Efficacy and Safety Profile of Tuberculin Protein Purified Derivative Injection As Immunotherapy For the Treatment of Cutaneous and Anogenital Warts: A Review Article.

Introduction: Various treatments available today for anogenital and cutaneous warts have limitations, including time-consuming, challenging to perform, and the risk of scarring. A new treatment using tuberculin purified protein derivative (PPD) has been developed, which is expected to generate cellular immunity against HPV. Objective: To assess the evidence for the efficacy and safety of PPD treatment for cutaneous and anogenital warts. Materials and methods: A literature search was performed with the keyword-based search on digital libraries, including the National Library of Medicine, Cochrane Controlled Register of Trial, and Google Scholar, using the following terms: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, and tuberculin purified protein derivative. Original studies on treating cutaneous or anogenital warts with PPD were included. The results were 47 clinical trials and 4 case reports. Most of the research was done in countries with common Mycobacterium tuberculosis infection. The treatment showed good efficacy. Comparative studies showed that the treatment has similar efficacy with other immunotherapies. No significant side effects were reported, with evidence of the safety use on the pregnant population. Conclusion: Based on good efficacy and safety, PPD can be considered an alternative therapy, especially in countries where tuberculosis is frequent.

Generalized Asymptomatic Nodulo-Ulcerative Lesions Without Systemic Symptoms in a Secondary Syphilis Patient Co-Infected with HIV.

Syphilis is a sexually-transmitted disease with various clinical stages. Secondary syphilis manifestations may mimic other skin lesions. Patient co-infected with Human Immunodeficiency Virus (HIV), with CD4 cell counts of 200-499 cells/mm3, often manifests an atypical cutaneous lesion, which may also occur as nodular or ulcerative lesions. Generalized nodulo-ulcerative lesions without systemic symptoms in secondary syphilis patients with HIV co-infection are rarely reported. A 22-year-old man presented with generalized asymptomatic multiple erythematous papules and plaques with scales, as well as nodular and nodulo-ulcerative lesions on the trunk, both arms, and both legs. His lesions spread progressively without the presence of any prodromal symptoms or adenopathy. He was previously diagnosed with HIV and is currently on antiretroviral medications, with a CD4 cell count of 388 cells/µL. His venereal disease research laboratories (VDRL) result was reactive (titer of 1:256). His Treponema pallidum hemagglutination assay (TPHA) result was also reactive (titer of 1:10,240). A skin biopsy was performed from the nodulo-ulcerative lesion on his back. Hematoxylin-eosin staining revealed a hyperplastic epidermis, a massive influx of plasma cells, and lymphocyte infiltration into the deep dermis, especially in the peri-adnexal, peri-vascular, and peri-muscular regions. The patient was diagnosed with secondary syphilis with HIV co-infection. He had no previous history of drug allergy. A single dose of 2.4 million units of benzathine penicillin G was administered. Almost all the lesions became hyperpigmented macules after two weeks and resolved completely after one month. His VDRL titer declined to 1:32 after three months. The various atypical lesions of secondary syphilis may lead to misdiagnosis and delayed treatment. The presence of multiple asymptomatic nodulo-ulcerative lesion without prodromal symptoms may indicate the presence of secondary syphilis, notably in patients co-infected with HIV. Therefore, knowledge of atypical cutaneous manifestations of secondary syphilis is warranted in order to treat patients accordingly.

Evaluation of Scalp Hydration and pH Values in Hijab-Wearing and Non-Hijab-Wearing Women.

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.

Lupus Erythematosus Profundus with Multiple Overlying Cutaneous Ulcerations: A Rare Case.

Lupus erythematosus profundus (LEP) is a rare subset of chronic cutaneous lupus erythematosus (CCLE), with a reported incidence of 1-3% in all LE cases. The most common cutaneous clinical presentation includes indurated plaques or subcutaneous nodules with an overlying normal skin. The clinical findings range from skin redness to features of CCLE, such as scaling, follicular plugging, and atrophy. Ulceration is rare and occurs in 28% of all LEP cases. We present a case report of LEP with multiple cutaneous ulcers on the right cheek and scalp accompanied by cicatricial alopecia. No other systemic manifestations were noted. Histopathological examination revealed periadipocyte, perivascular, and perivascular infiltration of lymphocytes, eosinophils, and plasma cells, supporting the diagnosis of LEP. The topical treatments given to the patient were sunscreen, 2% mupirocin cream, and wound dressing with dialkyl carbamoyl chloride (DACC). The patient was also treated systemically with oral corticosteroids and hydroxychloroquine. Clinical improvements were observed in the 3rd month of follow-up, and ulcer healing resulted in atrophic scars and fading erythematous macules. LEP is seldom associated with systemic or discoid lupus erythematosus. This occurs twice as frequently as a distinct entity does. Diagnosis accuracy plays an important role in determining the appropriate wound care, topical, and systemic treatments for LEP patients with multiple overlying cutaneous ulcerations.

The Efficacy of Topical Formulation Containing Ciplukan (Physalis angulata Linn.) in Modulating Interleukin-17 and Interferon Gamma Expression in Mice (Mus musculus) Psoriasis Model.

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.

Characteristics of Biofilm-Forming Ability and Antibiotic Resistance of Cutibacterium acnes and Staphylococcus epidermidis from Acne Vulgaris Patients.

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.

Spring-Powered Needle-Free Injection of Triamcinolone Acetonide and 5-Fluorouracil for Keloid Treatment.

Introduction: Keloid is an abnormal fibroproliferative healing response characterized by excessive and invasive tissue growth beyond the wound boundaries. The conventional treatment involves injecting drugs such as triamcinolone acetonide (TA), 5-fluorouracil (5-FU), or their combination intralesionally. However, the pain associated with injections often leads to low patient compliance and treatment failure. The spring-powered needle-free injector (NFI) provides an affordable alternative option for drug delivery with reduced pain. Case: This case report presents a 69-year-old female patient with a keloid treated using a spring-powered needle-free injector (NFI) for drug delivery. The keloid was assessed using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The patient's pain level was measured using the Numeric Pain Rating Scale (NPRS). TA and 5-FU mixed with lidocaine were loaded into the NFI and injected at a dose of 0.1 mL/cm2. The treatment was repeated twice a week. After four sessions, the keloid flattened by 0.5 cm, VSS score decreased from 11 to 10, and POSAS scores decreased from 49 to 43 (observer) and from 50 to 37 (patient). The NPRS during each procedure was 1, indicating minimal pain. Discussion: The spring-powered NFI is a simple and cost-effective device that operates based on Hooke's law, producing a high-pressure fluid jet for effective skin penetration. The NFI demonstrated effectiveness in treating keloid lesions, resulting in visible improvement after four treatments. Conclusion: The spring-powered NFI offers an affordable and painless alternative to keloid treatment.

Superficial Basal Cell Carcinoma on the Back Region Treated with a Combination of Cryotherapy and 5% Imiquimod Cream: A Case Report.

Basal cell carcinoma (BCC) is the most common skin malignancy, consisting of cells in the basal layer epidermis and its appendix. Superficial BCC is the second most common BCC subtype with a predilection on the trunk including the waist and can be treated with cryoimmunotherapy, a combination of cryotherapy and imiquimod cream. Herein, we report a case of superficial BCC in a 60-year-old woman which was triggered by short-wave diathermic (SWD) therapy on the waist one year previously. Superficial BCC was diagnosed based on clinical symptoms, a dermoscopy, and histopathology. The erythematous and hyperpigmented plaque on the waist had well-defined edges and bled easily. There were pseudopods, a blue-grey ovoid nest, haemorrhagic ulceration, and a deeply pigmented border with basaloid cells in the basal layer of the epidermis and palisade cells at the edges. The patient was treated with cryoimmunotherapy consisting of two cycles of a 30-second freeze time and a 5 mm margin, then two weeks later, 5% imiquimod cream was applied to the skin for five consecutive nights, followed by two days off for six cycles (six weeks). Follow-up at three months revealed clinical improvement with reduced lesion size, confirming that cryoimmunotherapy is an effective treatment for the management of superficial BCC with mild side effects.

Increased Expression of Toll-Like Receptor (TLR) 2 and TLR6 on Peripheral Blood Monocytes by Induction of Staphylococcal Enterotoxin B During Exacerbation of Atopic Dermatitis Patients.

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.

Atypical Nevus Sebaceus at an Unusual Location Treated with Carbon Dioxide Laser: A Case Report.

Nevus sebaceus (NS) or organoid nevus is an epidermal nevus comprising predominantly sebaceous glands with a prevalence of approximately 0.3% of the newborns. The initial clinical manifestations of NS are single or less commonly multiple yellowish patches with overlying alopecia, usually confined to the scalp. However, it can also appear on the face, preauricular area, and the neck. During puberty, skin lesions will turn into round or linear verrucous plaques accompanied with an increase in number due to the influence of androgens. As they progress, about 20% of the NS cases might turn into secondary tumors which can be benign or malignant (in 2.5% cases). NS can manifest as atypical lesions and may also arise on areas other than its predilection sites. A case of a lesion presented on an atypical location of an 18-year-old male patient treated with carbon dioxide (CO2) laser was reported. Physical examination revealed skin-colored and blackish-brown papules arranged in groups on the left side of the patient's chest. Histopathological examination on a sample taken from one of the skin lesions on the chest showed hyperkeratosis, acanthosis, papillomatosis, and sebaceous hyperplasia, confirming the diagnosis of NS. The patient was treated with CO2 laser, and clinical improvements were observed. Histopathological examination of NS is not routinely performed; however, it should be carried out when the lesion is atypical and presented at an unusual location, or there is a suspicion of malignancy.

Multiple Bullous and Ulcers as Cutaneous Manifestations of Wegener's Granulomatosis: A Rare Case Report.

Bullous dermatoses is a heterogeneous group of blistering skin disorders that can either be inherited or acquired. Subepidermal blisters may result in ulceration and scarring following their rupture. Wegener's granulomatosis (WG) is a granulomatous necrotizing vasculitis affecting small- to medium-sized blood vessels. It is associated with anti-neutrophil cytoplasmic antibodies (ANCA) and can be manifested cutaneously as multiple bullous and ulcers. A case of WG was reported in an 18-year-old man presented with multiple skin bullous and ulcers. The patient was diagnosed with WG based on the findings from nasopharyngoscopy examination that revealed crusts in his nasal cavity; necrotizing granulomatous appearance on chest radiograph; hematuria on urinalysis; and positive ANCA blood test. This patient received a combination of methylprednisolone and methotrexate, resulting in improvement within four weeks of therapy. His multiple skin ulcers were treated with a combination of dialkyl carbamoyl chloride, hydrocolloid, and hydrogel dressings. This patient was in complete remission state after six months of treatment, which later followed by a relapse episode that occurred within one year. WG with multiple skin bullous and ulcers can mimic other diseases. Various examinations such as histopathology, direct immunofluorescence, and ANCA blood test may aid in determining the etiology of skin bullous and ulcers.

Cryotherapy as an Effective therapeutic Option in Patients with Nodular Basal Cell Carcinoma - Case Report.

Basal cell carcinoma (BCC) is a malignant tumor originating from epidermal cells. A case of BCC was reported in a 67-year-old female, with the initial complaint of skin-colored papules, which later turned into a nodule with erosion and crusts on the right shoulder. The diagnosis is established from findings consistent with nodular BCC on physical examination, and from dermoscopic appearance revealing ulceration, blue-gray ovoid nests, deeply pigmented border, and arborizing vessels. Histopathological examination showed tumor cells forming palisading structures with myxoid stroma, polymorphic, hyperchromatic and mitotic nuclei, as well as fibrocollagen connective tissue cells with lymphocyte infiltrates. Cryotherapy is a therapeutic option for BCC in old patients and has a cure rate of around 95%. Observation on the 25th day revealed clinical improvement with reduced nodular lesion size; thus, further cryotherapy was needed to enhance the therapeutic outcomes.

Efficacy of Triamcinolone Acetonide Injection in a Case of Giant Spiradenoma.

Spiradenoma is a rare benign adnexal tumor with eccrine differentiation. The clinical manifestations include painful, skin-colored, red, gray, or bluish nodules on the upper half of the body. We report a case of spiradenoma in a 31-year-old man. The diagnosis was established from the patient's history, physical examination, and histopathological examination. In this case, the patient was treated with intralesional injection of triamcinolone acetonide (TA) 10 mg/mL. After the fourth injection, the lesions grew smaller and thinner. TA injection is easy to administer and showed good efficacy in spiradenoma case, although further research with a larger number of patients is needed.

A Case Report: Clinical Efficacy of Combination Treatment of Dexamethasone and Azathioprine in Recurrent Erythema Multiforme.

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.

Cutaneous Metastases from Thymic Carcinoma Primary Tumor: A Rare Case.

Cutaneous metastases (CM) are neoplastic lesions of the skin originating from a primary tumor elsewhere. CM originating from primary thymic carcinoma is rare, and its incidence remains uncertain. A case of CM from thymic carcinoma in a 57-year-old man was reported. The patient complained about lumps on the skin of the chest, right shoulder and neck that appeared eleven months before the diagnosis of thymic carcinoma was established. Physical examination revealed tumors on the chest, right shoulder and neck. Histopathological examination results were consistent with CM. An immunohistochemical (IHC) examination was performed to determine the primary tumor, with a positive result for CK7. The diagnosis of thymic carcinoma was established based on the results of enhanced chest CT-scan and immunohistochemistry on lymph node biopsies. The patient was treated with a chemotherapy regimen of cyclophosphamide, doxorubicin, and carboplatin scheduled for six cycles. However, the patient did not survive his third cycle of chemotherapy. Establishing the diagnosis and managing CM are challenging for clinicians. This requires careful historical and physical examination, supported by histopathological examination and specific immunohistochemical marker in accordance with the suspected tumor.

The Effect of Platelet-Rich Plasma on Type I Collagen Production, VEGF Expression, and Neovascularization after Femoral Bone Implants: A Study on Rat Models.

Introduction: Platelet-rich plasma (PRP) contains many growth factors, such as FGF, which induces the production of type I collagen, and VEGF, which induces neovascularization, all of which are important in bone healing. This study aimed to evaluate the effect of PRP administration on type I collagen production, VEGF expression, and neovascularization in rat models following femoral bone implants using K-wire. Methods: An experimental randomized control study was conducted on 24 white male rats (Rattus norvegicus) in the Wistar strain that underwent K-wire implantation, where PRP was administered to the treatment groups. The amount of type I collagen was measured by immunohistochemistry VEGF expression using sandwich ELISA, and neovascularization by histopathological examination. Results: The amount of type I collagen in the treatment group (50->150/field of view) was significantly higher than the control group (0-99/field of view; p=0.003). VEGF expression in the treatment groups was significantly higher than controls: 10.90±4.47 and 2.29±0.92, respectively (p=0.006). Mean number of new vessels formed on fibrotic capsules in the treatment groups was significantly (p=0.007) higher than the control groups (2.69±1.03 vs 0.67±0.52). Conclusion: The use of PRP significantly increased type I collagen production, VEGF expression, and neovascularization in rat models, elucidating the potential of PRP to be used in clinical settings to enhance the bone-healing process.

A Large Squamous Cell Carcinoma on the Face Treated with Wide Excision and Defect Closure Using Forehead Flap Reconstruction.

Introduction: Squamous cell carcinoma (SCC) is a non-melanoma skin cancer, with a rising worldwide incidence. Wide excision with an intraoperative frozen section decreases its recurrence rate and metastases. Case: We reported an SCC case in a 50-year-old woman with clinical manifestations of a 4 × 6 × 0.3 cm solitary ulcer that easily bled. Dermoscopy and histopathological examination support the diagnosis of SCC. Due to its size, a wide excision was initiated, followed by a frozen section being carried out to determine the cancer cell-free margin. We performed an additional 1 cm margin excision as residual tumor still remained in the margin on the first excision. The forehead interpolation flap reconstruction was performed right after the excision to cover the extensive defects on the cheek, followed by a full-thickness skin graft (FTSG) for the forehead. The patient recovered well without complication within eight weeks post-procedure. Discussion: SCC with a diameter larger than 2 cm is considered as high-risk, and a wide excision is the standard treatment in this condition. However, this may risk incomplete excision, leaving residual tumor and increased recurrence rate. Intraoperative frozen section aids the surgeon to determine tumor margin, thus improving the success rate of therapy by up to 95%. A skin graft on the cheek was avoided due to concerns of wound contraction, which may lead to lower tissue survival rates with poor color and texture matching. Therefore, we preferred a skin flap to increase tissue survival and preserve facial contour as well as skin color. Forehead interpolation flap was carried out as it could cover the large size of the skin defect. The forehead skin as donor was later closed by a FTSG. Conclusion: Wide excision surgery with frozen sections is the best option for managing large SCC while a skin flap is preferred to close defects on the cheek.

Comparison of clinical presentation and outcome of childhood-onset and adulthood-onset of systemic lupus erythematosus among Indonesian patients.

INTRODUCTION: The clinical presentation of childhood-onset systemic lupus erythematosus (SLE) is generally perceived to differ from that of adult-onset SLE. OBJECTIVE: We aimed to compare the demographic and clinical manifestation between childhood-onset vs. adult-onset SLE in a cohort of Indonesian patients at tertiary care centers. METHODS: This retrospective study included patients in the Hasan Sadikin Lupus Registry from 2008 until December 2017. The demographics, clinical presentations, and outcomes were compared between childhood-onset SLE (<18 years old) (Group 1) and adult-onset SLE (≥18 years old) (Group 2). RESULTS: Eight hundred seventy patients were involved into this study. The proportion of childhood-onset SLE was 20% (174 patients). The mean age of group 1 versus group 2 was 13.56 ± 3.04 vs 30.41 ± 8.54 years. The following clinical manifestations at SLE diagnosis were significantly more common in childhood-onset than in adult-onset SLE patients: hematological disorder (p = 0.033) and arthritis (p = 0.006). While discoid rash (p = 0.036) and photosensitivity (p < 0.001) were significantly found higher in adult-onset SLE. Cyclophosphamide therapy was significantly more common to be used in childhood-onset (38.5% vs 21.0%, p = <0.001). However, frequency of mortality on follow-up tended to be higher in childhood-onset group (11.5% vs 7.0%, p = 0.208). CONCLUSION: Arthritis and hematologic involvements at SLE diagnosis were more prominent in childhood-onset compared to adult-onset patients, and mortality in childhood-onset SLE during follow-up relatively higher. This data may suggest the need for more aggressive management approach to childhood-onset patients with SLE.

A Pilot Study: Composition and Diversity of 16S rRNA Based Skin Bacterial Microbiome in Indonesian Atopic Dermatitis Population.

BACKGROUND: Atopic dermatitis (AD) interferes with quality of life and is influenced by important factors like skin microbiome. The results of the skin microbiome composition and diversity in AD varied in some studies. PURPOSE: This study aims to determine the composition and diversity of the skin microbiome in Indonesian AD patients. PATIENTS AND METHODS: Genomic deoxyribonucleic acid (DNA) preparations were obtained from skin swabs of the cubital fossa of 16 subjects, nine of which were having mild AD, three moderate AD, and four healthy individuals. DNA extraction and sequencing of the 16S ribosomal ribonucleic acid (rRNA) gene using next-generation sequencing and bioinformatics analysis were further performed. RESULTS: Firmicutes (p), Bacilli (c), Bacillales (o), Staphylococcaceae (f), and Staphylococcus (g) were dominant in moderate AD. On the contrary, Proteobacteria (p), Gammaproteobacteria (c), Pseudomonadales (o), Moraxellaceae (f), and Acinetobacter (g) were dominant in mild AD. Staphylococcus aureus was found in the highest number in individuals with moderate AD. Interestingly, Ensifer adhaerens was found in mild AD. Microbial diversity was decreased in moderate AD. CONCLUSION: Metagenomic analysis in this study identified microbes in moderate and mild AD and showed a low diversity of skin microbiomes in moderate AD. Interestingly, this is the first time that the bacteria Ensifer adhaerens was detected on the human skin.

Erythema Induratum of Bazin Accompanied by Atrophy of the Subcutaneous Fat.

Erythema induratum of Bazin (EIB) is a predominantly lobular panniculitis with or without vasculitis due to Mycobacterium tuberculosis (MTB) infection. Atrophic scars may remain after EIB was healed. Rare cases of EIB showing sharp skin depression may mimic deep morphea and lupus profundus. A rare case of EIB was reported in a 35-year-old female with slightly tender erythematous-violaceous nodules and hyperpigmented depressed scars on both lower legs, resulting in asymmetrical lower leg shape. Histopathological examination showed lobular panniculitis without vasculitis and granulomatous inflammation consisted of caseous necrosis, epithelioid cells, and multinucleated giant cells. Polymerase chain reaction (PCR) from skin biopsy revealed deoxyribonucleic acid (DNA) of MTB. Tuberculin skin test (TST) was positive with a 20-mm induration, and nuclear 99mTc-ethambutol scintigraphy was positive for tuberculosis infection in one-third distal portion of the left lower leg. Clinical improvements were shown after 6 months of antituberculosis therapy. EIB must be considered in patient with erythematous-violaceous nodules on lower leg, especially in endemic areas of tuberculosis infection since diagnosis can be difficult and occasionally, deceptive.