sleep Habit Questionnaire (CSHQ), among children with atopic dermatitis (AD). Methods: This was an analytic study with a cross-sectional design involving two groups, AD children as the case group and participants without AD as the control group, conducted at the Pediatric Dermatology Clinic of Dr. Hasan Sadikin Hospital, Bandung, Indonesia. Melatonin levels and CSHQ score in the case group were compared to that in the control group. Correlation analysis was performed between melatonin levels and sleep quality based on CSHQ in the case group. Results: Participants in this study consisted of 19 children with moderate AD, (no patient with mild and severe AD was recruited), and 19 participants without AD. The mean CSHQ score in the case group was significantly higher than the control group (47.84 vs 36.79; p<0.05). The mean melatonin level in the case group was significantly lower than the control group (320.18 pg/mL vs 383.86 pg/mL; p<0.05). Comparative analysis was conducted using independent t-test. There was a significant Pearson's correlation index between SCORAD and CSHQ (p<0.05). However, there was no correlation between melatonin levels and CSHQ, as well as between melatonin levels and SCORAD (p<0.05). Conclusion: Children with moderate AD have impaired sleep quality and lower melatonin levels compared to controls. No correlation was found between melatonin levels and CSHQ, as well as melatonin levels and SCORAD, although there was a strong and significant correlation between SCORAD and CSHQ. Therefore, melatonin levels may not be the main cause of sleep disturbances in children with moderate AD.
Recurrent erythema multiforme (REM) may have frequent episodes over a period of several years and is considered to be a hypersensitivity reaction associated with infection or medication. REM is a mucocutaneous disorder which is characterized by targetoid lesions. Most of the cases are caused by herpes simplex virus infection. Systemic corticosteroid is frequently used to treat REM due to its effects in suppressing the disease. When REM is unresponsive to systemic corticosteroid, steroid-sparing treatment needs to be instituted. We reported a case of REM in a 49-year-old male. There were complaints of burning sensations on the skin lesions, along with swelling on both hands. On physical examination, erythematous macules and targetoid lesions were found on both palms, arms, and legs. During hospitalization, dexamethasone 20 mg was administered in a tapering dose but new skin lesions still appeared. Two days after azathioprine 50 mg twice daily was added to the treatment, skin lesions and swelling on the patient's hands were diminished and the burning sensation disappeared. No side effects of azathioprine were found in this patient and no recurrence until two weeks after hospitalization. This case report demonstrated the efficacy of combined treatment of dexamethasone and azathioprine for REM cases unresponsive to systemic corticosteroid.
Introduction: Pustular erythema nodosum leprosum (ENL) is an atypical manifestation associated with chronic ENL. The use of corticosteroid alone might not be sufficient for this condition, and addition of another anti-inflammatory drug is often necessary. Minocycline is a tetracycline antibiotic with anti-neutrophilic properties, which may accelerate the treatment of pustular ENL. This case report aimed to elaborate on the beneficial effect of minocycline for pustular ENL. Case: We report a case of pustular ENL in a 23-year-old male who had been released from treatment (RFT) of lepromatous leprosy (LL). The patient had been on prednisone for six months as treatment for ENL. The condition recurred when prednisone was tapered to 10 mg daily. Eventually, pustules developed on the erythematous nodules, and the lesions did not improve despite seven weeks of treatment with 40-60 mg prednisone. Later, 100 mg minocycline once daily was given in addition to 60 mg prednisone once daily and improvement was rapidly observed on the ninth day after minocycline administration. This condition was sustained for four weeks with prednisone tapering, and no side effects were reported during the treatment. Discussion: Minocycline is an antibiotic with anti-inflammatory properties. Only a few studies have been conducted regarding the use of minocycline in chronic ENL, but there was no reported case of minocycline use for pustular ENL in RFT patient. The addition of minocycline to prednisone may accelerate the improvement of pustular ENL. We observed an improvement after the ninth day of minocycline administration compared to seven weeks of prednisone monotherapy. No new ENL lesions occurred during four weeks of minocycline administration therapy. Conclusion: Pustular ENL is an atypical manifestation of chronic ENL, and the addition of minocycline to prednisone may accelerate its therapeutic effect on the patient.
Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease clinically characterized by recurrent, deep-seated, painful, subcutaneous nodules, sinus tracts, and hypertrophic scarring. This disease affects hair follicles in the apocrine gland-bearing areas such as the axillae, buttocks, as well as the genital and perineal areas. In women, the predilection sites of HS include the anterior part of the body, most commonly on the breasts, inframammary area, and groin. Intermammary location possibly represents a rare phenotype presentation. A case of intermammary HS in a 24-year-old woman was reported. The patient is overweight and is a smoker. Frequent friction and excessive sweating between big breasts were admitted. Chronic painful nodules accompanied by sinuses and scars between the breasts were found. Histopathological examination from a skin lesion on the intermammary area showed follicular occlusion, follicular hyperkeratosis, and destroyed hair follicles. There were also apocrine glands and hair follicles surrounded by massive neutrophils, lymphocytes, and histiocytes, suggestive of HS. The patient was given rifampicin and clindamycin. Clinical improvements were observed on the third week of observation. Typical lesion distribution is one of the criteria for establishing a definite diagnosis of HS. If the lesion is on an atypical site, it must be accompanied by at least one on the typical site. However, the predilection sites of HS often varied. The intermammary area is an intertriginous area, and mechanical friction, follicular occlusion, and rupture of the dilated follicles may contribute to the development of HS in the area. The existence of a typical lesion in an atypical distribution, without any lesion present in typical predilection sites, cannot rule out diagnostic consideration of HS. Therefore, clinicians should be aware and consider the diagnosis of HS even when the required criteria of HS are not fulfilled.
PURPOSE: Various graft sources had been identified to facilitate gap-filling in ankle arthrodesis procedures with related articular defects. This was a preliminary study with the aim of analyzing the efficacy and feasibility of using autologous osteophyte as a grafting source. METHODS: Retrospective evaluation of ten patients having ankle arthrodesis procedure using identical anterior approach and plate fixation technique was conducted. Basic anthropometric measurements and underlying disease were recorded. Functional outcome and fusion rate were assessed at a 12-month post-surgery follow-up visit. RESULTS: The underlying diseases include primary osteoarthritis (OA), post-traumatic OA, rheumatoid arthritis, and Charcot arthropathy. The patient's age mean was 56.6 years (range 36-71 years), and BMI varied from 17.9 kg/m2 to 29.3 kg/m2. Nearly all patients had improved functional outcomes as described by foot and ankle ability measure (FAAM) score and fusion rate as described by modified radiographic union score for tibia (RUST). One patient had failed surgery due to implant failure with diminished protective foot sensory. CONCLUSION: Osteophytes from the distal tibia and talar neck were a viable source of bone graft, especially for ankle arthrodesis using anterior approach among various ages and BMI, in which the surgeons would not need additional incision for graft harvesting.
Anogenital warts (AGW) are among the most common sexually transmitted infections worldwide. The condition may be persistent, increase in size and number, and have a high recurrence rate. There are many therapeutic options of AGW, but none of them prevented recurrence, only yielded partial responses and have the propensity to cause scars. Immunotherapy by purified protein derivative (PPD) is one of the therapeutic options for AGW, which effectively reduces the number of lesions until complete clearance, with minimal side effects and less recurrence rate. This case report aims to demonstrate the effectiveness, safety, and low recurrence rate of intralesional PPD injection as an alternative therapy for AGW. We reported one case of AGW in an immunocompetent 30-year-old homosexual man who was given 3 doses of 0.2 mL PPD injected intralesionally. As a result, clinical improvement was observed starting from the 18th day, with some of the lesions decreasing in size, and on the 46th day, all of the lesions disappeared. There was no significant side effect. Within two years of follow-up, no recurrence was observed. Intralesional injection of PPD can stimulate the immune response against human papillomavirus (HPV) infection both on the injection site and distant from the injection site. Previous studies have shown promising results of intralesional PPD, with low recurrence in over six-month follow-up and no side effects. Intralesional injection of PPD can be considered as an alternative therapy due to its minimal side effects and its long-term low recurrence rate.
Crusted scabies (CS) is a severe variant of scabies, highly contagious, caused by numerous Sarcoptes scabiei (S. scabiei) infestation. CS is associated with immunosuppressive conditions, like systemic lupus erythematosus (SLE). Various topical and oral scabicidals are used in the treatment of CS, including topical sulfur compounds, benzyl benzoate, crotamiton, lindane, malathion, permethrin, and ivermectin. The treatment of CS does not only need scabicidals, but also keratolytic agents to remove the thick crusts. The severity of CS is classified into three levels and related to the dose of oral ivermectin treatment. When oral ivermectin is not available, oral albendazole can be used as an alternative treatment. A case of CS in a 21-year-old girl with SLE was reported. Physical examination showed multiple lesions in the form erythematous papules, plaques, scales, and hyperkeratotic crusts in almost all parts of the body. The distribution of crusting >30% body surface area, the depth of crusting >10 mm, and there were pyoderma. Sarcoptes scabiei, eggs, and scybala were found on skin scraping. The patient was diagnosed as a moderate CS and treated with occlusive dressings using 5% salicylic acid in vaseline until crusts fell off, 5% permethrin cream three times per week, and 800 mg/day albendazole three consecutive days per week. A clinical and microscopic cure was achieved at day 19 of observation. Albendazole is an antiprotozoal agent with larvicidal effect, therefore it can be used as an alternative treatment of CS when oral ivermectin is unavailable, along with 5% permethrin and 5% salicylic acid.
Kyrle's disease (KD) is a rare type of acquired perforating dermatosis (APD) associated with various systemic diseases, particularly chronic kidney disease and diabetes mellitus (DM). It most commonly occurs at the lower extremities. Generalized lesions of KD are rare. We report a case of generalized KD in a 29-year-old woman with chronic kidney disease and DM. Physical examination revealed multiple hyperkeratotic and hyperpigmented papules, plaques, and nodules with central umbilication and keratotic plugs on almost all parts of the body. Histopathological examination showed keratinized epithelial layer with acanthosis and hyperkeratosis, invagination with the formation of keratin plugs, and basophilic cell debris accompanied by parakeratosis and abnormal keratinization of epithelial cells. These histopathological findings fulfilled the Constantine and Carter criteria for KD. This condition is characterized clinically by umbilicated, round, erythematous or hyperpigmented papules and nodules with central crusts or keratotic plug, predominantly involving the extensor surfaces of the extremities and the trunk. Although uncommon, it may also involve the face or the scalp. Nevertheless, generalized lesions involving faces are rarely found in KD.
Alopecia areata (AA) is an autoimmune disease-specific to specific organs mediated by T lymphocytes with hair follicles as targets. Severe AA could be in the form of alopecia universalis (AU). AU therapy is relatively difficult and challenging with varying outcomes. Herein, we reported a case of AU in a 19-year-old man with alopecia in the hairy scalp area, eyebrows, eyelashes, moustache, beard, and axillary hair since 2.5 years ago. The patient's severity of alopecia tool (SALT) score was 100%. The patient was given a combination therapy of 15 mg methotrexate per week and 16 mg methylprednisolone per day orally and topical treatment with minoxidil 5%. Observations after nine months of treatment showed an improvement in the decrease in SALT scores to 41%. However, striae were found after 3rd month of therapy. Systemic combination therapy of methotrexate and low-dose corticosteroids and topical minoxidil 5% in this patient gave responsive results. Performed the hematological examination, liver function levels, blood glucose levels, and cortisol during long-term use of methotrexate and corticosteroids are necessary. The combination of systemic methotrexate and corticosteroids, and topical minoxidil showed promising results in AU. Nevertheless, long-term observation is still needed to monitor the side effects of therapy.
