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All Journal Journal of General-Procedural Dermatology & Venereology Indonesia
Sandra Widaty
Faculty of Medicine University of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta
Medicine & Pharmacology

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Journal : Journal of General-Procedural Dermatology

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Subcutaneous mycosis at the Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital, Jakarta, 1989-2013 Yahya, Sammy; Widaty, Sandra; Miranda, Eliza; Bramono, Kusmarinah; Islami, Artini Wijayanti
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 1, No. 2
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Introduction: Subcutaneous mycosis (SM) is a fungal infection involving dermis and subcutaneous tissue, which can disseminate slowly through systemic blood or lymphatic circulation. The subacute or chronic infection usually found in workers of rural tropical and subtropical area. SM occurs due to trauma along with other predisposing factors such as sex, genetic and occupation.Aim: To identify the types of SM, its clinical findings, laboratory work-up and the treatment at the Dermatomycology Division, Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital between the year 1989 and 2013.Method: This retrospective study collected data from medical records and case reports of patients with SM who came at Department of Dermatology and Venereology dr. Cipto Mangunkusumo National Hospital (1989-2013).Results: We found 16 cases of SM, i.e. subcutaneous mucormycosis (5 cases), eumycetoma (4 cases), actinomycetoma (4 cases) and chromoblastomycosis (3 cases). There was a greater number of male than female patients ratio (3:1) and mostly were in the age group of 25-44 years. The direct microscopic examination did not reveal any fungal element, except for black spora in chromoblastomycosis (1 case). The culture revealed Basidiobolus ranarum in subcutaneous mucormycosis (5 cases), Nocardia transvalensis in actinomycetoma (1 case) and Phialophora sp. in 1 case of chromoblastomycosis. On histopathological examination, we found fine granules of actinomycetoma, sulphuric granules of actinomycetoma, coenocytic hyphae of subcutaneous mucormycosis, eosinophilic granule in 1 case of mycetoma and hyphae with black spore in chromoblastomycosis.Conclusion: SM is still a rare disease, comprehensive management of SM needs supporting laboratory work-up, particularly the histopathological examination.
Comparison of efficacy combination oral terbinafine pulse-dosed and topical 8% ciclopirox olamine with terbinafine monotherapy for onychomycosis: An evidence-based case report Bianti, Marsha; Nuary, Teffy; Widaty, Sandra
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 2, No. 1
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Background: Onychomycosis is a fungal infection of the nails, which manifested as nail discoloration, thickening, and detachment from the nail bed. It is not life-threatening, however inappropriate treatment of onychomycosis might lead to complications and affect the patient’s quality of life; making the management of the disease a challenge for clinicians. Objective: Investigate the efficacy of pulse-dosed oral terbinafine combined with topical 8% ciclopirox olamine to treat onychomycosis. Methods: Literature search was performed in Pubmed and Cochrane databases using the keywords 'combination' AND 'oral terbinafine' AND 'ciclopirox' AND ‘onychomycosis treatment’ along with their synonyms and related terms. Results and Discussion: After critical appraisal, studies by Avner et al. and Jaiswal et al. found to be valid, important, and applicable to the patient. The first study found that oral terbinafine combined with topical 8% ciclopirox olamine is more effective and safe compared to terbinafine as a monotherapy (p<0.05). The second study found similar results, but without statistical significance (p>0.05). Conclusions: Oral terbinafine combined with topical 8% ciclopirox olamine is more effective than monotherapy, despite statistical irrelevance in one of the studies appraised. Further studies are needed to support the implementation of combination therapy.
Correlation between clinical and histopathological findings of five puzzling cases of cutaneous tuberculosis Miranda, Eliza; Widaty, Sandra; Sirait, Sondang Pandjaitan; Rizky, Luddwi Achmad; Menaldi, Sri Linuwih; Lim, Henry W
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 5, No. 1
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Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings. Case Illustration: Five cases of cutaneous tuberculosis, which include two cases of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris were presented in this article. Four of the five cases demonstrated significant improvement after initiation of an antituberculosis drug regimen. Discussion: Diagnosis of cutaneous tuberculosis in these cases was confirmed through clinical findings and histopathological and microbiological examination. Conclusion: A negative result following microbiological examination does not completely exclude the diagnosis of cutaneous tuberculosis. Investigating the pathognomonic findings of cutaneous tuberculosis through histopathological examination is important to differentiate among its types correctly. Therefore, correlations between clinical and histopathological results are essential to establish a diagnosis of cutaneous tuberculosis.
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 Vol. 5, No. 1
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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.
User acceptance of DeSkab mobile application for early detection of scabies in Indonesia Widaty, Sandra; Friska, Dewi; Bramono, Kusmarinah; Sari, Siti Maulidya; Darmawan, Irene; Kekalih, Aria
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 7, No. 2
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Background: Individual case management strategy is not suitable for reducing scabies transmission, especially in high prevalence settings. A community-based approach has been proposed to control scabies. We developed a mobile application, called DeSkab, to empower non-medical personnel in crowded populations e.g., boarding schools, and to aid the identification of skin lesions suggesting scabies based on the cardinal signs of scabies. Early treatment and prevention of scabies transmission is expected to follow this approach. This was the initial development of the DeSkab mobile application which aims to assess user acceptance. Methods: The DeSkab mobile application was designed using Java and XML, supported by Google's Android. The scabies detection and education features were the app’s key distinctive aspects. An online survey was performed, aimed at potential users, including boarding school teachers and healthcare workers. The survey was divided into four sections: application design and user-friendliness, early detection data entry and interpretation, education features, and user recommendations. Result: Overall, users' acceptance of this application was good. More than 70% of the users gave good feedback for the application. Using mobile health makes it easier for the users to find information about scabies and check whether their skin lesions are suggestive of scabies. Conclusion: This application is expected to help expand scabies detection, especially in crowded communities. Improvements must be made to the interface, data entry, and educational material for the app's next iteration. Further study is needed to determine how mobile health application can improve scabies detection in communities.
Empowering nonmedical personnel to detect scabies in endemic area using DeSkab instrument: A diagnostic study Widaty, Sandra; Kekalih, Aria; Friska, Dewi; Bramono, Kusmarinah; Sari, Siti Maulidya; Darmawan, Irene; Sujudi, Yufanti; Hartanto, David Dwiadiputra; Kartika, Emiliana; Oktavia, Nikken Rima
Journal of General - Procedural Dermatology & Venereology Indonesia Vol. 8, No. 1
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Background: Scabies has been added to World Health Organization (WHO) list of neglected tropical disease in 2017. Various methods have been developed to control scabies in highly prevalent communities. In this study we conducted a diagnostic study to evaluate the performance of scabies detection by trained nonmedical personnel (NMP) using Deteksi Skabies (Deskab) instrument which has been validated for NMP. Methods: Eight NMPs in a boarding school were trained to detect scabies using DeSkab instrument. The NMPs diagnosis were compared to diagnosis of 10 medical doctors. The study was conducted in a religion-affiliated boarding school in West Java, Indonesia. Both examiners consecutively assessed boarding school students using DeSkab instrument and were blinded to each other findings. Results: Among 140 participants included in this study, scabies was confirmed by medical doctors in 60 participants. Diagnostic accuracy of NMPs examination is 72.14% [95% confidence interval (CI) 64.2-78.9], with sensitivity and specificity 67.42% (95% CI 57.13-76.26), and 80.32% (95% CI 67.54-88.98) respectively. The inter-rater agreement (Cohen’s kappa) for diagnosing scabies is 0.44. Conclusion: NMPs can be trained to detect scabies in their community with acceptable accuracy. Improving training are recommended to further improve the diagnosis skills and maintaining sustainable detection program.
Co-Authors Aria Kekalih Bianti, Marsha Darmawan, Irene Dewi Friska Githa Rahmayunita Hartanto, David Dwiadiputra Herwinda Brahmanti Islami, Artini Wijayanti Kartika, Emiliana Kusmarinah Bramono Lim, Henry W M. Yulianto Listiawan Miranda, Eliza Mustika, Rita Nuary, Teffy Oktavia, Nikken Rima Rizky, Luddwi Achmad Sari, Siti Maulidya Sirait, Sondang Pandjaitan Sri L. Menaldi Sujudi, Yufanti Wati, Huda Marlina Yahya, Sammy Yosi, Ariyati