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All Journal Journal of General-Procedural Dermatology & Venereology Indonesia
Wibawa, Larisa Paramitha
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Medicine & Pharmacology

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Acquired vulvar lymphangioma: Report of two cases Widyasari, Indah; Fathan, Hafiza; Wibawa, Larisa Paramitha; Cipto, Herman; Sampurna, Adhimukti T; Sirait, Sondang Pandjaitan
Journal of General - Procedural Dermatology & Venereology Indonesia
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Vulvar lymphangioma is a rare case and often being misdiagnosed as genital wart. This acquired disorder manifests as dilatation of superficial lymph vessel due to obstruction. It is caused by urogenital infection and most often occurs following surgery and radiotherapy of cervical cancer. The diagnosis is established based on clinical and histopathological features. Treatment aimed to eliminate the cause of obstruction. This article reports two cases of vulvar lymphangioma found in our Hospital. First case was a 43-year-old female with a history of surgery and radiation for cervical cancer 10 years ago presented with vesicular skin lesion in genital area, oozing copious clear fluid since 4 years ago. There are multiple lenticular vesicles containing clear fluid in vulvar area accompanied with bilateral lymphedema of lower extremities. Histopathological features demonstrated dilated superficial lymph vessels. Second case was a 44-year-old female with enlargement of lower abdomen with vesicular lesion containing clear fluid in genital area since 3 years ago. Abdominal USG showed enlarged inguinal lymph node. Histopathological features demonstrated dilated superficial lymph vessels. The treatment for both cases were gradual electrosurgery. In both cases,vulvar dermis’ superficial lymph node dilatation caused the skin lesions. Obstruction of lymph vessel due to radiation and surgery for cervical cancer in the first case and of inguinal lymph node in the second case lead to increased lymphatic pressure in the dermis and later on the dilatations. The treatment in both cases using electrical excision produced good responses; however, we should be attentive on recurrent case.
Challenge in diagnosis and management of lentigo maligna and lentigo maligna melanoma Anggraini, Ika; Miranda, Elisa; Wibawa, Larisa Paramitha; Krisanti, Roro Inge Ade; Sampurna, Adhimukti T
Journal of General - Procedural Dermatology & Venereology Indonesia
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Lentigo maligna (LM) is a subtype of melanoma in situ, which can evolve into lentigo maligna melanoma (LMM) if treated inadequately. LM and LMM are usually found on chronically sun damaged skin such as the face (cheek and nose) of the elderly on seventh or eight decades. Clinical manifestation of LM may be quite subtle, so early diagnosis is difficult to perform.The treatment of LM and LMM are challenging due to ill-defined clinical margin, predilection on the face with great size, and preponderance of the elderly, which are potential for recurrency and progressiveness from LM into LMM.
Vaginal microbiota in menopause Martinus, Martinus; Wibawa, Larisa Paramitha; Effendi, Evita Halim; Yusharyahya, Shannaz Nadia; Nilasari, Hanny; Indriatmi, Wresti
Journal of General - Procedural Dermatology & Venereology Indonesia
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The human vagina together with its resident, microbiota, comprise a dynamic ecosystem. Normal microbiota is dominated by Lactobacillus species, and pathogen microbiota such as Gardnerella species and Bacteroides species can occur due to decrease in Lactobacillus domination. Lactobacillus plays an essential role in keeping normal vaginal microbiota in balance. Vaginal microbiota adapts to pH change and hormonal value. Changes in the vaginal microbiota over a woman’s lifespan will influence the colonization of pathogenic microbes. They include changes in child, puberty, reproductive state, menopause, and postmenopause. Estrogen levels change will affect the colonization of pathogenic microbium, leading to genitourinary syndrome of menopause. Vulvovaginal atrophy is often found in postmenopausal women, and dominated by L. iners, Anaerococcus sp, Peptoniphilus sp, Prevotella sp, and Streptococcus sp. The normal vaginal microbiota’s imbalance in menopause will cause diseases such as bacterial vaginosis, and recurrent vulvovaginal candidiasis due to hormonal therapies. Changes in the vaginal microbiota due to bacterial vaginosis are characterized by decrease in H2O2-producing Lactobacillus. They are also caused by the increase in numbers and concentration of Gardnerella vaginalis, Mycoplasma hominis, and other anaerob species such as Peptostreptococci, Prevotella spp, and Mobiluncus spp.
The role of oral vitamin D in several skin diseases Adelia, Astri; Wibawa, Larisa Paramitha; Sampurna, Adhimukti T; Budianti, Windy K; Zubier, Farida
Journal of General - Procedural Dermatology & Venereology Indonesia
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Vitamin D has many benefits for body and skin health. One of them is to regulate the immune system, both cellular and humoral. The pathogenesis of many skin diseases is associated with disturbance in regulation of cellular immune system. Research on the relationship between blood level of vitamin D and several diseases in dermatology is currently very advanced. Oral vitamin D is known to have many functions that play a role in the pathogenesis of several diseases of the skin. Therefore, its current use as a primary or supplemental therapy has been widely studied. Knowledge on various skin diseases with indication of oral vitamin D use is important to be understood, especially in association with some chronic diseases requiring long-term therapy. The effects of using oral vitamin D analogues are minimal, but hypervitaminosis D might cause uncomfortable symptoms for patients. Therefore, it is important to understand and regulate the amount of doses of oral vitamin D supplements prescribed.
Eccrine poroma: The prominent mimicker Shihab, Nahla; Kristanti, Inge Ade; Sampurna, Adhimukti T.; Wibawa, Larisa Paramitha
Journal of General - Procedural Dermatology & Venereology Indonesia
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Background: Eccrine poroma (EP) is an adnexal benign tumor arising from the eccrine duct epithelium. The appearance of EP can mimic benign and malignant skin tumors, thus often making the diagnosis delayed or inaccurate. Case Illustration: We report two cases of EP, with clinical and dermoscopic features mimicking Bowen’s disease, verruca vulgaris, pyogenic granuloma, skin metastases of breast cancer, and amelanotic melanoma. Both patients were surgically excised and biopsied. Histopathology examination of both cases revealed eccrine poroma. Discussion: Both cases showed similarity with the theories, that EP is most found in middle age population and its predilection on extremities. The dermoscopy appearance of the first patient showed two major components, multiple red dots and lacunae mimicking glomerular vessels, and multiple whitish halos-likekeratosis. Red dots with whitish halos can be seen in dermoscopy of verruca vulgaris, while glomerular vessels and keratosis is usually found in Bowen’s disease. The dermoscopy examination of our second patient only showed some loop hemorrhagic and thrombosed vessels, which are quite inconclusive. Diagnoses were made with histopathology examination which revealed similar pattern of eccrine poroma in both cases. Conclusion: EP is a prominent mimicker, often misdiagnosed because it is uncommon in clinical practice, has variable clinical presentations and dermoscopic appearances. Hence, recognizing and diagnosing this disease becomes a challenge for dermatologist.
The epidemiology of skin cancer at Dr. Cipto Mangunkusumo National Central General Hospital from 2014 to 2017 Wibawa, Larisa Paramitha; Andardewi, Melody Febriana; Kristanti, Inge Adi; Arisanty, Riesye
Journal of General - Procedural Dermatology & Venereology Indonesia
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Background: The incidence of skin cancer has been increasing over the past decades globally. At present, there is no valid national cancer data in Indonesia. The purpose of this study is to evaluate the increment of skin cancer cases at Dr. Cipto Mangunkusumo National General Hospital, Jakarta. Methods: In this retrospective descriptive study, we evaluated all pigmented skin tumor cases from June 2014 to June 2017. Data were obtained from the Department of Anatomical Pathology and medical records at Dr. Cipto Mangunkusumo National General Hospital. Data were compared with previous reports. Results: From 263 skin cancer cases, the most frequent skin cancer was basal cell carcinoma (BCC; 66.9%), followed by squamous cell carcinoma (SCC; 27.4%), and malignant melanoma (MM; 5.7%). Most of the skin cancer were predominantly in the female population. In BCC and SCC, most of the patients were within the age group above 60 years (n = 106 and 18, respectively). In MM, the incidence is greater in age group of 41–50 years (n = 5). For BCC and SCC, the distribution sites of lesions were mostly in sun-exposed areas, whereas the distribution sites of MM were mostly in non-sun-exposed areas. Median diameters of BCC, SCC, and MM were 2, 4, and 6.5 cm, respectively. There was an increase of BCC incidence from 1996 to 2017. Conclusion: In comparison with other types, the incidence of BCC in Dr. Cipto Mangunkusumo National General Hospital is increasing. A well-documented skin cancer registry is required to establish national data of skin cancer in Indonesia.
The absence of prophylactic antibiotics administration and the surgical site infections rate in Mohs micrographic surgery Pradita, Riva Ambardina; Wibawa, Larisa Paramitha
Journal of General - Procedural Dermatology & Venereology Indonesia
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Background: The use of prophylactic antibiotics in dermatologic surgery, particularly in Mohs micrographic surgery (MMS), remains a gray area. Despite the low rate of surgical site infection (SSI), SSI can result in some significant morbidities. Thus, numerous dermatologists keep administering prophylactic antibiotics in MMS. Method: A search was conducted to identify clinically significant topics followed by literature review through the main available medical literature database. The three selected studies that met the inclusion and exclusion criteria were then critically assessed for their validity, importance, and applicability using the guidance from Centre for Evidence-Based Medicine for Critical Appraisal of Prognostic Studies. Results: Three articles showed a low SSI rate with a narrow confidence interval (CI): 0.91% (95% CI: 0.38%– 1.45%), 0.7% (95% CI: 0.21%–1.19%), and 0.72% (95%CI: 0.5%–0.9%). Conclusion: Based on the available studies, we conclude that the absence of prophylactic antibiotics is not related to the SSI incidence.
Dermoscopy-guided carbon dioxide laser destruction for nevus sebaceous: two case reports Wibawa, Larisa Paramitha; Ohara, Kuniaki
Journal of General - Procedural Dermatology & Venereology Indonesia
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Background: Nevus sebaceous (NS) is a common hamartoma of the cutaneous adnexal structure, clinically appear as a well demarcated yellow-orange plaque, sometimes with verrucous surface. Dermoscopy may aid the diagnosis of NS and also guide carbon dioxide (CO2) laser therapy. Case Illustration: Two cases of brown and yellowish plaque on the face, with clinical appearance, dermoscopic, and histopathological findings consistent with NS. The patients consented to undergo serial CO­2laser destruction, aimed to reduce recurrences and shorten the duration of the downtime. Dermoscopy aided in locating the area and the depth of each treatment. Discussion: The dermoscopy finding of NS were already reported as milia-like structure and multiple whitish structures (dots) varying in size, with orange background. The dermoscopy findings of these two cases were in accordance with previous reports. CO2laser destruction was reported to produce satisfying results, but with known recurrences. With the knowledge of dermoscopy appearance, we could determine the area and depth of the lesion to prevent reoccurrence. After two years of follow-up, the area where the deep ablation was performed had not reoccurred. Conclusion: Dermoscopy may aid the diagnosis and therapeutic confirmation of NS.
Co-Authors Andardewi, Melody Febriana Anggraini, Ika Astri Adelia, Astri Budianti, Windy K Evita Halim Effendi Farida Zubier Fathan, Hafiza Hanny Nilasari Herman Cipto Krisanti, Roro Inge Ade Kristanti, Inge Ade Kristanti, Inge Adi Martinus, Martinus Miranda, Elisa Nahla Shihab, Nahla Ohara, Kuniaki Pradita, Riva Ambardina Riesye Arisanty Sampurna, Adhimukti T Sampurna, Adhimukti T. Shannaz Nadia Yusharyahya Sirait, Sondang Pandjaitan Widyasari, Indah Wresti Indriatmi B. Makes