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BACKGROUND Onychomycosis is a common fungal nail infection with a low cure rate. While dermatophytes are the most common causal agent for onychomycosis, the incidence of Candida and nondermatophyte mold (NDM) onychomycosis is increasing. This study aimed to analyze the clinical and microbiological characteristics of patients with onychomycosis. METHODS Patients who visited the Department of Dermatology and Venereology, Cipto Mangunkusumo Hospital, and were diagnosed with onychomycosis from 2017 to 2022 were included. Diagnosis was established through clinical examination, supported by the result of direct microscopic examination with potassium hydroxide. RESULTS Of 171 patients, 93.6% had onychodystrophy, 65.5% were females, and 62.0% were aged 19-59 years. Most patients had onychodystrophy in more than three nails, affecting fingernails (31.6%) and toenails (34.5%). Interestingly, 84.8% of patients had no history of nail diseases. The median onset of disease was 24.0 (1-1,040) weeks, while the median onychomycosis severity index was 10.0 (2-40). Most cases were caused by Candida albicans (48.3%). Fusarium was the only NDM documented (2.3%). Some patients were resistant to itraconazole (11.4%) and miconazole (4.5%). Overall, 49.1% of the patients were declared not cured. CONCLUSIONS Candida was the predominant cause of onychomycosis, and onychodystrophy was the dominant feature. Current treatment regimens with systemic or topical antifungal agents did not yield satisfactory results, with more than half of the patients deemed not cured. [ABSTRACT FROM AUTHOR]

Background: An increased frequency of hand sanitizer use and washing hands with soap seems to increase the incidence of hand eczema (HE). Objectives: The aim was to analyze HE in nonmedical personnel, its severity, and the effect of hand sanitizer use on transepidermal water loss (TEWL) and skin capacitance. Methods: This observational cross-sectional study was conducted from July to September 2022. Subjects were recruited based on the study criteria with cluster random sampling method. Each subject's identity, data related to hand sanitizer use and handwashing, atopic stigmata, and duration of HE were documented. The severity of HE was assessed with the HE Severity Index (HECSI). TEWL and skin capacitance were measured with the Tewameter® TM 300 and Corneometer® CM 825 instruments. Results: Out of 240 subjects who were selected randomly, 24 normal subjects and 24 subjects with HE were recruited. The incidence of HE in nonmedical personnel using hand sanitizer was 10%, with a median disease duration of 22 weeks and a mean HECSI score of 9.25 ± 6.33. There was no significant difference in TEWL and skin capacitance between the groups (P > 0.05). There was no significant correlation between TEWL and skin capacitance with the HECSI score (P > 0.05). Subjects with HE washed their hands more frequently than subjects without HE (6 vs. 4.5 times per day; P 0.005). Conclusion: Most nonmedical personnel with HE had a mild form of the condition. There were no significant barrier function and skin hydration differences between the groups. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a chronic noncaseating granulomatous disorder with clinical manifestations involving various organs, including skin. The incidence of sarcoidosis reached 35.5 - 64 cases per 100,000 people in the United States while Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta reported the incidence of cutaneous sarcoidosis of 0.07% in 2015-2019. Numerous treatment modalities have been developed for the treatment of sarcoidosis and steroid becomes the first-line treatment for sarcoidosis. However, cases of sarcoidosis recalcitrant towards steroid are often reported, leading to consideration of other medications with possible efficacy in sarcoidosis, one of which is isotretinoin. Isotretinoin plays a role in sarcoidosis through its effect on inhibiting Tumor Necrosis Factor (TNF) and enhancing the production of prostaglandin E2 (PGE2). Based on several studies reported, level of evidence (LoE) of isotretinoin for the management of cutaneous sarcoidosis is level IV. Therefore, albeit being quite potential for the management of cutaneous sarcoidosis, further studies are necessary to prove the effectiveness of isotretinoin. [ABSTRACT FROM AUTHOR]

The increasing number of non-communicable diseases demands practical therapy innovations, including adipose-derived stem cell application. This study aimed to analyze the effectiveness of adipose stem cell therapy on non-communicable disease patients. The method used in this study was a systematic review according to PRISMA 2020 guidelines. The database search was done on PubMed, Google Scholar, Proquest, and the EBSCO host database between 2016 and 2021. ROBINS-I tool and RoB-2 were used to assess the risk of bias in the clinical trial study. The first literature search identified a total of 2615 articles. After exclusion for some reason, 6 articles were included in this systematic review study. A total of five studies were included in this study. Based on the risk of bias assessment of the included studies, it was found that all studies had a low risk of bias in all domains. This study showed that the efficacy of adipose-derived stem cell therapy was inconsistent; however, the results were promising. In addition, the results showed that adipose-derived stem cell therapy was safe without significant side effects. Further study was needed to identify therapeutic strategies based on Evidence-based Medicine (EBM). [ABSTRACT FROM AUTHOR]

Hand eczema (HE) is a chronic inflammatory disorder of the hand with a prevalence of 14.5% worldwide. The incidence of HE has increased considerably during Coronavirus-19 (COVID-19) pandemic due to increased hand hygiene practice. Despite not affecting the mortality rate, HE can decrease the patient's quality of life significantly and increase morbidity. In general, HE can be classified based on its onset, etiology, precipitating factors, and clinical morphology. The diagnosis of HE is established through history taking and physical examination, however, several diagnostic tests should be performed to identify the etiology and exclude the differential diagnosis, including dermoscopic examination, histopathological examination, patch test, and prick test. In addition to diagnostic tests, the severity of HE should also be established to determine the appropriate therapy and monitor the therapeutic responses. After HE is identified, comprehensive management should be provided immediately so that HE will not progress into a chronic disorder which will further decrease the patient's quality of life. [ABSTRACT FROM AUTHOR]

Background: To date, integrated care for people living with human immunodeficiency virus (PLHIV) has improved. However, although the management of mucocutaneous mycosis cases has improved, disease progression might be different in immunocompromised patients, which leads to variable clinical manifestations. Objectives: To describe the characteristics of mucocutaneous mycosis cases in the PLHIV population and its associated factors in Indonesia. Methods: This retrospective study was conducted from January 2014 to December 2018 in four academic hospitals. Data were acquired from medical records with the inclusion of mucocutaneous mycosis patients with concurrent HIV infection. Analysis with the chi‐squared test was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: A total of 1,796 cases of mucocutaneous mycoses were identified in 1782 PLHIV. The most common types of infection were candidiasis (63%), followed by dermatophytosis (35.1%), and malasseziosis (1.9%), which were significantly higher in PLHIV with CD4 level <200 cells/mm3. The proportions of male gender (78.6% vs. 56.3%, p <.001), high level of education (48.0% vs. 64.1%, p <.001), office workers (73.8% vs. 64.1%, p <.001), combination of topical and systemic antifungal agents (59.1% vs. 48.5%, p =.006) and not receiving antiretroviral therapy (63.2% vs. 7.8%, p <.001) were significantly higher in PLHIV with a CD4 level <200 cells/mm3. Conclusion: In Indonesia, the most common fungal infection in PLHIV is candidiasis. This study also addressed the important matters regarding mucocutaneous mycoses in PLHIV. Education is an important measure to prevent the incidence of cutaneous mycoses in PLHIV, especially in high‐risk groups. [ABSTRACT FROM AUTHOR]

Onychomycosis contributes as many as half of all nail disorder cases. In 2017, the incidence of onychomycosis was 15% of all dermatomycosis cases at our hospital, a tertiary hospital in Indonesia, with only 25% of the patients achieving mycological cure. This study aims to identify the prognostic factors influencing the treatment outcome of onychomycosis Candida. This is a retrospective study, using data obtained from outpatient registry at our hospital. Fifty‐four onychomycosis patients were included in this study. Potential prognostic factors were analysed by STATA15.0. Retrospective analysis with cox proportional‐hazard was used to measure the contribution of each variable to the treatment's outcome. Onset of disease, history of nail disorder, and site of infection were not associated with mycological cure (P >.05). Based on retrospective analysis, age[odds ratio (OR)1.46; 95% confidence interval (CI)1.07‐2.03], onset of disease (OR 1.14; 95%CI 1.11‐1.17), comorbidities (OR 1.07; 95%CI 1.03‐1.11), type of onychomycosis (OR 1.08; 95%CI 1.05‐1.16), site of infection (OR 1.12; 95%CI 1.04‐1.22) and number of infected nails (OR 1.50; 95%CI 1.25‐1.68) were significantly associated with poor treatment outcome, while type of treatment and type of systemic agents showed no significant association with the outcome. Kaplan‐Meier curves showed that subjects elderly age and more than 3 infected nails had the lowest median survival. Elderly, longer onset, presence of comorbidities, multiple sites of infection, and high number of infected nails can affect the mycological cure negatively. Unstandardised treatment was associated with the mycological cure despite not affecting the prognosis. Therefore, the management's goal is to identify these specific prognostic features. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Atopic dermatitis (AD) is a chronic inflammatory skin disease which is associated with a significantly decreased quality of life. Overall, the conventional treatment approaches for moderate to severe AD are prone to relapses. Hence, the exploration of new adjuvant therapies, such as the use of platelet-rich plasma (PRP), is expected to enhance the effectiveness of existing interventions, which remain paramount in improving the quality of life for patients with moderate to severe relapsing AD. METHODS: The literature search primarily focused on original English-language articles on PRP as a therapeutic approach for the management of adult AD. Literature reviews, systematic literature, and meta-analyses were excluded. The databases searched include PubMed/Medline, Science Direct, and Cochrane, up to October 2023. Seven articles were reviewed. RESULTS: PRP is reported to be used as a therapy for AD in both injectable and topical forms. Various studies showed that PRP could significantly reduce free radical accumulation, proinflammatory mediators, provide healing environment, and restore the metabolic activity disruption. Clinically, PRP therapy was reported to improve clinical symptoms, patient's satisfaction, quality of life, and reduce frequent recurrence. Mild side effects (pain and ecchymosis) due to the injection were reported. Another advantage is that it is safe to be used in pregnant and breastfeeding women. LIMITATIONS: Heterogeneity of methods in preparing PRP and further research with larger scale standardized protocols are warranted. CONCLUSION: PRP yields favorable outcomes when used in AD treatment and can serve as an alternative for moderate to severe or refractory AD through its anti-inflammatory and proliferative properties. [ABSTRACT FROM AUTHOR]