IMCAS

A case of twenty nail dystrophy with alopecia universalis

Objectives: Twenty nail dystrophy can be associated with alopecia universalis although the underlying disease and treatment strategies of both conditions differ.1 This case report shows the incidence of both cases in one patient with different treatment results.

Introduction: Twenty nail dystrophy, also known as trachyonychia, is an abnormality of the proximal nail matrix. It presents as a homogenous roughness, giving the nail a sandpaper-like appearance. It can either present as its own entity or as a manifestation of another condition, which alopecia areata is the most common disease associated.2 Alopecia areata is the most frequent cause of inflammation-induced hair loss that can progress into severe forms named alopecia universalis, which involves the whole body hair.3 Several autoimmune and atopic disorders are thought to be associated with alopecia areata.4

Materials / method: A 13-year-old boy was consulted from pediatric department with diagnosis of thyrotoxicosis and asthma with other chief complaint of yellowish discoloration and roughness of all his fingernails and toenails that followed by progressive hair loss on the whole body. Important laboratory results were IgE = 631 iu/mL, TSH = 0,005 μIU/mL, T3 = 0,80 ng/mL, FT4 = 1,62 ng/dL. The patient was treated using urea 20% and tretinoin 0,1% for the twenty nail dystrophy and minoxidil 5% and desonide lotion for alopecia universalis along with the treatment of thyrotoxicosis and asthma as the underlying diseases

Results: Excellent result of twenty nail dystrophy treatment was achieved in 18 months duration of topical treatment. On the contrary, there was no good progress report in the treatment of alopecia universalis although the underlying diseases had been under control.

Conclusion: Treatment for twenty nail dystrophy associated with alopecia universalis is challenging.1 The treatment for twenty nail dystrophy is done only for cosmetic reasons. The basis of treatment involves regulating the differentiation of keratinocytes and/or decreasing the inflammation in the nail fold or nail matrix.2 Thyroid dysfunction can affect the scalp hair and hair on other parts of the body that result in alopecia universalis.5 Poor outcome of hair regrowth may be associated with the extent of involvement, nail involvement, atopic diseases, and thyrotoxicosis.6

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

A case of concurrent infections of syphilis and chancroid

Objectives: Combination therapy for STD

Introduction: Syphilis is a chronic and systemic disease caused by Treponema palidum. Syphilis in the clinical course is divided into three stages, namely primary, secondary and tertiary syphilis which are separated by latent phases, without clinical signs of infection. Syphilis is often co-infected with other STI diseases, such as chancroid. Chancroid is an infectious disease of the acute genitals, locally, caused by Streptobacillus ducrey. We reported a case of roseola sifilitica in a man with chancroid, this case report was made because of the high combination of STIs that could overlap.

Materials / method: 21-year-old male patient with complaints of multiple ulceration on penis, and reddish spots on the palms and feet. On physical examination the dermatological status found multiple erythematous macules, copper-red, round shaped. Venereological status results in multiple ulcers, purulent base, kissing-lesions (+), easily bleeds. On VDRL examination 1:64 titer was obtained and TPHA positive. The patient was diagnosed with roseola sifilitica and a genital ulcer suspected to be caused by H. ducreyi. Patient was treated with Benzathine penicillin and Azithromycin.

Results: The most common clinical manifestation in secondary syphilis is roseola sifilitica, the maculopapular rash, generally not itchy, pale to copper red. Serological results for the patient confirmed the diagnose for syphilis. Chancroid is a rare infection in the United States and most other developed countries. The actual chancroid event is still uncertain because the exact diagnosis requires detection of the causative organism, H ducreyi. An important explanation for this observation is the widespread use of WHO guidelines for the treatment of sexually transmitted infections, in which the treatme

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Effectiveness of Juvederm Ultra Plus dermal filler in correcting nasolabial folds - A systematic review and network meta-analysis

Objectives: To compare the effectiveness and safety of five hyaluronic acid dermal fillers for nasolabial folds improvement (Juvéderm Ultra Plus, Restylane, Perlane, Elravie and BioHyalux).

Materials / method: Systematic review has been conducted among all potential studies published in electronic database which were randomized controlled trials. Bayesian network meta-analysis was used to evaluate and compare the effectiveness and safety of these products.

Results: 10 studies were identified and network Meta-analysis indicated that the responder rate of Juvéderm Ultra Plus was significantly better than that of Restylane (RR=2.22, 95% CI: 1.25, 4.00) and Perlane (RR=4.35, 95% CI: 2.44, 7.69), but no significant difference in effectiveness was observed when compared to Elravie or BioHyalux. The effectiveness of Juvéderm Ultra Plus on NLFs scores improvement in week 24 was comparable to Restylane (MD=0.19, 95% CI: -0.21, 0.59) and Perlane (MD=0.21, 95% CI: -0.56, 0.98). Probabilistic sensitivity analysis demonstrated that Juvéderm Ultra Plus had higher prob

Conclusion: The results of this network Meta-analysis were basically consistent with those obtained in previous traditional Meta-analysis. Juvéderm Ultra Plus is a more ideal HA dermal filler in terms of its clinical effectiveness and durability in nasolabial folds correction.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo es presentado gracias al apoyo de: Allergan China

A case of halo nevi treated with punch excision

Objectives: causes and treatment of halo nevi

Introduction: Background: Melanocytic nevi change throughout a person’s life and can cause cosmetic problem. Nevi frequently form, but the exact mechanisms involved in their generation remain unknown. Nevi less commonly transform into targetoid presentations that surrounded by a white depigmented circle or halo phenomenon. Nevi can be removed by excision and continued with histopatological analysis.

Materials / method: Case report

Results: Observation: A 20-year-old man with nevus on his right cheek since 2 years ago. A depigmented circle appear surround the nevi since 1 month ago, that had been causing him much social embarrassment. The nevus measured diameter 2 mm with halo phenomenon. In dermoscopy examination showed reticular lession with homogenous pigmentation, surrounded by symmetrical depigmentation rim. Based on clinical features and dermoscopy examination, the lession was diagnosed as halo nevi. A punch excision was carried out and histopatological analysis showed a dense inflammatory infiltrate in the dermal-epiderma

Conclusion: Disscussion: In halo nevi, a symmetrical hypopigmented rim can be observed surrounding a central nevus. The progressive involution of the central part of this variety of nevus might be seen over the course of months to years. Complete removal of nevi is best accomplished by excision. The advantages of punch excision was simple in technique, minimal scarring, didn’t require a long time and provide tissue for histopatological analysis.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Oral tranexamic acid with fluocinolone-based triple combination cream in centrofacial epidermal melasma

Objectives: To determine the effectivity of oral tranexamic acid and fluocinolone-based triple combination cream in melasma

Introduction: Melasma is a pigmentary skin disorder that presents as symmetrically distributed hyperpigmented macules in sun exposed areas. The management of melasma is challenging and requires a long-term treatment plan. Fluocinolone-based triple combination cream has been proven to be effective in melasma. Addition of oral tranexamic acid to fluocinolone-based triple combination cream may increase the efficacy of topical treatment.

Materials / method: A 44-years-old female with hyperpigmented macules on her forehead, cheeks, and nose since 8 years ago. Patient always exposed to sunlight during work but never used sunscreen or sun protection. The lesion worsen when the patient was pregnant. Patient with Fitzpatrick skin type IV. Wood lamp examination revealed an enhancement of contrast. Dermoscopic examination obtain reticular pigment with a brownish homogenous pigmentation. The patient was diagnosed with centrofacial epidermal melasma and got oral tranexamic acid with fluocinolone-based triple combination cream.

Results: Combination of both therapy results in a faster and sustained improvement in melasma. This treatment resulted in 56,5% decreased of MASI score at fourth week.

Conclusion: Combination of oral tranexamic acid with fluocinolone-based triple combination cream can be an effective treatment for melasma

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Atrophic acne scars treated with combination of subcision and trichloroacetic acid chemical reconstruction of skin scars (TCA cross)

Objectives: Introduction: Acne scarring occurs in most people after the resolution of acne vulgaris. It is aesthetically unappealing and can be challenging to treat. Acne scars associated with low self-esteem and reduced quality of life.

Introduction: Case : A 24-year old man came with scars on the face since 6 years ago. He suffered from mild to moderate acne throughout puberty and often picked his acne. He never had any treatment for the scars. Dermatologic examination revealed multiple atrophic acne scars on the forehead and cheeks with rolling, boxcar and ice pick type. We diagnosed this patient with acne scar grade 3 according to Global Acne Scarring Classification. Patient was treated with subsicion for the rolling scars and TCA CROSS for the icepick scars. Follow-up after the second treatment showed improvement of the scars, we still

Materials / method: plan for repeated treatments.

Results: smooth the surface contour. Subcision is useful for any depressed scars on the face, especially rolling scar. The CROSS technique with 80-100% TCA is a safe, efficacious and cost-effective technique for the management of ice pick acne scars that are difficult to treat. It will induce collagenization and cosmetic improvement. These treatments have to be repeated to get the best results.

Conclusion: Keywords: acne scar, TCA CROSS, subcision

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Facial angiofibromas successfully treated by topical sirolimus in combination with carbondioxide laser

Objectives: Facial Angiofibromas successfully treated by topical sirolimus in combination with carbondioxide laser
Introduction
Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome which causes hamartomatous growth in multiple organs due to mutations in TSC1 or TSC2 genes which inhibit the mammalian target of rapamycin (mTOR). Among the hamartomatous skin lesions, facial angiofibromas occur in 80% of patients with TSC resulting in cosmetic disfigurement.
CASE REPORT
Twenty-six years old woman applied to our clinic with complaint of facial lesions. Multiple erythematous papull

Introduction: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome which causes hamartomatous growth in multiple organs due to mutations in TSC1 or TSC2 genes which inhibit the mammalian target of rapamycin (mTOR). Among the hamartomatous skin lesions, facial angiofibromas occur in 80% of patients with TSC resulting in cosmetic disfigurement.

Results: CASE REPORT
Twenty-six years old woman applied to our clinic with complaint of facial lesions. Multiple erythematous papulles distributed symmetrically on the face. Facial lesions diagnosed with angiofibromas. Computer tomography of head revealed cortical subcortical tubers. Hyperechoic multiple nodular appearance was observed by renal ultrasonography that were interpreted as angiomyolipomas. TSC was suggested in the patient. Ablative CO2 laser treatment was performed to the facial angiofibromas for aesthetic purpose twice. Topical 0.1 % sirolimus vaseline mixture(Rapamune® 1 mg tablets were

Conclusion: DISCUSSION
Guidelines do not exist for the treatment of facial angiofibromas. Sirolimus is an off‐license treatment with good outcomes.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

A case report: henoch-schonlein purpura on an adult female patient

Objectives: case report

Introduction: Background: Henoch-Schönlein Purpura (HSP) is a leukocytoclastic vasculitis variant that is acute, systemic and mediated by immune complexes. The manifestation of this disease, includes clinical triads: palpable purpura, abdominal pain, and arthritis. More than 90% of cases of Henoch-Schönlein purpura occur in children under 10 years, and this disease in adult is uncommon. In 2006, the American College of Rheumatology made a diagnosis criteria: dermatologic manifestation of palpable purpura, followed by one or more diffuse abdominal pain, the presence of immunoglobulin deposits, arthritis or a

Materials / method: case report

Results: Observation: A case of Henoch Schönlein Purpura was reported in a 29 years old Javanese with palpable purpura on the buttocks, arms, thighs and left and right leg since 2 weeks before admission to the hospital. Patient had diarrhea, nausea and vomiting for 4 days prior. Joint pain was observed on the patient’s fingers. Urinalysis was found positive for proteinuria and hematuria, which confirmed the kidney involvement. Histopathological examination presented perivascular lymphocytes in the superficial dermis and deep dermis, endothelial swelling, extravasation of erythrocytes, eosinophils, neut

Conclusion: Key message: HSP is not only a dermatological disease, but could affect the internal organs. Proper medication, close monitoring of progressivity and complications from the disease is important to prevent morbidity.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Safety and effectiveness of VYC-12 injectable gel for treatment of facial fine lines: 6-month results from a prospective study

Objectives: To evaluate the effectiveness and safety of VYC-12, a hyaluronic acid injectable gel, for the treatment of superficial cutaneous depressions such as fine lines and the improvement of skin quality attributes such as hydration and elasticity of the full face (cheeks and forehead) and neck (optional) in a 6-month, prospective study.

Introduction: VYC-12 hyaluronic acid injectable gel was designed to treat superficial cutaneous depressions such as fine lines and to improve skin quality attributes such as hydration and elasticity. This prospective, single-arm study aimed to evaluate the safety and effectiveness of VYC-12 treatment on the full face (cheeks and forehead) and neck (optional).

Materials / method: Adults with moderate-to-severe cheek skin roughness on the Allergan Skin Roughness Scale (ASRS) received intradermal VYC-12 injections; touch-up treatment, if needed, was provided ~30 days later. The primary endpoint was the proportion of cheeks with ≥1-point improvement (responder) from baseline ASRS score at month (M) 1 after last treatment. Other assessments included instrument measures of skin smoothness, hydration, firmness, and thickness; investigator-assessed severity of fine lines (Allergan Fine Lines Scale [AFLS]); adverse events; and injection-site responses (ISRs).

Results: Of 131 subjects (261 cheeks), 31 (23.7%) required touch-up (46 cheeks; 17.6%). The ASRS responder rate was 96.2% at M1, 76.3% at M4, and 34.9% at M6. Skin smoothness, hydration, firmness, and thickness significantly improved from baseline to M1 (P<0.05). For 189 cheeks with moderate to severe fine lines (AFLS: 2 or 3) at baseline, the responder rate was 89.4% at M1, 66.7% at M4, and 40.5% at M6. All treatment-related adverse events were mild or moderate. ISRs typically lasted for ≤1 week, as expected. A day after initial treatment, 95% of subjects returned to normal social activities.

Conclusion: VYC-12 was observed to be safe and effective for treating superficial skin depressions and improving skin quality, with effects lasting for 4 to 6 months.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
Si
Por favor especifique las entidades (individuo, empresa, sociedad): Allergan

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
Si
Por favor especifique las entidades (individuo, empresa, sociedad): Employee of Allergan

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
Si
Por favor especifique las entidades (individuo, empresa, sociedad): Employee of Allergan

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo es presentado gracias al apoyo de: Allergan

Keloid resembling acne conglobata: a case report

Objectives: Keloids sometimes appear very similar to acne conglobata. The aim of this case report is to distinguish between the two entities through careful physical examination in order to administer the correct treatment.

Introduction: Keloids are characterized by dense, fibrous tissue nodules without spontaneous regression. This condition often appear as soft and doughy to rubbery hard nodules. Keloids may appear red due to either persistent inflammation or permanently dilated capillaries beneath the skin’s surface. Acne conglobata is a type of acne characterized by unusually severe inflammation, forming erythematous nodules. At a glance, keloids may appear very similar to acne conglobata. A thorough physical examination is needed to distinguish between the two entities in order to administer the correct treatment.

Materials / method: An 18-year-old male complained of recalcitrant acne on face and trunk two years prior to coming to our centre which gradually worsened during the past year. Although acne had been extensively treated using multiple regimens of medications, the patient has not experienced any improvement. Dermatology examination on the face, chest and back revealed multiple erythematous to skin colored smooth firm nodules as well as erythematous papules and comedones.

Results: Keloid and acne conglobata can be distinguished by its consistency and the presence of comedones. Stretching of the skin, using a good light, at a shallow angle, will allow visualization of comedones. Close inspection showed that the patient suffered from a mixture of multiple acne cyst-like keloid formations in addition to mild acne vulgaris.

Conclusion: Keloids in acne patients sometimes can be mistaken as acne conglobata. Careful clincial inspection is important in distinguishing both entities in order to administer appropriate treatments.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

A case of generalized pustular psoriasis in a pregnant woman

Objectives: We reported a case of generalized pustular psoriasis in a pregnant women. How to make diagnosis and management generalized pustular psoriasis in a pregnant women.

Introduction: Generalized pustular psoriasis (GPP) is one variant of pustular psoriasis that is acute and severe. The clinical manifestations are prodromal symptoms, erythematous macules covered with pustules, some pustules confluence forming “a lack of pus” configuration, sterile pustules, and generalized distribution. GPP could be induced by hormonal changes. Hormonal fluctuation caused disruption of keratinocyte proliferation and inflammatory stimulation. Choices of therapy for GPP in pregnancy are cyclosporine, systemic corticosteroids, and topical corticosteroid. We reported a case of GPP

Materials / method: Case Report

Results: A 33 –year- old Asian female, pregnant, seek medical advice for blister and erythema on the skin since 10 days ago. Initially erythema appeared on her face then spread throughout the body, followed by pustules on top of the erythematous skin, and accompanied with fever. Some pustules united to form “lake of pus”. The diagnosis is GPP in pregnancy. We gave dexamethasone 5 mg twice a day intravenously, desoxymethasone 0.25% cream twice a day topically,and open dressing. The lesion had improved but new lesion returned when steroid was tapered off to 36 mg methylprednisolone. The fetus is healthy.

Conclusion: GPP could be induced by hormonal changes. Hormonal fluctuation cause disruption of keratinocyte proliferation and inflammatory stimulation. Choices of therapy for GPP in pregnancy are cyclosporine, systemic and topical corticosteroid. Effective therapy could prevent complications. Studies revealed that when the patient has gave birth, spontaneous remission could occur without treatment.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Upper face rejuvenation with botulinum toxin type A and hyaluronic acid dermal fillers

Objectives: Botulinum toxin type A in combination with hyaluronic acid filler treatment for glabellar complex rhytides demonstrated a good outcomes.

Introduction: Aging changes in the upper face reflect the effects of ultraviolet damage, gravitational changes, and muscles of facial expression on overlying skin. Botulinum toxin type A has become the standard for nonsurgical upper facial rejuvenation which can significantly reduces the severity of upper facial rhytides. Dermal fillers have been developed for correcting facial rhytides in the last decade. Preference dermal fillers should be safe, effective, biocompatible, non-immunogenic, easy to remove if necessary, and have an acceptable persistency. Hyaluronic acid fillers have most of these features.

Materials / method: A 56-year-old woman came with chief complain skin wrinkles on her forehead and eye-bag appearance since 2 years ago. On physical examination, we observed static lines at rest on forehead area and glabellar complex. In addition, the presence of dynamic lines during animation observed in the forehead and lateral canthus. Based on these observations we managed to combine botulinum toxin type A and hyaluronic acid filler treatment.

Results: A total of 20 units of botulinum toxin type A injections for treatment of horizontal forehead lines were performed at frontalis muscle, 12 units on glabellar lines at the procerus muscle and corrugator muscles, and 3 units per side of crow’s feet lines. A 5-cm blunt cannula was used for more safe tear trough filler procedure. The amount of hyaluronic acid dermal filler was approximately 0.5 ml per site. Excellent result was achieved in 2 weeks after treatment session.

Conclusion: Careful selection of patients for treatment with fillers is essential to achieve optimal outcomes and avoid potential complications. The upper face is considered a basic area for use of botulinum toxin but a challenging area for use of fillers, particularly because serious complications such as blindness and necrosis may occur. The use of a careful injection technique is imperative for all facial areas. The combination of botulinum toxin type A and hyaluronic acid dermal filler treatment will increase the durability of outcome and more natural appearance.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
Si
Por favor especificar la fecha...: Patient of dermatology outpatient-clinic
y el estado: 02/05/2019

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Case report: DRESS syndrome induced by phenytoin

Objectives: case report

Introduction: Background : Drug-induced hypersensitivity or Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. Most of the aromatic anticonvulsants, such as phenytoin, phenobarbital, and carbamazepine, can induce DRESS. Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment

Materials / method: case report

Results: Observation : A 48 years old woman with prior known medical history post resection intracranial glioma tumor in January 2017. She has history treatment using phenytoin was prescribe by neurosurgeon to prevent convulsion. On the 9th weeks after the initiation of phenytoin she develop rash, mild itchy, also sore troat and fever. On admission, her temperature was 39°, blood pressure 110/70 mmHg, heart rate was 110beats/minute and respiratory 20beats/minute. She had scaly exanthematous rash on her trunk, limb, face, sole and palm. Laboratory examination found leucocyte 15,97, eosinofil 2,39, SGO

Conclusion: Disscussion : Drug rash with eosinophilia and systemic symptoms (DRESS) is a rare but potentially life-threatening condition with high mortality. Prompt recognition and the removal of offending agent remain the key to successful treatmen. In cases of severe organ involvement, corticosteroids may be helpful.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Staphylococcal scaled skin syndrome in newborn baby: a case report

Objectives: a case report of Staphylococcal Scalded Skin Syndrome (SSSS) of a newborn

Introduction: Staphylococcal scalded skin syndrome (SSSS) is a disease characterized by desquamating erythematous skin caused by exotoxin that is produced by Staphylococcus aureus. The symptoms of Staphylococcal scalded skin syndrome (SSSS) include blistering of skin and epidermal peeling. The disease usually affects infants and children aged < 5 years. Early diagnosis and appropriate treatment can prevent the mortality associated with SSSS complications.

Results: Case
A 23 day-old male newborn admitted with erythematous lesions almost over the whole body surface area. The Erythematous rash started over the face and groin then spread to other parts of the body with fragile blisters which leading to extended areas of eroded skin within the next day. On examination, baby was febrile and lethargic with eroded and oozing areas covered by epidermal desquamation over the face, trunk, hands, and gluteal region. Nikolsky’s sign was positive. Culture of the nose swab showed a growth of Staphylococcus.The baby was treated with Cefoperazone sulbactam IV.

Conclusion: Discussion

Staphylococcal scalded skin syndrome (SSSS) is an acute exfoliation of skin due to staphylococcal exfoliative toxins. Staphylococcus aureus produces two exfoliative toxins A and B, the toxins bind to Desmoglein 1 within the desmosome and cause loss of cell adhesion in the epidermis. The diagnosis of SSSS is usually based on the clinical manifestations, and supported by the presence of S. aureus in the nasal, conjunctival, pharyngeal or wound swabs. The baby skin condition improved after prompt therapy with early proper antibiotics and supportive treatment.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Therapy oral eryhtromycin with topical azelaic acid 15% and tretinoin 0,025% in rosacea patient: a case report

Objectives: Therapy oral eryhtromicin with topical azelaic acid 15% and tretinoin 0,025% in papulopustular rosacea patient was effective in 1 month evaluation. There are remarkable decreased of inflammation lesions (papule and pustule), also decreased of macule and plaque for the affected area.

Introduction: Rosacea is a common skin condition with characteristic symptoms and signs, including symmetric flushing, stinging sensation, inflammatory lesions (papules and pustules), and telangiectasia on face. In most patients, the central area of the face is affected, such as the nose, forehead, chin, and perioral areas. Papulopustular rosacea (PPR) papules/pustules combined with transient or persistent facial redness, telangiectasias, red plaques, burning and stinging. The therapeutic for rosacea is avoidance of triggers and combination with medical therapy.

Materials / method: We present a 43 years old Asian female, seek for medical attention with chief complaint redness, pimples and bumps on her face and also on her scalp since 1 year ago. It’s started with pimples and bumps, also complained of stinging and burning sensation, swollen, flushing, and persistent erythema most common on central area. Physical examination found erythema papule, pustule, erythema and hyperpigmented macule, and erythema plaque. Scrapping for demodex is done and the result was negative.

Results: Therapy was given erythromycin 250 mg once daily, azelaic acid 15%, tretinoin 0,025%, sunscreen SPF 15. After 1 month therapy, there are remarkable decreased of papule and pustule for quantity, decreased of macule and plaque for the affected area.

Conclusion: Papulopustular rosacea therapy oral erythromycin with topical azelaic acid 15% and tretinoin 0,025% was effective

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Surgical acne scar revision using punch technique and tumescent anesthesia

Objectives: This case report aims to provide better understanding of the use and benefits of surgical acne scar revision with punch technique, specifically punch excision and punch elevation method, with the utilization of tumescent anesthesia solution.

Introduction: Introduction
Atrophic scarring remains a common type of scarring encountered after acne. Scarring caused by acne may affect physiological and social aspects, often leads to distress, especially in adolescent. Scarring may appear as a result of damage to the skin during healing process of active acne. Many modalities have been proposed to manage the occurrence of acne scar. We reported a case of surgical acne scar revision using punch technique and tumescent anesthesia.

Materials / method: Case
A male patient seek medical advice for acne scars predominantly on his cheeks.The scars had persisted for 4 years, preceded by severe acnes.Physical examination showed multiple atrophic scars, boxcar type, oval depression with sharply demarcated edges, some with diameter more than 3 mm.Diagnosis of moderate acne scars was established.The patient had not received any treatment for his acne scars.We performed punch elevation and punch excision on the scars. Initially, tumescent anesthesia using lidocaine solution was infiltrated to the surgical sites.Improvement was seen within few weeks.

Results: Discussion
The utilization of punch technique has been proclaimed to give effective and satisfying outcome in managing the scars with safe and uncomplicated process. Through punch procedure, removal of the base of the scars is expected to promote skin heals and assisting more even skin surface. The use of tumescent anesthesia was preferred to provide optimal effect with minimal toxicity of the anesthetic agent, as it also reduces the amount of bleeding.

Conclusion: Keywords
acne scar, acne surgical revision, punch elevation, punch excision, tumescent

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Relapse of multibacillary leprosy during pregnancy

Objectives: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. It primarily affects skin and peripheral nerves and if untreated, leads to deformity and disabilities. The treatment of leprosy is unique in terms of the fixed dose, duration of regimen, and definition of “cure”. Efficacy of therapeutic regimens in leprosy is determined by the “relapse rate”. Pregnancy is associated with decrease in cellular immune response that allows the multiplication of persisters and increases the risk of relapse in leprosy.

Materials / method: A 22-years-old, pregnant woman, 3-months of gestation, presented with multiple hypoesthetic, erythematous, scaly plaques over her body of 8 weeks duration. She denied fever or changes in vision, but she complained of tingling sensation on the soles. Five years ago, she was diagnosed with leprosy, treated with multidrug therapy (MDT) for 6 months and declared cured (defined by negative slit skin smear test). She was a housewife, lived at Sumba Island with her leprosy-treated grandfather. The non-tender enlargement of bilateral auricularis magnus nerves was found during palpation. Slit skin smea

Conclusion: Altered immunological response during pregnancy is associated with downregulation of cellular immune response, that leads to increase susceptibility for leprosy relapse. Multidrug therapy consisting of dapsone, rifampin, and clofazimine is highly effective for pregnant woman with leprosy and considered safe, both for mother and child. Antileprosy drugs are excreted into human milk but there is no report of adverse effects except for skin discoloration of the infant due to clofazimine

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Clinical application of mult-dimensional improvement of aging of nasolabial sulcus

Objectives: Multi-dimensional improvement of nasolabialgroove aging by minimally invasive methods

Introduction: the deepening of naso-labial groove is the main sign of aging in the middle of face. A natural and harmonious naso-labial groove expresses youth, beauty and vitality. So in clinical practice, those who are eager to improve the aging of naso-labial groove are in the majority.and with preoperative facial assessment and image design, and adopt the "future" design method to improve naso-labial groove combined with multiple facial aesthetics unit.

Materials / method: Combined with hyaluronic acid, wire, botox,skin nutrient to improve the aging of nasal labial groove

Results: Comprehensive improvement, facial rejuvenation, high satisfaction

Conclusion: As for the facial aging problem, it is quite complicated, so the combination of multiple treatment methods is an inevitable trend and an effective joint scheme

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Clinical outcome of 1064-nm picosecond laser using a micro-lens array for the treatment of atrophic scars

Objectives: The aim of this study was to evaluate the efficacy of a fractional 1064-nm ps-Nd:YAG for the improvement of atrophic scars.

Introduction: Picosecond neodymium–doped yttrium aluminium garnet Laser (ps–Nd:YAG) has emerged as a new alternative in the treatment of various dermatologic diseases.

Materials / method: A retrospective chart review and clinical photo analysis were performed on subjects treated with a low-fluence 1064-nm ps-Nd:YAG laser with a micro-lens array (MLA). The Manchester Scar Scale (MSS), 5-point Global Assessment Score (GAS) were measured to evaluate the improvement of the scar.

Results: A total of 18 Korean patients (7 males and 11 females; mean age of 27.94 ± 13.66 years) were retrospectively analyzed. All patients were treated with a ps-Nd:YAG at the wavelength of 1064-nm, pulse duration of 450 or 750 ps, mean spot size of 5.95 mm, mean fluence of 2 J/cm2, and mean pulse rate of 6.13 Hz. The mean number of treatments was 4.05 ± 2.19, and mean total duration of treatment was 29.94 ± 23.42 weeks. After treatment, the average MSS score was statistically significantly reduced from 9.83 to 7.55 (p < 0.001). The average GAS was measured as 3.61 ± 0.92, in fair gross improvement.

Conclusion: For the treatment of atrophic scars in Asian skin, the fractional low-fluence 1064-nm ps-Nd:YAG can be a effective modality.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Oradores	Título de la presentación	Resumen	Número
Dr Zahruddin AHMAD	A case of twenty nail dystrophy with alopecia universalis	Ver	94622
Dr Sissy CHEN	A case of concurrent infections of syphilis and chancroid	Ver	94616
Prof Xiangdong CHEN	Effectiveness of Juvederm Ultra Plus dermal filler in correcting nasolabial folds - A systematic review and network meta-analysis	Ver	86394
Dr Maria Patricia DIAN PUTRI	A case of halo nevi treated with punch excision	Ver	94607
Dr Dewi GOTAMA	Oral tranexamic acid with fluocinolone-based triple combination cream in centrofacial epidermal melasma	Ver	94618
Dr Monica Rosalind KAWILARANG	Atrophic acne scars treated with combination of subcision and trichloroacetic acid chemical reconstruction of skin scars (TCA cross)	Ver	94629
Dr Umut Ayberk KUKUL	Facial angiofibromas successfully treated by topical sirolimus in combination with carbondioxide laser	Ver	94619
Dr Ricky Fernando MAHARIS	A case report: henoch-schonlein purpura on an adult female patient	Ver	94614
Ann P MARX	Safety and effectiveness of VYC-12 injectable gel for treatment of facial fine lines: 6-month results from a prospective study	Ver	94657
Dr Stefani NURHADI	Keloid resembling acne conglobata: a case report	Ver	94603
Dr Corry Khathreen Olivia PANGARIBUAN	A case of generalized pustular psoriasis in a pregnant woman	Ver	94601
Dr Karina Dyahtantri PRATIWI	Upper face rejuvenation with botulinum toxin type A and hyaluronic acid dermal fillers	Ver	94611
Dr Ana RAHMAWATI	Case report: DRESS syndrome induced by phenytoin	Ver	94612
Dr I Gusti Ayu SATTWIKA PRAMITA	Staphylococcal scaled skin syndrome in newborn baby: a case report	Ver	94654
Dr Luh Made SHANTI MAHESWARI	Therapy oral eryhtromycin with topical azelaic acid 15% and tretinoin 0,025% in rosacea patient: a case report	Ver	94620
Dr Irene Jessica Angela SOPUTRO	Surgical acne scar revision using punch technique and tumescent anesthesia	Ver	94597
Dr Venny TANDYONO	Relapse of multibacillary leprosy during pregnancy	Ver	94621
Dr Rongrong TANG	Clinical application of mult-dimensional improvement of aging of nasolabial sulcus	Ver	88212
Dr Jung Hwa YANG	Clinical outcome of 1064-nm picosecond laser using a micro-lens array for the treatment of atrophic scars	Ver	87866

IMCAS Asia 2019
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IMCAS Asia 2019 Programa

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IMCAS Asia 2019
Programa