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Kartika Ruchiatan,1,2 Trustia Rizqandaru,1 Panji Respati Satjamanggala,1 Nisrina Tache,1 Adi Imam Cahyadi,3 Andri Rezano,4,5 Hendra Gunawan,1 Eva Krishna Sutedja,1 Reiva Farah Dwiyana,1 Risa Miliawati Nurul Hidayah,1 Pati Aji Achdiat,1 Endang Sutedja,1 Oki Suwarsa,1 Reti Hindritiani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia; 2Doctorate Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 3Division of Microbiology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 4Division of Cell Biology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia; 5Graduate School of Biomedical Sciences Master Program, Faculty of Medicine, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Kartika Ruchiatan, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62811247932, Email kartika.ruchiatan@unpad.ac.idIntroduction: Acne vulgaris (AV) is a common and chronic disorder of the pilosebaceous unit and has a multifactorial pathology, including activities of Cutibacterium acnes (C. acnes) and Staphylococcus epidermidis (S. epidermidis). Antibiotic resistance has become a major concern in dermatology daily practice, and the ability of biofilm formation by both bacteria is suggested to increase antibiotic resistance in acne.Purpose: Our aim was to analyze the comparison of antibiotic resistance between biofilm-forming (BF) and non-biofilm-forming (NBF) strains of C. acnes and S. epidermidis towards seven antibiotics commonly used for acne.Methods: This is a cross-sectional analytical study involving 60 patients with AV. Samples were obtained from closed comedones on the forehead using the standardized skin surface biopsy (SSSB) method at the Cosmetic Dermatology Clinic Dr. Hasan Sadikin in Bandung, Indonesia. Isolates were cultured and identified before undergoing the biofilm-forming test using the tissue culture plate method. Antibiotic susceptibility testing for each antibiotic was then performed using the disc diffusion method.Results: The incidence of antibiotic resistance to clindamycin in BF and NBF C. acnes isolates was 54.5% (p=1.00), while in BF and NBF S. epidermidis isolates, it was 54.5% and 45.5% respectively (p=0.67). The incidence of antibiotic resistance to erythromycin and azithromycin in BF and NBF C. acnes isolates was 54.5% and 63.6% respectively (p=1.00), whereas for S. epidermidis BF and NBF isolates, it was 54.5% (p=1.00). There was no resistance observed to tetracycline, doxycycline, levofloxacin, and cotrimoxazole in all groups.Conclusion: There were no significant differences in resistance against seven antibiotics between the C. acnes and S. epidermidis in BF and NBF groups. Furthermore, although statistically not significant, some resistances were observed against clindamycin, erythromycin, and azithromycin. Consequently, the use of these three antibiotics should be judiciously regulated.Keywords: acne vulgaris, antibiotic resistance, biofilm, Cutibacterium acnes, Staphylococcus epidermidis

Reti Hindritiani, Muhamad Radyn Haryadi Widjaya, Diah Puspitosari, Trustia Rizqandaru, Kartika Ruchiatan Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Reti Hindritiani, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, Indonesia, 40161, Tel +62222032426 ext. 3449, Fax +62222032426, Email r.hindritiani@unpad.ac.idAbstract: Partial unilateral lentiginosis (PUL) is a pigmentation disorder characterized by multiple lentigines restricted to the normal skin in a unilateral and segmental pattern. Various lasers have been used for the treatment of this pigmented disorders, one of which is the copper bromide (CuBr) laser, which emits a dual-wavelength beam at 511 nm and 578 nm. A 35-year-old woman presented with multiple brown macules with a sharp demarcation from the midline of the forehead to the right cheek in a dermatomal distribution. Histopathological results showed increased melanin pigmentation in the basal layer with elongated rete ridges, supporting the diagnosis of PUL. Following photoprotection and skin priming, CuBr laser treatment was performed in two steps using 511 nm and 578 nm wavelength as the first and second steps, respectively, with the second step delivered immediately after. Clinical improvement was achieved after two sessions of treatment at a one-month interval, as shown by an increasing lightness value (L*) in spectrophotometry. No side effects, such as hyperpigmented macules, was observed. The patient also expressed satisfaction at her brighter facial skin. A sustainable favorable result persisted after six months of laser treatment. Interactions between cutaneous vasculature and melanocytes can affect the development of pigmented lesions. Melanocytes express the functional vascular endothelial growth factor receptor (VEGF) and are responsive to angiogenic factors. Ideally, these conditions should be treated with a dual-wavelength CuBr laser. The combination of 511 nm and 578 nm CuBr laser showed favorable results, supporting its potential as an effective treatment choice for PUL.Keywords: copper bromide, dual wavelength, effective, laser, partial unilateral lentiginosis

Miranti Pangastuti, Trustia Rizqandaru, Oki Suwarsa, Hartati Purbo Dharmadji, Endang Sutedja Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Miranti Pangastuti, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281223114874, Email pangastuti.miranti@gmail.comAbstract: Bullous dermatoses is a heterogeneous group of blistering skin disorders that can either be inherited or acquired. Subepidermal blisters may result in ulceration and scarring following their rupture. Wegener’s granulomatosis (WG) is a granulomatous necrotizing vasculitis affecting small- to medium-sized blood vessels. It is associated with anti-neutrophil cytoplasmic antibodies (ANCA) and can be manifested cutaneously as multiple bullous and ulcers. A case of WG was reported in an 18-year-old man presented with multiple skin bullous and ulcers. The patient was diagnosed with WG based on the findings from nasopharyngoscopy examination that revealed crusts in his nasal cavity; necrotizing granulomatous appearance on chest radiograph; hematuria on urinalysis; and positive ANCA blood test. This patient received a combination of methylprednisolone and methotrexate, resulting in improvement within four weeks of therapy. His multiple skin ulcers were treated with a combination of dialkyl carbamoyl chloride, hydrocolloid, and hydrogel dressings. This patient was in complete remission state after six months of treatment, which later followed by a relapse episode that occurred within one year. WG with multiple skin bullous and ulcers can mimic other diseases. Various examinations such as histopathology, direct immunofluorescence, and ANCA blood test may aid in determining the etiology of skin bullous and ulcers.Keywords: anti-neutrophil cytoplasmic antibodies, bullous, ulcers, Wegener’s granulomatosis

Raden Mohamad Rendy Ariezal Effendi, Trustia Rizqandaru, Renata Yuliasari, Srie Prihianti Gondokaryono, Inne Arline Diana, Reiva Farah Dwiyana Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Raden Mohamad Rendy Ariezal Effendi, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur no. 38, Bandung, West Java, 40161, Indonesia, Tel +62 22 2032426, Email rendy.ariezal.effendi@unpad.ac.idAbstract: Non-Langerhans cell histiocytosis (non-LCH) is a group of diseases characterized by the proliferation of histiocytes in tissues that is excluded from the diagnostic criteria for LCH. Juvenile xanthogranuloma (JXG) and benign cephalic histiocytosis (BCH) are the most common types of cutaneous non-LCH. These two diseases share similarities in both clinical and histological features, therefore, they can be difficult to differentiate. Thorough physical, dermoscopic, and histopathological examinations are required to distinguish between JXG and BCH. We hereby present two rare cases of non-LCH in pediatric patients, presented with JXG and BCH. The dermoscopic examination of both cases showed a setting-sun appearance, while the histopathological examination revealed Touton giant cells in the JXG case, and massive lymphocyte infiltration in the BCH case. Both patients were treated with 1% topical rapamycin in a split-side comparison for the first 12 weeks, followed by applications on both sides for a total duration of 24 weeks. As a result, there was a significant reduction in the size of the lesion, leading to patient’s satisfaction. Rapamycin is an immunosuppressive agent with antineoplastic activity. Rapamycin can be used as an alternative non-invasive topical treatment option for JXG and BCH. However, long-term observations are required to assess its effectiveness and side effects.Keywords: benign cephalic histiocytosis, dermoscopy examination, histopathological examination, juvenile xanthogranuloma, non-Langerhans cell histiocytosis

Eva Krishna Sutedja, Trustia Rizqandaru, Kartika Ruchiatan, Endang Sutedja Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Eva Krishna Sutedja, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +62 8122014300, Email evakrishna@yahoo.comAbstract: Cutaneous metastases (CM) are neoplastic lesions of the skin originating from a primary tumor elsewhere. CM originating from primary thymic carcinoma is rare, and its incidence remains uncertain. A case of CM from thymic carcinoma in a 57-year-old man was reported. The patient complained about lumps on the skin of the chest, right shoulder and neck that appeared eleven months before the diagnosis of thymic carcinoma was established. Physical examination revealed tumors on the chest, right shoulder and neck. Histopathological examination results were consistent with CM. An immunohistochemical (IHC) examination was performed to determine the primary tumor, with a positive result for CK7. The diagnosis of thymic carcinoma was established based on the results of enhanced chest CT-scan and immunohistochemistry on lymph node biopsies. The patient was treated with a chemotherapy regimen of cyclophosphamide, doxorubicin, and carboplatin scheduled for six cycles. However, the patient did not survive his third cycle of chemotherapy. Establishing the diagnosis and managing CM are challenging for clinicians. This requires careful historical and physical examination, supported by histopathological examination and specific immunohistochemical marker in accordance with the suspected tumor.Keywords: cutaneous metastases, immunohistochemistry, thymic carcinoma