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Tatalaksana Melanoma Maligna Kutaneus Chandra, Rudi
Cermin Dunia Kedokteran Vol 48, No 7 (2021): Infeksi - [Covid - 19]
Publisher : PT. Kalbe Farma Tbk.

Melanoma merupakan suatu tumor maligna dari melanosit, dengan lokasi paling sering adalah kulit (95% kasus). Tatalaksana melanoma tergantung stadium saat diagnosis; pembedahan masih merupakan pilihan utama. Pengobatan melanoma primer adalah bedah eksisi definitif dengan batas eksisi berdasarkan ketebalan tumor. Pada keterlibatan nodus limfatikus regional, dapat dilakukan diseksi elektif komplit. Pada rekurensi lokal dilakukan bedah reseksi komplit dengan penutupan luka primer atau eksisi lokal luas dengan skin grafting atau penutupan flap. Metastasis melanoma dibedakan menjadi metastasis kulit atau jauh. Tatalaksana metastasis melanoma dapat terapi sistemik (targeted therapy, terapi imun, dan kemoterapi) dan radiasi. Terapi adjuvan hanya untuk pasien tanpa bukti metastasis tetapi berisiko tinggi penyebaran tumor lebih lanjut.Melanoma is a malignant tumor of melanocytes, the most frequent location is in the skin (95% cases). Management of melanoma depends on the stage at diagnosis. Surgery is still the main choice of therapy. Treatment of primary melanoma is definitive excision surgery with excision limit based on the thickness of the tumor. In regional lymph node involvement, complete elective dissection can be performed. In local recurrence, complete resection is performed with primary wound closure or extensive local excision with skin grafting or flap closure. Treatment of melanoma metastasis can be divided into skin metastases or distant. Management of melanoma metastases can be systemic therapy (targeted therapy, immune therapy, and chemotherapy) and radiation. Adjuvant therapy is only given to patients without evidence of metastasis but is at high risk for further spread of the tumor.

Teknik Diagnostik dan Staging Melanoma Maligna Kutaneus Chandra, Rudi
Cermin Dunia Kedokteran Vol 47, No 10 (2020): Optalmologi
Publisher : PT. Kalbe Farma Tbk.

Melanoma maligna merupakan keganasan sel-sel penghasil pigmen (melanosit) yang terletak terutama di kulit. Tujuan setiap alat diagnostik adalah deteksi dini dan membedakan lesi jinak dan ganas, dengan sensitivitas dan spesifisitas tinggi. Diagnosis melanoma klinis dapat menggunakan Glasgow 7-point checklist, checklist ABCD, total-body photography, dan dermoskopi. Diagnosis histopatologi merupakan pemeriksaan baku emas untuk diagnosis. Diagnosis molekular dengan menilai status mutasi BRAF V600, MEK, NRAS, dan CKIT. Sedangkan teknik staging TNM menggunakan modalitas pencitraan lanjutan dengan kontras intravena, seperti computed tomography (CT) atau fluorodeoxyglucose (FDG)-based positron emission tomography (PET) CT scan, dan pemeriksaan sentinel nodus lymphatic.Malignant melanoma is a malignancy in pigments producing cells (melanocytes), located mainly in the skin. The aim of each diagnostic tool is early detection and differentiating benign and malignant lesions with high sensitivity and specificity. Clinical diagnosis can use the Glasgow 7-point checklist, ABCD checklist, total-body photography, and dermoscopy. Histopathological examination is a gold standard for diagnosis. Molecular diagnosis is done by assessing the status of mutations of BRAF V600, MEK, NRAS, and CKIT. Diagnostic techniques in melanoma TNM staging system use advanced imaging modalities with intravenous contrast, such as computed tomography (CT) or fluorodeoxyglucose (FDG)-based positron emission tomography (PET) CT scans, and examination of sentinel lymphatic lymph nodes. Rudi Chandra.

Gambaran Klinis dan Patologi Melanoma Maligna Kutaneus Chandra, Rudi
Cermin Dunia Kedokteran Vol 47, No 11 (2020): Infeksi
Publisher : PT. Kalbe Farma Tbk.

Melanoma maligna (MM) merupakan keganasan sel-sel melanosit terutama di kulit. Paling sering didiagnosis pada pada wanita < 40 tahun, dan pada pria > 40 tahun. Predileksi MM tersering pada kulit punggung (pria) dan pada ekstremitas bawah (wanita). Secara klinis dan patologis, melanoma maligna diklasifikasikan sebagai superï¬cial spreading melanoma, nodular melanoma, lentigo maligna melanoma, acral lentiginous melanoma, dan varian lain yang jarang.Malignant melanoma (MM) is melanocyte cells malignancy located mainly in the skin; most often diagnosed in women <40 years, and in men >40 years. MM predilection is in the back (men) and in lower extremities (women). Clinically and pathologically, malignant melanoma is classified as superficial spreading melanoma, nodular melanoma, malignant lentigo melanoma, acral lentiginous melanoma, and other rare variants.

Aspek Dermatologi Penuaan Kulit Periorbital Chandra, Rudi
Cermin Dunia Kedokteran Vol 47, No 9 (2020): Neurologi
Publisher : PT. Kalbe Farma Tbk.

Periorbital merupakan salah satu area pertama yang menunjukkan tanda-tanda penuaan, meliputi kerutan, perubahan tekstur, kekeringan, perubahan volume dan pigmentasi yang tidak merata dan tidak teratur. Hiperpigmentasi periorbital adalah lingkaran hitam bilateral atau coklat homogen setengah lingkaran atau gelap makula berpigmen coklat di regio periokular. Kantung kelopak mata disebabkan oleh melemahnya otot orbicularis oculi. Secara klinis, pola penurunan volume periorbital dapat dikategorikan menjadi kelas I sampai III. Kerutan periorbital disebabkan faktor intrinsik (seperti penuaan, genetik, dan status hormonal) dan faktor ekstrinsik (seperti paparan radiasi ultraviolet dan merokok). Berdasarkan kedalaman kerutan, Glogau mengusulkan klasifikasi tipe I (tidak ada kerutan), tipe II (kerutan saat bergerak), tipe III (kerutan saat istirahat), dan tipe IV (kerutan dalam)Periorbital is one of the first areas that shows the signs of aging, including wrinkles, changes in texture, dryness, changes in volume and uneven and irregular pigmentation. Periorbital hyperpigmentation is bilateral or brown homogeneous semicircular or dark brown pigmented macules in the periocular region. Eyelid sacs are caused by weakening of the orbicularis oculi muscle. Clinically, patterns of periorbital volume decrease can be categorized into 3 classes. Periorbital wrinkles are caused by intrinsic factors (such as aging, genetic, and hormonal status) and by extrinsic factors (such as exposure to ultraviolet radiation and smoking). Glogau proposed a classification consisting of type I (no wrinkles), type II (wrinkles when moving), type III (wrinkles at rest), and type IV (deep wrinkles).

Pitiriasis Rubra Pilaris yang Berhubungan dengan HIV Chandra, Rudi; Arif, Abdul; Antonius, Cayadi S
Cermin Dunia Kedokteran Vol 47, No 8 (2020): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Pitiriasis rubra pilaris (PRP) merupakan dermatosis papuloskuamosa idiopatik yang tidak diketahui penyebabnya, ditandai dengan papul-papul folikular hiperkeratotik berkoalesen menjadi plak bersisik jingga-kemerahan, islands of sparing, dan keratoderma palmoplantar. PRP awalnya diklasifikasikan oleh Griffiths ke dalam 5 kelompok berdasarkan gambaran klinis, onset usia, dan prognosis. Kemudian oleh Miralles et al diusulkan kelompok ke-6 yang berhubungan dengan human immunodeficiency virus (HIV). Insidensi PRP berkisar dari 1 dari 5.000 di Inggris sampai 1 dari 50.000 di India, puncaknya pada dekade pertama dan ke lima. Diagnosis PRP melalui manifestasi klinis dan pemeriksaan histopatologi. Pilihan pengobatan PRP tipe VI berbeda dengan tipe lainnya.Pityriasis rubra pilaris (PRP) is an idiopathic papulosquamous dermatosis with unknown etiology; characterized by hyperkeratotic follicular papules which coalesce into reddish-orange scaly plaques, islands of sparing, and palmoplantar keratoderma. PRP was initially classified by Griffiths into 5 groups based on clinical features, age of onset, and prognosis. Miralles et al. proposed the 6th group related to human immunodeficiency virus (HIV). The incidence of PRP ranges from 1 in 5.000 in the UK to 1 in 50.000 in India, with peaks in the first and fifth decades. Diagnosis can be established through clinical manifestations and histopathological examination. Treatment options for PRP type VI is different from other types.Â

Pilihan Pengobatan Dermatologis Penuaan Periorbital Chandra, Rudi
Cermin Dunia Kedokteran Vol 47, No 12 (2020): Dermatologi
Publisher : PT. Kalbe Farma Tbk.

Penuaan periorbital merupakan suatu proses tanpa henti dan tak terhindarkan seiring waktu. Meskipun tidak membahayakan fisik, kondisi ini memiliki berbagai efek psikososial dan fungsional. Tanda-tanda penuaan periorbital meliputi pembentukan kantung kelopak mata, kerutan periorbital, dan hiperpigmentasi kelopak mata. Penyebab utama serta faktor kontribusinya harus diidentifikasi dan diobati. Pilihan pengobatan antara lain agen topikal (hidrokuinon, asam kojic, asam azelaic, asam retinoat topikal), dan terapi fisik (chemical peel, terapi laser, transplantasi lemak autolog, injeksi fillers, plasma kaya platelet, dan injeksi botulinum toxins), sebagian besar telah teruji secara ilmiah.Periorbital aging is an endless and inevitable process. Although this condition does not cause physical harm, it has various psychosocial and functional effects. Signs of periorbital aging include eyelid pouch formation, periorbital wrinkles, and eyelid hyperpigmentation. The goal of treatment is to identify and treat the main causes and their contributing factors. Available treatment options are topical agents (hydroquinone, kojic acid, azelaic acid, topical retinoic acid), and physical therapy (chemical peels, laser therapy, autologous fat transplants, fillers injection, platelet rich plasma, and injection of Botulinum toxins), most have been scientifically tested.

Childhood-onset borderline tuberculoid leprosy with reversal reaction Lubis, Ramona D; Darmi, Mila; Chandra, Rudi
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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Background: Leprosy is a chronic granulomatous infection caused by Mycobacterium lepraethat predominantly affects the skin and peripheral nerves. Leprosy among children is still common in endemic countries. Case Illustration: A 12-year-old girl complained about a hypopigmented anesthetic patch on her face for 11 years, which became larger and spread slowly to her arms and legs. She had a history of close contact with her aunt, who was diagnosed with multibacillary leprosy. On slit-skin-smear test, acid-fast-bacilli (bacteriologic index +1) were found. She was diagnosed with multibacillary leprosy and treated with children’s multidrug therapy-multibacillary (MDT-MB) regimen. After 2 months of MDT-MB treatment, she complained that the hypopigmented patches became reddish and swollen with enlarged peripheral nerves. She underwent a reversal reaction (RR) and was treated with 40 mg prednisone daily and continued the MDT regimen. Discussion: RR is found less frequently in children than the adult.Accurate diagnosis is vital because of its psychosocial impact on the family. One of the most prominent features of borderline tuberculoid leprosy is its susceptibility to RR. It is characterized by rapid changes from existing plaques to edematous lesions with or without abrupt neuritis. Conclusion: We reported a girl with borderline tuberculoid leprosy with developed RR after taking MDT-MB for 2 months. The risk factors for developing RR were being diagnosed with borderline tuberculoid leprosy, female, multiple and disseminated patches involving larger body areas and multiple nerve involvement, large facial patches, and starting treatment. These risk factors were found in our patient.

Alternative modality in the treatment of acne vulgaris: Low level laser therapy Chandra, Rudi; Jusuf, Nelva K.
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 2
Publisher : UI Scholars Hub

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Acne vulgaris is a chronic inﬂammatory disease of the pilosebaceous unit with polymorphic manifestations. The four key elements leading to the formation of acne lesions are alteration of follicular keratinization that leads to comedones, increased and altered sebum production under androgen control, follicular colonization by Propionibacterium acnes, and complex inflammatory mechanisms that involve both innate and acquired immunity. Phototherapy (light, lasers, and photodynamic therapy) has been proposed as an alternative therapeutic modality to treat acne vulgaris and is proposed to have less side effects compared to other treatment options. Recently, low-level laser (light) therapy (LLLT) which refers to the use of red-beam or near-infrared laser with a wave-length between 600 and 1000 nanometers and power from 5 to 500 milliwatts, starts to be used in the treatment of acne. Mechanism of action of LLLT for acne is through photochemical reaction that produces reactive free radicals and singlet oxygen species which in turn lead to bacterial destruction by blue light. Meanwhile, red light can affect the sebum secretion of sebaceous glands, change keratinocytes behavior, and modulate cytokines from macrophages and other cells that reduce inflammation. LLLT is proposed to be effective as an alternative modality for inflammatory type lesions in acne vulgaris.

Dermoscopic and histopathologic findings in diagnosing postpartum pemphigoid gestationis Chandra, Rudi; Roesyanto-Mahadi, Irma Damayanti
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 8, No. 1
Publisher : UI Scholars Hub

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Background: Pemphigoid gestationis (PG) is an uncommon autoimmune vesiculobullous skin disorder associated with pregnancy, that occurs during mid-to-late pregnancy and immediate postpartum period. The diagnosis of PG is based on histopathology and direct immunofluorescence. Dermoscopy is a non-invasive diagnostic tool that provides a connection between macroscopic clinical dermatology and microscopic dermatopathology. Case Illustration: We reported a case of a 22-year-old primigravida woman with postpartum PG. This PG case was diagnosed clinically, dermoscopically, and histopathologically. Discussion: Since PG is thought to be a variation of the bullous pemphigoid (BP), the two resemble each other clinically and immunologically. The well-defined structures with brown-black dots in the central, yellowish translucent areas, follicular openings, peri-eccrine and perifollicular pigmentations, and a distorted pigment network were the dermoscopic findings of PG. To date, there is no literature about the dermoscopic features of PG. Conclusion: Dermoscopy is a simple non-invasive tool that can assist in making a rapid diagnosis, as well as in evaluating the prognosis, observing the response to treatment, and helping to determine the appropriate lesion and location for histopathological examination. We recommend that the dermoscopic features of PG in our case as a dermoscopic picture of PG.

Hubungan antara ketuban pecah dini dengan nilai Apgar pada kehamilan aterm Alexander, Rico; Rahimi, Armon; Mukhtar, Zulfikri; -, Djohan; Chandra, Rudi; Nasution, Syamsul Arifin
Jurnal Prima Medika Sains Vol. 3 No. 1 (2021): Juni
Publisher : Program Studi Magister Kesehatan Masyarakat Universitas Prima Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.34012/jpms.v3i1.1775

Ketuban pecah dini merupakan salah satu penyebab terjadinya asfiksia neonatorum dan infeksi yang dapat meningkatkan mortalitas dan morbiditas perinatal. Penelitian ini bertujuan untuk menilai hubungan antara lama ketuban pecah dini dengan nilai Apgar pada kehamilan aterm yang dirawat inap di Rumah Sakit Umum Mitra Sejati Medan. Jenis penelitian yang digunakan adalah penelitian analitik dengan desain penelitian cross sectional dengan metode pengambilan sampel accidental sampling. Dari sampel yang memenuhi kriteria restriksi didapat 68 ibu dengan kasus KPD. Hasil penelitian menunjukkan hasil lama KPD < 12 jam dengan Apgar baik adalah sebesar 22 kasus (73,3%) dan dengan Apgar buruk sebanyak 8 kasus (26,7%) sedangkan KPD ≥ 12 jam dengan Apgar baik sebesar 10 kasus (26,3%) dan nilai Apgar buruk sebesar 28 kasus (73,7%). Dari uji statistik dengan tes Chi Square didapatkan nilai X2 = 14,876 dan probabilitasnya (ρ) = 0,001. Dapat disimpulkan terdapat hubungan antara lama ketuban pecah dini dengan nilai Apgar.

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