Search

Seiring dengan bertambahnya usia seseorang, kulit sebagai jaringan terluar dari tubuh manusia akan memberikan gambaran paling terlihat dari proses penuaan. Penuaan kulit dipengaruhi oleh dua faktor yaitu faktor intrinsik dan faktor ekstrinsik. Faktor intrinsik terjadi secara alamiah dan berkaitan dengan proses degenerasi seluler. Faktor ekstrinsik berkaitan dengan pajanan sinar matahari, rokok, dan polusi udara. Penyebab utama penuaan kulit akibat faktor ekstrinsik berupa pajanan kronik sinar ultraviolet dikenal sebagai photoaging. Tanda klinis photoaging dapat bervariasi, namun yang sering ditemukan berupa perubahan pigmentasi dan keriput. Saat ini telah tersedia lebih dari 100 instrumen penilaian penuaan kulit menggunakan fotografi, dermoskopi, dan alat diagnostik multifungsi namun masih belum ada yang dianggap sebagai baku emas. Tinjauan pustaka ini bertujuan untuk membahas berbagai instrumen penilaian photoaging yang sering digunakan dalam praktik klinis sehari-hari dan karakteristik dari masing-masing instrumen tersebut.

Penuaan kulit merupakan fenomena biologis yang tidak dapat dihindari oleh manusia. Mekanisme yang mendasari penuaan kulit selalu berkembang sehingga penting untuk mengetahui mekanisme molekular terbaru, serta perubahan yang terjadi akibat penuaan agar klinisi dapat menentukan tata laksana yang tepat untuk mencegah dan mengobati penuaan kulit. Terdapat dua faktor yang berperan dalam terjadinya penuaan kulit, yaitu faktor intrinsik dan ekstrinsik. Faktor intrinsik adalah genetik, metabolisme sel, dan perubahan hormonal. Selain itu, terdapat faktor ekstrinsik seperti radiasi ultraviolet, inframerah, dan karsinogen lingkungan yang turut berperan pada penuaan kulit. Pemendekan telomer, stres oksidatif, disfungsi mitokondria, radiasi ultraviolet dan inframerah, peranan polusi udara dan rokok, peranan aryl hydrocarbon receptor (AhR), kerusakan deoxyribo nucleic acid (DNA), cellular senescence, perubahan hormon, pengaruh mikrobiota, vitamin D, akumulasi advanced glycation end products (AGEs), serta inflammaging memegang peranan penting dalam proses penuaan. Proses penuaan tersebut menyebabkan penurunan fungsi dan kapasitas kulit secara progresif yang berpuncak pada gangguan fungsi kulit dan kerentanan terhadap penyakit.

Skin cancer is a global health concern due to its growing incidence and high mortality rate. The most common therapeutic modalities in skin cancer include surgery, radiotherapy, and chemotherapy. However, those therapies do not specifically target cancer cells and may damage healthy tissues. Cancer induces immune response by releasing soluble antigens and danger signals caused by tumor cellular stress or death, while the immune system continuously monitor and control malignant proliferation through cancer immunoediting. Therefore, targeting this mechanism is a promising approach to manage cancer, especially those unresponsive to conventional therapies. Immunotherapy is a specific therapy that manipulates the immune system to fight the disease. Previous studies have shown promising results in its clinical use in melanoma and non-melanoma skin cancer (NMSC). However, its potential toxicity and tolerability may pose significant obstacles in developing effective cancer immunotherapy. Biomedical, immunological, and clinical research in skin cancer is still needed to elaborate further on its pathogenesis and design safe and effective therapy for each skin cancer. Keywords: immunotherapy, melanoma, NMSC, toxicity

BACKGROUND: Dermatological emergency is a condition requiring immediate identification and treatment to reduce mortality and morbidity. There are several dermatoses resulting in emergency room (ER) visits frequently demonstrated by the geriatric population. However, there is a lack of data about elderly with dermatological presentation seen at the ER in Indonesia. AIM: This retrospective study aims to identify the prevalence of dermatological emergency cases in the elderly at three national referral hospitals in Indonesia within 3 years. METHODS: The sample was geriatric patients who came and/or were consulted by the ER to dermatology and venereology (DV) department. The data (e.g., age, sex, history taking, physical findings, and diagnoses) were collected from medical record from each hospital and presented as a descriptive data. RESULTS: This study showed that there were only 37% of all geriatric emergency dermatological consultations from 2017 to 2020. CONCLUSION: This study concluded that there were more than half non-emergent cases of 3-year period consultation. This condition may raise the need of better training about true emergency and standardized curricula of emergency dermatological presentations in geriatric patients.

Shannaz Nadia Yusharyahya,1 Valdi Ven Japranata,2 Ratih Wulan Kusumahapsari,2 Lili Legiawati,1 Rinadewi Astriningrum,1 Karin Rachmani,1 Chia-Yu Chu3 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia; 2Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, Indonesia; 3Department of Dermatology, National Taiwan University and Taiwan University College of Medicine, Taipei City, TaiwanCorrespondence: Shannaz Nadia Yusharyahya, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jalan Diponegoro Nomor 71, Kenari, Senen, Jakarta Pusat, Indonesia, 10430, Tel/Fax +62 21 31935383, Email nadiayusharyahya@yahoo.comBackground/Purpose: COVID-19 pandemic has compromised healthcare services in dermatology and venereology. Given such circumstances, studies investigating the consultation pattern of related fields in hospitals were relatively scarce. The present study aimed to delineate such matter from tertiary hospital viewpoint.Methods: Details concerning referred patients from the emergency room, inpatient wards, intensive care unit, and nursery to the Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo Hospital were retrospectively collected from electronic health records. Cases admitted in the 17 months span before and during COVID-19 global outbreak were included. The obtained data were presented descriptively, and Chi-squared test was performed upon attributes of interest at a significance level of 0.05.Results: A slight increase of total consultation was found in the COVID-19 era with an initial reduction at the beginning (April–May 2020). One-time consultation was the most inquired to our department in both periods of which dermatitis was the most prevalent case and Gram staining was the most common examination. Topical antibiotics and emollient were the most prescribed medications before and during the outbreak, respectively. The conformity of initial-final decision, appropriateness of initial-final diagnosis, and consult response time were significantly different (p < 0.05) between the two groups.Conclusion: There were changes of the number of consultation requests in the pandemic era with statistically significant change of decision conformity, diagnoses, appropriateness, and consult response time. Although some changes appeared, the most prevalent diagnoses remained.Keywords: consultation pattern, COVID-19, dermatology, venereology

Background : Narrowband ultraviolet B (NB-UVB) become the mainstay of widespread vitiligo therapy due to its great efficacy and safety compared with other modalities. The use of NB-UVB for vitiligo has been widely studied in adult patients, while studies on geriatric patients specifically are still very limited. This report aims to show the immediate response after the initial treatment , side effects of therapy, and other problems that were encountered during therapy in two geriatric patients with vitiligo who have been followed up for more than 12 months. Case Illustration : We reported two geriatric patients with vitiligo treated with NB-UVB phototherapy combined with topical treatment for more than 12 months. The first patient was 68-year-old woman, with Fitzpatrick skin type IV, who had vitiligo on her face, both lower arms and hands, and both legs and feet. The second patient was a 61-year-old man with Fitzpatrick skin type IV who had generalized vitiligo. The first repigmentation occurred on the 5 th session in the first patient and on the 6 th session in the second patient, using a cumulative dose of 1223 mJ/cm 2 and 1541 mJ/cm 2 , respectively. Discussion : After NB-UVB phototherapy, there was a great improvement on the face in both patients, followed by the trunk and legs. However, the duration of treatment needed to achieve homogeneous repigmentation is longer in geriatric patients than in the general population. Conclusion : NB-UVB was well tolerated and showed good clinical response to treat vitiligo in the elderly. However, little is known about the safety and efficacy of phototherapy in elderly patients with vitiligo. Keywords: Geriatric, narrowband, phototherapy, therapy, vitiligo

Penuaan merupakan proses perubahan dinamis yang ditandai oleh kemunduran progresif berbagai sistem tubuh disertai penurunan kapasitas fisiologis. Salah satu faktor intrinsik penuaan kulit pada perempuan adalah penurunan kadar hormon estrogen di dalam tubuh saat memasuki masa pascamenopause. Estrogen merupakan hormon yang memiliki peran penting dalam regulasi fisiologis kulit. Berkurangnya kadar estrogen dapat mempercepat proses penuaan kulit yang ditandai dengan penurunan ketebalan, elastisitas, dan hidrasi kulit. Selama ini pemberian terapi hormon estrogen terbukti dapat mengurangi gejala penuaan kulit pada perempuan pascamenopause, namun terapi ini berpotensi meningkatkan risiko terjadinya efek samping berat contohnya kanker payudara, kanker endometrium, dan kanker ovarium. Fitoestrogen merupakan senyawa nonsteroid berasal dari tanaman yang memiliki aktivitas biologik serupa dengan estrogen. Setiap jenis fitoestrogen memiliki aktivitas biologik yang berbeda satu sama lain. Studi terkini menunjukkan bahwa fitoestrogen dapat menjadi terapi alternatif untuk mengatasi penuaan kulit pada perempuan pascamenopause. Fitoestrogen yang diberikan baik secara oral maupun topikal terbukti dapat meningkatkan elastisitas, ketebalan, dan kelembaban kulit serta mengurangi pigmentasi dan proses inflamasi pada kulit.Â

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. Keywords: children, dermatology, diagnostic procedures

Dermatitis seboroik (DS) merupakan kelainan inflamasi kulit di area seboroik berupa lesi eritematosa dan skuama, bersifat kronik-residif, sedangkan ketombe adalah DS derajat ringan berupa skuama pada skalp. Etiopatogenesis DS bersifat multifaktor, salah satunya berupa kolonisasi Malassezia. Studi pendahuluan ini menguji efikasi dan keamanan sampo dengan formulasi khusus yang mengandung climbazole 1% dan piroctone olamine 0,75%. Sebanyak 28 pasien ketombe dan 18 pasien DS ringan di skalp dibagi menjadi dua kelompok secara paralel, acak, dan tersamar ganda, yaitu kelompok uji dan kontrol. Kedua kelompok dilakukan pemeriksaan setiap 1 minggu selama 4 minggu. Efikasi dinilai menggunakan skor modifikasi Seborrheic Dermatitis Area and Severity Index (SDASI) dan penilaian pruritus menggunakan visual analogue scale (VAS). Analisis efikasi dilakukan secara intention-to-treat dan per-protokol. Pada kelompok pasien ketombe, didapatkan penurunan skor modifikasi SDASI, luas lesi, derajat skuama yang berbeda bermakna antara kelompok uji dan plasebo (p0,05). Sampo uji terbukti efektif mengobati ketombe, namun pada DS ringan di skalp sampo hanya efektif mengurangi jumlah skuama tetapi tidak mengurangi lesi inflamasi.Kata kunci: climbazole, dermatitis seboroik, ketombe, piroctone olamine, sampo

Introduction: Seborrheic dermatitis (SD) is a chronic-recidive inflammatory skin disorder with predilection in areas rich of sebaceous gland. The most common clinical manifestations are pruritus and scales. Although SD can be diagnosed without special tools, other examinations may be needed to determine additional specific therapy. Trichoscopy is one of the noninvasive tools which can help to diagnose SD as it can provide the microstructure view of the scalp. Materials and Methods: This descriptive study was conducted to explore the trichoscopic features of SD and its characteristics. There were 96 SD patients enrolled in this study. The scalp was divided into four areas, and each area was scored based on Seborrheic Area Severity Index, comprising erythema, desquamation, number of papules, and percentage of lesion area. The most severe area was examined with a trichoscopy to observe the characteristics of hair and scalp. The association between trichoscopic findings and SD severity was analyzed with Fisher's exact test. Results: Overall, the participants were 36% males and 64% females with the mean age of 30 (13–70) years old. Based on the trichoscopic examination, the most common findings were thick hair shafts (72%), white scales (69%), arborizing thin vessels (38%), yellowish area (36%), and structureless red area (19%). These findings were not significantly different between mild and moderate SD (P > 0.05). Conclusion: Considering the merits and demerits of trichoscopic examination, it can be helpful to aid the diagnosis of SD. Further studies in Asian population with greater sample size are needed to demonstrate more significant result.