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IMCAS Asia 2019
Program

FOCUS ON S052B

Udayana University Session

Partner of the session

Udayana University

Indonesia

Room: Room 2
Date: Saturday 6 July 2019 at 12:20 to 13:00
Format: FOCUS SESSION > lectures covering a major topic of the congress
Objectives: 1. Evaluate present and future therapies for dermatologic conditions 2. Recognize and correctly diagnose skin diseases

Chair

Dr Andreas WIDIANSYAH

Dermatologist

Indonesia

Lectures of the session

Hours	Speakers	Lecture title	Abstract	Number
12:20	Dr I Gusti Nyoman DARMAPUTRA	Power-assisted liposuction for abdominal liposculpture	View	85172
12:26	Prof Made Swastika ADIGUNA	A neglected case of leprosy with second degree impairtment: a case report	View	94947
12:32	Dr Ni Luh Putu Ratih Vibriyanti KARNA	Conglobata acne treated with low dose oral isotertinoin in combination with topical tretinoin	View	94955
12:38	Dr I Gusti Ayu Agung Elis INDIRA	Lipschutz ulcer with vulvovaginal candidiasis in a virgin		94958
12:44	Dr I Gusti Ayu Agung Dwi KARMILA	One case of chronic varicosum ulcer in a child treated with topical platelet rich fibrin (PRF)	View	94972
12:50	Dr Ni Made Dwi PUSPAWATI	Concurrent infections of perianal and intra-anal condyloma acuminata with secondary syphilis in a bisexual man	View	94973
12:56		Questions and answers		95059

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Skin diseases

Vaginal rejuvenation (non-surgical)

Liposculpture

Liposuction

Abdominoplasty

Dr I Gusti Nyoman DARMAPUTRA

Dermatologist

Indonesia

Other author(s) :

Power-assisted liposuction for abdominal liposculpture

Objectives: to provide understanding about abdominal liposculpture

Introduction: Introduction
Power-assisted liposuction is a popular liposuction techniqueby utilizingtiny cannulas equipped with rapid vibration, which allows the operator to exerts less force, provides better focus, and alsoshortenthe duration of the liposuction procedure. However, liposuction on the abdominal area has a major complication risk of skin contour irregularity, by prompt technique and modality, this risk could be prevented.

Materials / method: case report

Results: Case
We reported a case of 35-year-old Asian female who wanted to reduce the abdomen size for cosmetic purpose. Liposuction procedure was conducted using local anesthesia (tumescent), continued by LipoSculptor machine. The cannula size was 3 mm then decreased to 2.4 mm for smoothing the operated area. After the procedure, the patient was educated on how to use supportive bandage in order to achieve better end-result.

Conclusion: Discussion
Liposuction is the best procedure for body sculpting by removing excess fat from a specific area of the body. Power-assisted liposuction utilized tiny cannula with rapid vibration to break up fat cells before suctioned out of the body. This technique reduces fatigue for the operator, thus giving the operator a higher chance to focus and increasing precision on the fat removal which eventually minimizes the risk of contour irregularity. Power-assisted liposuction also promotes a shorter operation duration, which leads to enhanced result and faster recovery.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Prof Made Swastika ADIGUNA

Dermatologist

Indonesia

Other author(s) : sissy

A neglected case of leprosy with second degree impairtment: a case report

Objectives: Leprosy-related disability is a challenge to public health, and social and rehabilitation services in endemic countries. Disability is more than a mere physical dysfunction, and includes activity limitations, stigma, discrimination, and social participation restrictions. This case is reported to increase awareness of the disability that can be caused by leprosy

Introduction: Indonesia is recognized as the third leading country with the highest incidence of leprosy. The lack of basic knowledge of this illness among the infected individuals contributes to delayed diagnosis and treatment that is attributed to increased impairment and potential bacterial transmission. In this paper, we reported a case of multibacillary leprosy with second-degree impairment.

Materials / method: A 64-year-old woman with the chief complaint of having painful nodules with fluctuating fever and open wounds in her palms and soles that persist since 1 year prior to her visit. Physical examination revealed madarosis (+/+), saddle nose (+). On both upper extremities, there were multiple erythematous round nodules. Shortening of all the fingers and toes were also noted. Acid-fast bacilli staining showed positive results. Patient was diagnosed with multibacillary leprosy with mild erythema nodosum leprosum reaction and second-degree impairment. The patient was given MDT-MB regiment

Results: Leprosy-related morbidity is more common among the elderly and tends to be irreversible. Shortening of the digits and sensory loss are attributed to bacterial infiltration and local destruction. We found several deformities in both arms, legs, and nose. These findings indicated second-degree impairment that is defined as structural abnormalities, such as claw hand, claw toes, and shortening of the fingers. The primary goal of leprosy treatment is to cut off the chain of transmission to suppres its incidence, treat and cure the affected individuals, as well as to prevent further complications.

Conclusion: The loss of nerve function and incapacitating deformities occurring in a small proportion of leprosy patients result in serious social and psychological handicaps that need to be overcome with help from medical personnel as a part of the management of the disease. Hence, it is important that medical and paramedical personnel know how to respond to this challenge.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ni Luh Putu Ratih Vibriyanti KARNA

Dermatologist

Indonesia

Other author(s) :

Conglobata acne treated with low dose oral isotertinoin in combination with topical tretinoin

Objectives: ACNE CONGLOBATA TREATED WITH COMBINATION OF LOW-DOSE ISOTRETINOIN, TOPICAL TRETINOIN AND ANTIMICROBIAL
Ratih Vibriyanti Karna
Departement of Dermatology and Venereology Faculty of Medicine Udayana University, Sanglah General Hospital Denpasar, Bali

Abstract

Introduction: Acne conglobata is a rare form of severe nodular acne. It can cause severe scars and psychological impact such as anxiety and depression. Acne conglobata is very difficult to treat.

Introduction: Case : A 31-year old woman referred to hospital with severe acne on her face since 1 year ago, accompanied with pain and itchy. She had mild acne since 3 years ago, but 1 year ago after divorced with her husband, the acne getting worse. Patient complaints lack of confidence because of the acne. History of treatment with oral antibiotics, acne injection and topical treatment only resolved the acne temporarily.

Materials / method: Examination revealed multiple erythematous nodules, some tender and fluctuant with pain on palpation, multiple papules, pustules and atrophic acne scars in variant sizes, also open and closed comedones. No fever and arthralgia, laboratory tests within normal limit. Patient was diagnosed with acne conglobata and treated with isotretinoin 10 mg orally once daily, tretinoin cream 0.025% and clindamycin 2% cream topical once daily. The resolution of the acne completed on the 5th weeks of treatment, the isotretinoin will be continued for 6 months.

Results: Discussion: Acne conglobata is characterized by burrowing and interconnecting abcesses and irregular scars. It usually affects youth and adults. The lesion is polymorphic, with comedones, papules, pustules, nodules, abscesses and scars. Isotretinoin is the first treatment choice for acne conglobata with therapeutic dose 0.5-1 mg/kgBW/day. The combination of low-dose isotretinoin with topical tretinoin and antimicrobial is effective in treating acne conglobata.

Conclusion: This low dose therapy decreases the side effect of isotretinoin, such as cheilitis, xerosis, epistaxis, etc. Tretinoin topical is a potent comedolytic and anti-inflammatory, combination with topical antimicrobial can increase the drug penetration, prevent the comedone formation and decrease the proliferation of P. acnes.
Keywords: acne conglobate, low-dose isotretinoin, topical tretinoin

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr I Gusti Ayu Agung Elis INDIRA

Dermatologist

Indonesia

Other author(s) : Vanessa Vijayamurthy, Made Dwi Puspawati, Anak Agung Gde Putra Wiraguna

Lipschutz ulcer with vulvovaginal candidiasis in a virgin

Objectives: 1: Diagnose Lipschutz ulcer
2: Formulate a tailored approach to treat Lipschutz ulcer

Introduction: Lipschutz (UL) ulcer is an acute ulcer in vulva where the etiology and pathogenesis of UL is unclear, but it is known to be associated with infectious diseases which the most cause by Epstein-Barr Virus. This ulcer appears in adolescent women aged 14-20 years, with 70% of cases occurring in virgin women. The diagnosis is mainly clinically based after excluding several possible ulcers that can affect the genital area. It is important to understand non-STD ulcer causes so the clinicians can make an accurate diagnosis reduce psychological impact from misdiagnose the cases.

Materials / method: A painful wound in the genital area in 20-year-old virgin woman. She was diagnosed with Lipshutz ulcer with vulvaginal candidiasis based on the anamnesis, physical examination and laboratory examination obtained from vaginal discharge using potassium hydroxide ,gram staining and blood test to exclude genital ulcer caused by sexually transmitted agent. Blood test was taken including serological tests for syphilis and genital herpes. Test for EBV also performed.

Results: Patients were treated only with single dose fluconazole 150 mg orally and saline compress on the ulcer. Genital ulcer and vaginal discharge improved 1 week after treatment.

Conclusion: Lipshutz ulcer management is symptomatic, usually self-limiting and disappears spontaneously within 1-2 weeks without recurrences. It also can occured as a single lesion but also can be coinfected by other agents, for example with candidiasis which in this case, it requires treatment of comorbidities. Hygiene factors play an important role to preventing the occurrence of a secondary infection and the disease develops further.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr I Gusti Ayu Agung Dwi KARMILA

Dermatologist

Indonesia

Other author(s) :

One case of chronic varicosum ulcer in a child treated with topical platelet rich fibrin (PRF)

Objectives: To provide better understanding about chronic varicose ulcer treated with platelet rich fibrin topically.

Introduction: Varicose ulcers, including chronic ulcer variants, are difficult to cure. The managements of chronic ulcer are debridement, wound-dressing, infection control, off-loading of localized pressure, resolve malnutrition, and reconstructive surgery. If the ulcer did not respond to standard therapy, we can gave advanced therapy such as growth factor with platelet rich fibrin (PRF). PRF came from autologous blood and is the second generation of platelet concentrate that contains growth factors which has reported to help accelerate wound healing.

Materials / method: A case report.

Results: A 17 –year- old Asian female seek medical advice for wound in the ankle area since 6 months ago. Physical examination showed multiple ulcers, geographical shaped, irregular border, slough wall with granulation, and necrotic tissue based. The diagnosis was chronic varicose ulcer. We performed debridement on ulcer for necrotic tissue before we gave topical PRF. Furthermore, PRF was applied on lesion topically, followed by wound closer using transparent film, sterile gauze and wrapped with elastic bandage. Wound care was done every three days. Good result was seen in one month.

Conclusion: Varicose ulcers are chronic ulcers, difficult to cure, clinical manifestation predominantly located in the medial part of ankle, shallow, have irregular border, slough wall with granulation and necrotic tissue based, pigmented, painful, and lipodermatosclerosis. Ulcer care must be adequate to prevent infection. Treatment using PRF has currently being developed at this time, because PRF came from autologous blood and is the second generation of platelet concentrate that contains with growth factors component.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

Dr Ni Made Dwi PUSPAWATI

Dermatologist

Indonesia

Other author(s) : I Gusti Ayu Agung Elis Indira, Angeline Dewi

Concurrent infections of perianal and intra-anal condyloma acuminata with secondary syphilis in a bisexual man

Objectives: To provide better understanding about concurrence STI

Introduction: INTRODUCTION
Concurrence in sexually transmitted infections (STIs) refers to the state of finding more than one type of STI at a time. The presence of STI concurrency has increased in bisexual group. Studies showed that bisexual men have a higher incidence of Human Papilloma Virus (HPV) and syphilis infection than heterosexual and homosexual men. Syphilis will facilitate the entry of HPV, while the presence of the HPV affects the integrity of the mucosa epithelial barrier which allows translocation of viruses and bacteria.

Materials / method: CASE
A 34-year-old man, Balinese, came with chief complaint of lumps around anus since 5 months ago. Patient also had blackish red spots on both palms and soles since 6 months ago. History of sexual multipartners with women and men without condoms was admitted. Based on history taking, physical examination and investigation, the diagnosis of peri and intra-anal condyloma acuminata and secondary syphilis with roseola syphilitica was established. Patient was treated using 80% TCA in condyloma acuminata lesions and single-dose injection of benzathine penicillin 2.4 million IU intramuscularly.

Results: Clinical improvement was observed during follow-up examination.

Conclusion: DISCUSSION
The term bisexual defined as sexual orientation that affects aesthetic, psychological, emotional, and sexual interest in men and women. Bisexual groups tend to have multiple sexual partners, which leads to higher impact on the transmission of HIV and other STIs. In addition, bisexual groups are at risk of getting more than one STI. Further awareness in assessing clinical manifestations, complications, and prognosis is essential in handling individuals with more than one type of STI.

Disclosures

Did you receive any funding to support your research for this TOPIC?
No

Were you provided with any honoraria, payment or other compensation for your work on this study?
No

Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No

Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No

This work was not supported by any direct or non direct funding. It is under the author's own responsability

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IMCAS Asia 2019 Program

FOCUS ON S052B

Udayana University Session

Chair

Lectures of the session

Recommended sessions

IMCAS Asia 2019
Program