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All Journal Medical Journal of Indonesia Journal of General-Procedural Dermatology & Venereology Indonesia
Githa Rahmayunita
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Medicine & Pharmacology

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Cushings syndrome induced by misuse of topical corticosteroids in a child with psoriasis vulgaris Rahmayunita, Githa; Pulungan, Aman B.; Wiryadi, Benny E.; Wisesa, Tina W.; Sugito, Titi L.; Boediardja, Siti A.
Medical Journal of Indonesia Vol 17, No 4 (2008): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (18683.375 KB) | DOI: 10.13181/mji.v17i4.323

Abstract

Prolonged exc)genous corticosteroid aclministration may cause Cushingi syndrome. Howeve7 the development of Cushings syndrome from topical corlico,sleroid therapy is rare. A  7%-year- old boy has sufferedfrom psoriasis vulgaris since the age of nvo. He was treated by a dermatologist with a mixlure of 3% salicylic acid, 50% liquor carbonis delergens, 10 grams of 0.1% mometasonefuroate ointment, ancl 5 grams combination cream consisting of 0.1% gentamycin sulphate and 0.0250 Àfiuocinolone acetonide. The parents continued the treatment without the doctorb supervision. They applied it lo all over the patients body three times dailyfor 3% years. The patient showed milcl hypertension, moonface, btffilo hump, obesity, multiple striae, and suppression of hypothalamus-pituitary-adrenal axis. The bone minerttl density and bone age examinations revealed normal results. Children are more prone to develop systemic side fficts of topical medicalion beccntse o/their higher ratio of btal body surface area to body weight. Corticosteroid must be used with great care, especially in children. It is very important to inform the parents abott polential side effects of corticosteroid. (Med J Indones 2008; 17: 281-6)Keywords: Cushings syndrome - topical corticosleroids, sicle fficts
A double-blind randomized controlled trial of topical Curcuma xanthorrhiza Roxb. on mild psoriasis: clinical manifestations, histopathological features, and K6 expressions Rahmayunita, Githa; Jacoeb, Tjut N.A.; Novianto, Endi; Indriatmi, Wresti; Rihatmadja, Rahadi; Pusponegoro, Erdina H.D.
Medical Journal of Indonesia Vol 27, No 3 (2018): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (703.258 KB) | DOI: 10.13181/mji.v27i3.2511

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Background: Curcuma xanthorrhiza Roxb. exerts its anti-inflammatory effects by reducing the concentration of IL-6, IL-8, and phosphorylase kinase, which has role in keratinocyte proliferation. Our study aimed to evaluate the efficacy of C. xanthorrhiza in psoriasis.Methods: From 18 to 59 year-old patients with mild psoriasis, 2 similar lesions were selected. The severity assessment was based on the psoriasis area severity index (PASI), Trozak score, and K6 expression. Using a double-blinded randomized method, lesion was treated with 1% C. xanthorrhiza ointment vs placebo for 4 weeks. The results were analyzed by the chi-square test using STATATM V.12 software (Stata Corp.).Results: The study was conducted in 2010 to 2012 with 17 subjects participated. The median of PASI score were reduced significantly in both lesions, either treated with 1% C. xanthorrhiza ointment vs placebo; however when compared between the group, it was not significant (p=0.520). The Trozak score were reduced in lesions treated with 1% C. xanthorrhiza ointment; but it was not significant (p = 0.306). In lesions treated with placebo, the Trozak score was increased significantly. The difference of Trozak score between lesions treated with C. xanthorrhiza and placebo was significant (p=0.024). There was no significant difference of K6 expression in lesions treated with 1% C. xanthorrhiza ointments or placebo as well as on the difference of mean values of K6 expression between the group (p=0.827).Conclusion: Based on the results, 1% C. xanthorrhiza ointment is effective treatment option for mild psoriasis, but longer follow-up period is suggested to confirm this results. C. xanthorrhiza ointment is safe for topical administration as there were no side effects reported in this study.
Multiple juvenile xanthogranuloma: A rare case of having clinical appearance mimicking molluscum contagiosum or syringoma Nugraha, Heru; Rosandi, Ridha; Nainggolan, Evelyn; Rahmayunita, Githa; Agustin, Triana; Rihatmadja, Rahadi; Boediardja, Siti Aisah
Journal of General - Procedural Dermatology & Venereology Indonesia
Publisher : UI Scholars Hub

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Introduction: Juvenile xanthogranuloma (JXG) is an uncommon benign cutaneous fibrohistiocytic, self-healing, class II non-Langerhan’s cell histiocytosis (NLCH). JXG accounts for 80-90% of cases of NLCH. It occurs most commonly on the head and neck of infants and young children and resolves spontaneously. Case: A one year-old boy presented with asymptomatic, multiple yellowish, shiny, and firm nodules with telangiectasia on the surface, measuring around 1 centimeter in diameter, on the face, the trunk, the arms, and lower extremities. The first lesion appeared on the face 8 months prior to consultation then spread gradually to other areas. He was referred from another hospital and was diagnosed as molluscum contagiosum (MC) with differential diagnosis of syringoma. Enucleation had been performed but failed to produce the molluscum bodies. Initial histopathological examination provided the diagnosis of syringoma. The second histopathological examination showed dermal inflammatory cells consisting of eosinophils, lymphocytes, and histiocytes with marked foam cells and giant cells. Eccrine sweat glands were normal. Some lesions decreased in size at subsequent follow-ups; observation was advised until 3-6 years. Discussion: JXG should be suspected in cases with multiple yellowish nodules appearing in the first year of life. MC usually presents with whitish papules, whereas syringoma is more rarely appeared, presenting with yellow-to-brownish papules. Histopathological examination can easily differentiate the suspected diagnoses; however, selection of lesion, timing and complete clinical information was crucial in reaching the final diagnosis. In this case there was a good clinicopathological correlation that the diagnosis of JXG was made with certainty. There was no eye and other organ abnormalities.
Occupational skin cancer and precancerous lesions Raissa, Fifinela; Rahmayunita, Githa; Menaldi, Sri Linuwih; Soemarko, Dewi
Journal of General - Procedural Dermatology & Venereology Indonesia
Publisher : UI Scholars Hub

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Occupational skin cancer and precancerous lesions are skin disorders caused by exposure to chemical carcinogens such as polycyclic hydrocarbons and arsenic, or radiation, such as ultraviolet light and ionizing light in the workplace. Annual increase in skin cancer incidence is believed to be related to various factors such as frequent intense sunlight exposure (i.e. at work, recreational activities, and sun-tanning habit), ozone depletion, an increase in number of geriatric population, and an increase of public awareness in skin cancer. The most common occupational skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Examples of occupational precancerous lesion of the skin are actinic keratosis and Bowen’s disease. Particular diagnostic criteria to diagnose occupational diseases has been developed. Early detection of occupational skin cancer and precancerous lesion is necessary. An effective prevention program consists of primary prevention such as prevention of hazardous material exposure, secondary prevention such as early detection of disease for early intervention, and tertiary prevention such as minimizing long-term impact of the disease.
Profile of vitiligo patients and distribution of narrowband-UVB therapy at dr. Cipto Mangunkusumo General Hospital Suseno, Lis Surachmiati; Sukma, Putu Martha Gerynda; Rihatmadja, Rahadi; Agustin, Triana; Rahmayunita, Githa; Novianto, Endi
Journal of General - Procedural Dermatology & Venereology Indonesia
Publisher : UI Scholars Hub

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Background: Vitiligo is a disease marked by depigmented macules. Prevalence of vitiligo varies between 0.1- 2.3% worldwide. The objectives of this study are to identify the socio-demographic profile of vitiligo patients and distribution of narrowband-UVB given as a treatment modality. However, in Indonesia, including at dr. Cipto Mangunkusumo General Hospital, there has not been any study on the profile of vitiligo patients. Therefore, a preliminary study on the patients’ profile would be very useful for healthcare providers in calculating the need for narrowband-UVB equipment and evaluation of its current use. Methods: A retrospective descriptive study, using secondary data obtained from dr. Cipto Mangunkusumo General Hospital medical records during the period of 2015-2017. Results: There were 255 vitiligo patients enrolled. Females were greater in number (55.3%). Most patients were distributed evenly in all age groups, highest number of patients were the 21-30 years age group (18.8%). Most patients received elementary school–high school education (56.9%), worked as private employees (36.9%), resided in Jakarta (47.8%). The common diagnosis were unspecified vitiligo (53.3%). Onset of symptoms were mostly around 2 months prior to diagnosis (38.8%) and most of the patients received other treatments other than narrowband-UVB (N=180, 70.6%). Conclusion: The number of vitiligo cases decreased each year with the average vitiligo cases of 85 cases per year and mostly women whereas the number of unspecified vitiligo were quite high. Therefore, more attention is needed from the physicians to treat the patient starting from the establishment of vitiligo to the decision treating with narrowband-UVB.
Diagnostic procedures in pediatric dermatology Widodo, Arini Astasari; Rahmayunita, Githa; Agustin, Triana; Astriningrum, Rinadewi
Journal of General - Procedural Dermatology & Venereology Indonesia
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Diagnostic procedures in pediatric dermatology are different and significantly more challenging than those in adult patients, especially on how to approach the patients. We need to acknowledge that pediatric patients have unique anatomical, physiological, and psychological aspects. Compared to adults, children have smaller procedure area, are less cooperative, and more difficult to understand. For these reasons, we should perform diagnostic procedures on children cautiously. Having extensive knowledge in this field can facilitate us to carry out an ethical, efficient, targeted procedure with less risk. This article reviewed the most appropriate, most comfortable, and least invasive diagnostic procedures for children. Some of the most commonly performed pediatric dermatology procedures highlighted in this article are potassium hydroxide examination, Gram staining examination, acid fast bacilli examination, skin test for allergies, and skin biopsy for children. We also discuss the process of obtaining a written informed consent from the parents who were involved in decision making process and play a crucial role in assisting physicians to calm their children during the diagnostic procedures.
Langerhans cell histiocytosis: Diagnosis and Management Lusiana, Lusiana; Sjakti, Hikari Ambara; Rahmayunita, Githa; Jacoeb, Tjut Nurul Alam; Krisanti, Inge Ade
Journal of General - Procedural Dermatology & Venereology 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.
The use of systemic medications in pediatric dermatoses: A review Narla, Shanthi; Rahmayunita, Githa; Astriningrum, Rinadewi; Shwayder, Tor; Yosi, Ariyati; Lim, Henry W.
Journal of General - Procedural Dermatology & Venereology Indonesia
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Research has begun to illustrate a favorable efficacy and side-effect profile for many systemic agents used in pediatric dermatological conditions (i.e. atopic dermatitis, psoriasis, scleroderma, alopecia areata, chronic spontaneous urticaria, autoimmune blistering disorders, and hidradenitis suppurativa) despite not having extensive randomized clinical trials. The purpose of this article is to summarize the available data on the treatment regiments, safety, and efficacy of systemic immunosuppressants, including the newer biologics, focusing on the most up-to-date systematic reviews or randomized clinical trials. The review demonstrates that many of the present studies lack data on long-term efficacy and consist of small patient populations. Further research into the long-term safety of these systemic medications is of vital importance especially due to the chronic nature of most pediatric dermatological conditions that require the use of systemic agents.
The management of seborrheic dermatitis 2020 Widaty, Sandra; Bramono, Kusmarinah; Listiawan, Muhammad Yulianto; Yosi, Ariyati; Miranda, Eliza; Rahmayunita, Githa; Brahmanti, Herwinda; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia
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Background: Seborrheic dermatitis (SD) is a chronic relapsing dermatitis manifesting in the seborrheic area, affecting infants or adults. In Indonesia, the prevalence of SD is 0.99–5.8% of all dermatology cases from 2013 to 2015. SD has been known to be a prominent manifestation among HIV patients, but there is an increasing trend in the general population. Therefore, in 2017, the Indonesian Society for Dermatology and Venereology proposed a consensus for the management of SD in Indonesia based on the discussion from 12 dermatological centers. Concurrent with the development of new drugs, this study aims to evaluate and develop a guideline for the treatment of seborrheic dermatitis in Indonesia to update the previous guidelines in 2017. Methods: Systematic review was based on evidence-based methods, and scientific evidences were acquired through systematic search. Evidence analysis was in accordance with the level of evidence. The available evidences were evaluated, and conclusion was based on the grade of recommendation. Critical appraisal was conducted by experts in dermatology and venereology. Results: Severity of SD can be determined by using the Seborrheic Dermatitis Area Severity Index. The principle of scalp SD management is controlling the scalp condition in a cost-effective manner to make patients comfortable. The recommendations for treatment of adult SD are topical agents, such as antifungals, nonsteroidal anti-inflammatory agents with antifungal properties, corticosteroids, and calcineurin inhibitors. Conclusion: We have updated and added newer agents for the treatment of SD. The approach is divided into scalp or nonscalp and also adult or infantile SD.
Generalized pustular psoriasis and Cushing’s syndrome in childhood due to corticosteroids misuse Azizah, Fitri; Rahman, Yusnita; Rihatmadja, Rahadi; Agustin, Triana; Astriningrum, Rinadewi; Rahmayunita, Githa
Journal of General - Procedural Dermatology & Venereology Indonesia
Publisher : UI Scholars Hub

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Background: Generalized pustular psoriasis (GPP) is characterized clinically by yellowish sterile pustules surrounded by erythema. GPP in children is very rare and may appear following steroid withdrawal in psoriasis vulgaris.Case Illustration: A 14-year-old female presented to the emergency unit with generalized erythematous plaques and multiple pustules with lake of pus after abruptly stopped oral and topical corticosteroid for two weeks. The patient had used topical and oral corticosteroids for almost a year to treat psoriasis. Physical examination revealed moderately ill and tachycardic, with short stature, moon face, amenorrhea, and multiple erythematous plaques with multiple pustules and lake of pus along with red-purple striae all over the body.Discussion: Adverse effects of steroid-induced adrenal insufficiency are time-dependent and generally reversible. Gradual discontinuation of steroids must adhere to physiological dose of steroids, mostly in 3.49 ± 2.92 months. Other treatments available are emollients, salicylic acid, calcipotriol, coal tar, topical steroids, phototherapy, retinoids, and cyclosporine. Topical steroids cannot be the main therapy in severe psoriasis due to the possible side effects of excessive usage. Conclusion: Misuse of topical and systemic steroid in children could lead to Cushing’s syndrome, a multisystem disorder resulting from prolonged exposure to excess glucocorticoids, either both systemic or topical. Children could easily develop systemic reactions to topical steroids due to their higher total body surface area to body weight ratio.
Co-Authors Aman B. Pulungan Arini Astasari Widodo Astriningrum, Rinadewi Azizah, Fitri Benny E. Wiryadi Dewi Sumaryani Soemarko Herwinda Brahmanti Hikari Ambara Sjakti, Hikari Ambara Jacoeb, Tjut N.A. Jacoeb, Tjut Nurul Alam Krisanti, Inge Ade Kusmarinah Bramono Lim, Henry W Lim, Henry W. Lusiana Lusiana M. Yulianto Listiawan Miranda, Eliza Nainggolan, Evelyn Narla, Shanthi Novianto, Endi Novianto, Endi Nugraha, Heru Pusponegoro, Erdina H.D. Rahadi Rihatmadja Rahman, Yusnita Raissa, Fifinela Rosandi, Ridha Sandra Widaty Shwayder, Tor Siti A. Boediardja Siti Aisah Boediardja Sri L. Menaldi Sukma, Putu Martha Gerynda Suseno, Lis Surachmiati Tina W. Wisesa Titi L. Sugito Triana Agustin Wresti Indriatmi B. Makes Yosi, Ariyati