Lusiana Lusiana
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia – dr. Cipto Mangunkusumo General Hospital

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Case series of primary psychiatric skin disorders with multi-disciplinary approach Lusiana Lusiana; Rizky Lendl Prayogo; Shannaz Nadia Yusharyahya; Irma Bernadette S. Sitohang; Kusmarinah Bramono
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 4, No 2 (2020): June 2020
Publisher : Universitas Indonesia

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Background: The incidence of psychodermatologic diseases, a group of skin abnormalities associated with psychosomatic factor, are increasing recently. About 20-40% patients with skin symptoms have concurrent psychiatric problems which are often difficult to diagnose and treat. The new classification of primary psychiatric skin disorders are delusional disorders, obsessive-compulsive and related disorders, and factitious disorders. This classification could be used for effective treatment in each patient which involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Illustration: The first case was a 39-year-old unmarried female, with anemia and dermatitis artefacta occurred as wound due to blade cuts. Patient was with schizoaffective depressive type and was not under regular treatment. The second case was a 61-year-old male referred with unresolved prurigo nodularis for the past 30 years. After in-depth assessment, there were delusional parasitosis and neurotic excoriations disorders. The third patient was a 50-year-old female admitted with recurrent ulcer on her face. She was aware that the lesions were intentionally manipulated by her own fingers when she was depressed. Discussion: All patients were classified as primary psychiatric skin disorders with varied skin manifestations. Symptoms usually occurred when the patient was in the depression state or low compliance for the psychotropic drugs. Patients generally had poor insight and refused to be associated with psychiatric factors. Dermato-venereologists are expected to conduct early detection and treat this disease. Conclusion: It is important to approach psychocutaneous disease in multi-disciplinary manner, especially with the psychiatrist. Keywords: psychodermatologic, dermatitis artefacta, neurotic excoriations, delusion of parasitosis
Langerhans cell histiocytosis: Diagnosis and Management Lusiana Lusiana; Hikari Ambara Sjakti; Githa Rahmayunita; Tjut Nurul Alam Jacoeb; Inge Ade Krisanti
Journal of General - Procedural Dermatology and Venereology Indonesia Vol 4, No 1 (2019): December 2019
Publisher : Universitas Indonesia

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Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal clonal proliferation of Langerhans dendritic cells. The incidence of LCH is 1 to 3 cases per 1 million children worldwide, and occurs most frequently in children of 1–4 years of age. The etiopathogenesis of LCH, whether it is neoplastic or reactive, is still controversial. Langerhans cell histiocytosis has a wide spectrum of clinical features, and dermatological abnormalities usually occur early. The most frequent lesions are elevated yellowish-red translucent papules about 1–2 mm in diameter and generally located in seborrheic areas. The most recent classification (the Histiocyte Society study 2017) categorized LCH into four groups; a single system with involvement of unifocal or multifocal organs, lung LCH, and multi-system LCH with either low- or high-risk multiorgan involvement. The definitive diagnosis of LCH are typical morphology along with Birbeck granules and/or positive results on CD1a antigen stain on cells found on lesions. Treatment of LCH is multimodal, determined based on age, extent of lesion, organ involvement, and organ location. Keywords: histiocytosis, Langerhans cells, dendritic cells, children