Evaluation of Wrinkle and Dermal Thickness in the Forearm before and after Picosecond Laser Therapy

Background

Skin wrinkles are generated as a result of the aging process. Dermal thickness underneath a wrinkle decreases absolutely. Approximately 20% of dermal thickness disappears as people become elderly. In recent times, people have attempted to reduce wrinkles using various procedures. Currently, available picosecond lasers in dermatology can create mechanical stress and the energy can be fractionated via diffractive lens arrays (DLA). An emerging indication for the picosecond laser includes photorejuvenation. Non-ablative laser skin rejuvenation therapy demonstrates the dermis can be safely reconstructed by only irradiating the skin surface with a laser. The clinical effects of picosecond pulse laser have been frequently reported, but few studies have included histological investigation.

Aims and Objectives

This study aimed to evaluate wrinkle and dermal thickness in the forearm before and after picosecond laser therapy.

Materials and Methods

Twenty healthy male and female subjects between 36 and 55 years old with wrinkles in the forearm who met the sample requirements and were willing to participate were recruited in this study. Clinical examination and biopsy for histopathological examination were carried out before and 4 weeks after therapy, then treatment was carried out using a picosecond laser.

Results

At 1-month follow-up, a significant improvement was noted in wrinkle and dermal thickness (P < 0.05).

Conclusions

This picosecond 755 nm alexandrite laser with DLA was found to be very effective in treating wrinkles, which was confirmed by a dermatologic assessment from forearm photographic assessment scaled and dermal thickness improvement.

The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial

Background Wound healing shows a unique interaction of several cells, growth factors and cytokines. The healing of chronic plantar ulcer of leprosy is influenced by various factors, one of which is the concentration of growth factors and cytokines related to the pathogenesis of impaired wound healing. Growth factors and cytokines can be found in the secretome of adipose mesenchymal stem cells. Aim To compare the effectiveness of topical adipose mesenchymal stem cell-conditioned medium and framycetin gauze dressing only on the healing of chronic plantar ulcer of leprosy. Methods In this randomised controlled trial, 32 patients with chronic plantar ulcer of leprosy were recruited. After detailed clinical and initial debridement, patients were randomised to two groups to receive either topical adipose mesenchymal stem cell-conditioned medium (n = 16) or framycetin gauze dressing only (n = 16) applied every three days for up to eight weeks, following which the ulcer size, adverse reactions and complications if any were monitored weekly. Results Healing percentage increased each week in all groups. Statistical differences between groups (P < 0.05) were observed from week 2 onwards for ulcer mean size reduction and from week 3 onwards for ulcer mean depth reduction. There were no adverse reactions or complications. Limitations Off-loading on subjects were not performed. Conclusion Adipose mesenchymal stem cell-conditioned medium is a potential therapeutic agent in the management of chronic plantar ulcer of leprosy.

Combination of Fractional Er:YAG Laser, Pulsed Dye Laser, and Intralesional Triamcinolone With 5-Fluorouracil for Keloid Treatment

Introduction: Benign fibroproliferative scars that are larger than the initial lesion are called keloids. Keloids treatment in clinical practice is still difficult. Although there are various therapy choices, none is embraced by everyone or is relapse-free. Various treatment modalities such as intralesional corticosteroid injection with 5-fluorouracil (5-FU), fractional Er:YAG laser, pulsed dye laser (PDL), and others can be used either as monotherapies or combined therapies. Therefore, efforts should be made to select the treatment that will provide the best results. Case Presentation: A 6-year-old boy with keloids on the lower lips extending to the chin was successfully treated with a 2940-nm fractional Er:YAG laser alternated with a 595-nm long-PDL followed by the combined intralesional injection of corticosteroid and 5-FU. The patient was followed up for 1 year with no lesion recurrence. Conclusion: Our case supports a combined therapy to successfully treat a patient with a keloid on the chin. Therapy using a combination of these four modalities seems safe and effective and may have a synergistic effect with minimal downtime.

Leprosy Epidemiology According to Leprosy Type in 13 Teaching Hospitals in Indonesia between 2018 and 2020

BACKGROUND: Leprosy or Hansen’s disease is an infectious disease caused by Mycobacterium leprae (M. leprae) bacilli which results in chronic infections in humans that affect the peripheral nerves, skin, and other organs such as the eyes, mucous membranes, bones, and testicles. Leprosy has a variety of clinical presentations, depending on the cell-mediated immunity of the host. Leprosy is classified by the World Health Organization (WHO) as paucibacillary type (PB) and multibacillary type (MB) depending on the number of lesions. This multicenter study aims to provide representation of leprosy types and its epidemiology in Indonesia. AIM: The purpose of this study is to find out the epidemiology according to the leprosy type in 13 teaching hospitals in Indonesia between 2018 and 2020. METHODS: This is a descriptive study with cross-sectional design. All patients with the diagnosis of PB or MB type of leprosy who underwent Multidrug Therapy (MDT) treatment between 2018 and 2020 were included in this study. Data collection was carried out by tracing medical records data in 13 teaching hospitals in Indonesia. RESULTS: A total of 2129 leprosy patients were included in this study. There were 232 cases (10.8%) of PB leprosy and 1897 cases (89.1%) of MB leprosy. The average age of the patients is 38.7 years (SD ± 16.2 years). Males are more affected by leprosy (n = 1,441; 67.7%) compared to female (n = 688; 32.3%). CONCLUSION: Leprosy remains as a national health problem. The increasing cases of MB leprosy in Indonesia are caused by several factors including the lack of knowledge about leprosy, the delay in diagnosis of leprosy, and the stigma of leprosy within the community; therefore, it becomes a challenge to eliminate leprosy in Indonesia.

Facial Rejuvenation in Indonesian Skin With a Picosecond 755-nm Laser

Introduction: The aging process in the skin naturally happens over time, affected by several factors, of which ultraviolet irradiation is a major factor, and this leads to the appearance of wrinkles, pigmentations, and textural irregularities. Lasers for facial rejuvenation are very popular in Asian patients, but melanin rick skin types like Asians are more susceptible to pigmentary alterations. Most Indonesians have brown skin, and just a few have light skin. The purpose of this study was to know the efficacy and safety of the picosecond 755 nm laser in facial rejuvenation in Indonesian skin. Methods: This is an analysis of 20 healthy patients with Fitzpatrick skin type III-V with facial photoaging from 36 to 55 years. Examinations were evaluated before therapy and 4 weeks after the second therapy. The front and side of both cheeks were photographed and analyzed by using VISIA. Clinical improvement was categorized as excellent-mild. The patients were also asked and examined about the presence of adverse events. Results: The patients were predominantly female with an average age of 44 years. Sixty percent of the patients had a good improvement and 40% of the patients had a moderate improvement. The VISIA analysis showed a significant improvement in wrinkles, pigments, and textures (P < 0.001). Only mild anticipated adverse events were observed, and there was no post-inflammatory hyperpigmentation or hypopigmentation. Conclusion: the picosecond 755 nm laser is effective and safe for facial rejuvenation in the skin of Indonesian patients without significant adverse events.

The Stress of Leprosy as a Mediator of the Relationship Between Coping Resources, Coping Strategies, and Psychological Well-Being in Persons Affected by Leprosy. The Structural Equation Models Through a Correlation Study

Intoduction

Psychological strength plays an important role in reducing stress due to leprosy because leprosy can cause physical, psychological, and social problems. For that reason, this study aims to investigate the relationship between coping sources, coping strategies, and psychological well-being through leprosy stress.

Methods

This research instrument uses a stress perception scale, coping sources, coping strategies, and psychological well-being scale to collect data from 125 participants consisting of women (33.60%) and men 66.40%. The test analysis in this study uses SmartPLS through structural equation modeling to prove the correlation.

Results

The results of the SEM test indicate that there is a negative relationship between coping resources and leprosy stress, with a coefficient value of (−0.380), p-value of (0.000) <0.05, and a positive relationship is obtained with psychological well-being with the coefficient value of (0.427), p-value of (0.000) <0.05. Meanwhile, the SEM test shows a negative relationship between coping strategies and stress of leprosy, with the coefficient of (−0.566), p-value of (0.000) <0.05, and a positive relationship is obtained with psychological well-being (0.355), p-value of (0.000) < 0.05. Furthermore, on psychological well-being, stress shows a negative relationship, with the coefficient of (−0.212), p-value of (0.002).

Discussion

Exploration of important coping sources is done to weaken the power of leprosy as a stressor and the use of effective coping strategies is needed to solve physical, psychological, and social problems for “People Affected by Leprosy”, and simultaneously these two attributes are used to achieve prosperity. psychological. better.

Patient preferences for surgery or non-surgery for the treatment of clavus and callus at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Clavus and callus are common hyperkeratotic lesions that can be very painful and affect the quality of life. The clinicians are faced with various factors affecting the resolution of the lesion, and no treatment has been considered ideal. Surgical has been preferable to conservative treatment but is still more likely to increase patients' desirability due to great discomfort. This study aims to evaluate the factors contributing to the resolution of callus and clavus. Methods: Retrospective analysis was done on 25 medical records of patients who met the inclusion criteria. Factors contributing to the lesion resolution were identified and analyzed using the SPSS version 17 program. Result: Among 25 (33.7%) patients recruited for the study, 13 were (52%) male and 12 (48%) female. The most common types of lesions were clavus (20 [80%]). In both cases, the distribution of lesion locations was mostly found in the lower extremities (20 [80%]). Excision was performed in 21 cases (84%), and 20 patients (80%) achieved resolution. Treatment modalities were found to be a factor that had a significant relation to the resolution of the lesion after receiving treatment (p = 0.003; Spearman test). Conclusion: Treatment of callus and clavus has shown satisfactory results in our center. Excision was found to be the most preferred method, with 80% resolution observed during 1 month. The treatment choice was found to be significantly related to the resolution of the lesion after receiving therapy.

Risk factors for disability in leprosy patients: a cross-sectional study

Background: The disability in leprosy is caused by M. leprae invasion and infiltration into the skin and the mucous membrane that results in nerve damage and deformities, loss of sensation, paralysis, and ocular manifestation. The risk of disability can be influenced by several factors, including the type of leprosy, disease duration, the number of nerves affected, leprosy reactions, gender, age, type of treatment, socioeconomic factors, and leprosy case detection methods. This study aimed to evaluate the risk factor of disability in leprosy patients. Methods: It was a cross-sectional retrospective analytical study to discover the correlation between risk factors with the grade of disability in leprosy patients who were treated in Dermatovenerology Outpatient Clinic Dr. Soetomo General Hospital Surabaya from 2017 to 2019. Result: This study found a total of 275 leprosy patients with disabilities, consisting of 76 patients (27,6%) with grade-1 disability and 199 patients (72,4%) with grade 2 disability. There was a statistically significant correlation between age (p=0,025), duration of disease (p=0,001), and multidrug therapy (MDT) history (p=0,001) with the incidence of disability. Gender, bacterial index, type of leprosy, and leprosy reaction were not significantly related to disability. Conclusion: This study showed that age, duration of disease, and the history of MDT treatment were related to the incidence of disability. The longer the disease's duration despite the patient having received MDT, the more risk of the patient having a disability.

The life experience of leprosy families in maintaining interaction patterns in the family to support healing in leprosy patients in Indonesian society. A phenomenological qualitative study

Background

Family involvement in overcoming the severity of leprosy is very important in the life of leprosy sufferers in communities who experience the clinical and, psychological, social and behavioral consequences of the disease. However, this need, psychosocial, is felt to be not optimal. This study is to identify how the experiences of family members as caregivers provide assistance to individuals with leprosy in improving healing and maintaining patterns of interaction in the family.

Methods

The design uses qualitative research with in-depth, face-to-face interviews with family members in a semi-structured manner with the hope of obtaining complete data. Using purposive sampling with Participatory Interpretative Phenomenology analysis, there are 12 families with 15 family members consisting of 4 men and 11 women.

Results

This study produced a family theme that tried to follow what would happen to individuals with leprosy, with four sub-categories: 1) Using various coping alternatives to recognize the disease, 2) Family members in the shadow of leprosy, 3) Trying to empathize with other family members. sick, 4) Caring for the emotional response of the family and seeking support.

Conclusions

This analysis shows that deficiency in cognitive aspects can be closed by maintaining a lifestyle in the family through efforts to understand, support, establish communication, increase maximum involvement in restoring self-confidence, especially in individuals with leprosy with psychosocial problems in the family. The results of this study can be used as psychosocial support in maintaining communication between family members to support treatment programs and accelerate the recovery of leprosy.

Although families have high empathy for the physical, psychological, and social problems faced by individuals with leprosy, they are rarely involved in the personal affairs of individuals with leprosy, and there are indications that they left them to cure their disease. Meanwhile, overcoming problems in their own way without involving other family members, becomes the main choice for people with leprosy to avoid conflicts between family members, because they realize that leprosy is a disgrace in their family. However, the interaction between family members is an Indonesian culture that continues to be preserved. And for whatever reason, the culture of interaction between family members cannot be abandoned, even though there are obstacles that must be faced because this is a tool to strengthen kinship. The writer found that the family tried to help in healing leprosy suffered by their family members, even though they were in the shadow of leprosy. Through various coping strategies implemented, families try to help the healing process of their illness, with the hope that they will rise from adversity and have high motivation to recover. And restoring the confidence of people with leprosy is important to support a definitive treatment program.

Profile of melasma patients in dermatology and venerology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Melasma is characterized by symmetrical brownish macules with well-defined borders. The etiology of melasma is still unknown, but factors that are thought to influence include genetic predisposition, ultraviolet radiation, hormonal factors, thyroid disorders, use of cosmetics, and drugs. This study aimed to determine the epidemiological data, evaluate risk factors, management, and follow-up in new melasma patients. Methods: The medical records of patients with melasma attending Dermatology and Venereology Outpatient Clinic over a 4-year period from 2015 to 2018 were analyzed retrospectively for this descriptive, observational study. Data were analyzed using SPSS version 23 for Windows. Results: This study found 739 new melasma patients from January 2015 to December 2018, with the proportion of women 734 patients (99.3%) more than men only 5 patients (0,7%). The age of most patients who were treated was 46-55 years in 320 patients (43.3%), with the highest age of onset being 37-45 years in 308 patients (41.7%). About 561 patients (75.9%) had a melasma duration of more than 1 year. The most common job of melasma patients was housewives in 366 patients (49.5%). The most frequent risk factor for melasma was ultraviolet radiation in 258 patients (34.9%). The most common melasma was malar type in 482 patients (65.2%) and mixed melasma in 617 patients (83.4%). The most widely administered therapy was sunscreen in 735 patients (99.5%) and Tretinoin 0.05% in 235 patients (31.8%). Most patients did not make repeat visits as many as 448 patients (60.6%). Conclusion: The most common disease in women of childbearing age with ultraviolet radiation is the most precipitating risk factor. The low number of patient repeat visits can be caused by a lack of doctor education or a lack of patient adherence to treatment due to chronic and recurrent diseases.

Combination effect of methotrexate with Narrowband Ultraviolet B (NB-UVB) phototherapy in psoriasis vulgaris patients in dermatology and venereology outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Psoriasis is a chronic, recurrent, inflammatory skin disease that alters the quality of life. Systemic therapy and biologic agents are prescribed for severe and widespread psoriasis, but these drugs may have systemic side effects and immune suppression. Narrowband Ultraviolet B (NB-UVB) phototherapy remains one of the most effective and safe treatments for psoriasis.Methods: This study was an observational retrospective cohort with one group pretest and post-test design. A retrospective analysis was done on 16 medical records of patients who met the inclusion criteria. The efficacy of the therapy was identified and analyzed using the SPSS version 17 for Windows.Results: This study found that 16 psoriasis patients received NB-UVB phototherapy, 11 (68.75%) in men and 5 (31.25%) in women. The mean age was 47.31 years. There was a statistically significant difference in the reduction in PASI score before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy (p=0.000); the delta PASI score was 45,02%. A statistical analysis based on the number of phototherapy sessions per week showed enhanced results when patients attended 3 phototherapy sessions per week (p = 0.001).Conclusion: There was a statistically significant reduction in PASI score in psoriasis vulgaris patients before and after receiving combination methotrexate with 24 sessions of NB-UVB phototherapy.

Pediatric Leprosy Profile in the Postelimination Era: A Study from Surabaya, Indonesia

Children who live in leprosy-endemic areas are susceptible to infection due to early and frequent exposure to Mycobacterium leprae. Indonesia is on the verge of eliminating this disease (prevalence rate < 1/10,000 population), but pediatric leprosy continues to occur in low-endemic areas. This study aimed to evaluate pediatric leprosy over a decade in a tertiary hospital in Surabaya, Indonesia. A retrospective study of leprosy in children under 15 years old between 2010 and 2019 was conducted in the Morbus Hansen Division, Outpatient Clinic at Dr. Soetomo Hospital in Surabaya, Indonesia. Seventy pediatric leprosy cases were identified between 2010 and 2019, consisting of 58 multibacillary (MB)-type cases and 12 paucibacillary (PB)-type cases. Slit skin smear (SSS) was positive in 26 cases. There were two cases of grade-2 disability and 15 cases of leprosy reaction (erythema nodosum leprosum) in children at the time of diagnosis. There was an insignificant decline in the number of pediatric leprosy cases in the last 10 years. Cases and disabilities in children were found in some leprosy pocket areas even though the national elimination rate has been achieved. MB infections, disability, and treatment defaults were common problems in pediatric leprosy.

The differences in maternal and child health factors amongst leprosy patients in endemic and non-endemic areas

Introduction: Leprosy, a chronic infectious disease caused by Mycobacterium leprae infection arise new concern in pediatrics health problems. Total number of pediatric leprosy cases are hard to eliminate due to dominance of parenting and household position of mothers. In this study, we evaluated the roles of maternal and child health factors amongst leprosy patients in endemic and non-endemic areas.Methods: Cross sectional study was conducted on Tuban Regency, East Java through interview guided by questioner on 106 pairs mother-child selected from local primary health center’s registry data and selection through inclusion and exclusion criteria. Several parameters were analyzed: mother’s age, children’s age, gender of children, antenatal care, breastfeeding, and childbirth methods. Data were analyzed using ANOVA test.Results: Statistically significant results were found in the age of mother (p = 0.007) and child (p =0.001) with older ages observed in the population lived in the endemic area. Gender of children (p=0.997), childbirth methods (p=0.172), antenatal care (p= 0.353), and breastfeeding (p=0.507) in this study showed insignificant results.Conclusions: The differences in mothers and children ages are associated with leprosy among the population lived in leprosy endemic areas compared to the control group with delayed in diagnosis and long incubation period should be considered as factors contributed in this findings.

COMPARING SOCIO-ECONOMIC CONDITIONS OF MOTHER AND CHILDREN WITH LEPROSY IN ENDEMIC AND NON-ENDEMIC AREAS IN EAST JAVA, INDONESIA

Background

Leprosy is a disease that causes social, psychological, and economic issues. Failure to treat the causes of the immune system dysregulation in endemic areas of leprosy conditions makes the transmission of the bacteria easier. This paper aims to analyze the comparison of family income, occupation types of mothers and fathers, number of children, access to health facilities, and education of mothers, fathers, and children in mothers and children with leprosy in endemic and non-endemic areas.

Materials and Methods

A cross sectional study by survey was done in both an endemic and a non-endemic area of leprosy in Tuban Regency, East Java, Indonesia. Retrieval of research data was done using interview techniques. Respondents who participated in this study were 106 pairs of mother and child respondents who met the research restriction criteria. Subjects were divided into 5groups based on diagnosis of leprosy and area of living. Bivariate analysis was performed by comparing the independent variables in each group A, B, C, and D with group E.

Results

It was found that the variables that differed significantly between the endemic and non-endemic areas were the variable number of children with a p-value=0.004, family income with a p-value=0.049 and the variable mother's education with a p-value=0.016. Meanwhile, other variables do not have significant difference.

Conclusions

We found significant difference on the number of children, father's education, mother's education, and family income. These variables can be a risk factor for leprosy. To make efforts to prevent the transmission of leprosy, stakeholders should consider these factors.

Efficacy of topical epigallocatechin gallate (EGCG) 1% on the healing of chronic plantar ulcers in leprosy

BACKGROUND

Chronic plantar ulcers in leprosy (CPUL) occur in areas that have a sensory and an autonomic nerve impairment where the wound healing takes longer. Framycetin gauze dressing (FGD) is best used in the wound healing process during the inflammatory phase because it contains antibiotics. Epigallocatechin gallate (EGCG) is the highest component in the extract of green tea that can accelerate blood vessel formation, has an anti-inflammatory effect, and reepithelialization.

OBJECTIVE

To investigate the effect of topical EGCG 1% on the healing of CPUL.

MATERIALS AND METHODS

An analytical experimental approach comparing the topical EGCG 1% and FGD applied every 3 days up to 8 weeks on the healing of CPUL. Size of the ulcers, side effects and possible complications from both approaches were monitored weekly.

RESULTS

Ulcer healing in the EGCG group was significantly better than the FGD group with significant clinical and statistical differences (p < .032). There were no side effects in both the study groups. Complications, such as an increase in the size of the ulcer, were noted in one subject in the control group. This may have been caused by FGD and claw foot condition.

CONCLUSIONS

EGCG 1% is more effective than FGD in accelerating the healing process of CPUL.

Lucio phenomenon of leprosy LL type on pregnancy: A Rare Case

INTRODUCTION

Lucio phenomenon is a rare type of reaction in untreated, diffusely infiltrative form of lepromatous leprosy type, characterised with ulcerative type of skin lesions.

CASE

A 29 year old Indonesian female, 7th months primigravida with a four-month history of painful scarlet spots that darken and ulcerate on both of her hands and legs. The patient was experiencing fever. The patient’s eyebrows were lost and her earlobes were thickened 3 years ago. Slit-skin smear: BI 6þ,MI 7%. Histopathology: Lucio phenomenon. PCR detecting M. leprae DNA on skin lesion and amniotic fluid: positive; umbilical cord membrane and umbilical cord: negative. Anti-PGL-1 IgM and IgG: patient: 4,854 U/mL and 1,061 U/mL, respectively; 5 month-old baby: 5 U/mL and 1,724 U/mL, respectively; 1 year-old baby: 0 U/mL and 3 U/mL, respectively.

CONCLUSION

Placenta is considered a protective barrier toward feto-maternal transmission of M. leprae. The baby had the passive antibody to M. leprae from the mother’s blood transmitted through the umbilical cord as demonstrated by the presence of anti-PGL-1 IgG antibody.