The effectiveness and safety of 3% tranexamic acid cream vs. 4% hydroquinone cream for mixed-type melasma in skin of color: a double-blind, split-face, randomized controlled trial.

INTRODUCTION: Melasma, a chronic acquired skin pigmentation disorder, is characterized by the presence of irregular-edged brown to gray-brown patches with a symmetrical distribution, primarily on sun-exposed areas such as the face. Topical hydroquinone (HQ) is the gold standard for melasma treatment but has numerous side effects. This study assesses the effectiveness of topical tranexamic acid (TA) as an alternative for melasma treatment. METHODS: In a double-blind, split-face, randomized controlled trial involving 20 subjects, the effectiveness of 3% TA versus 4% HQ cream was evaluated over 8 weeks. The modified melasma area and severity index (mMASI), melanin index, erythema index, and side effects were assessed. Subjective improvement was measured using the patient global assessment (PtGA). RESULTS: A significant decline in the mMASI score was observed at weeks 4 and 8 in both groups compared to baseline. There were no statistically significant differences in PtGA scores between the 3% TA group and the 4% HQ group. CONCLUSIONS: Topical 3% TA is as effective and safe as 4% HQ for treating melasma in the Indonesian population, with potential advantages in terms of side-effect profiles.

Effect of adipose derived stromal vascular fraction on leprosy neuropathy: A Preliminary report.

BACKGROUND: Adipose derived stromal vascular fraction (SVF) contains a heterogeneous population of mononuclear cells, progenitor cells and about 1-10% are mesenchymal stromal cells. These cells are an ideal candidate for regenerative medicine for peripheral neuropathy. Leprosy is a disabling disorder with neuropathy, usually with consequences of permanent disability of the extremities. We conducted a preliminary study to evaluate the cell yield, its characteristics and clinical outcomes after SVF injections in four leprosy patients. METHODS: Four post leprosy patients were recruited and evaluated for sensory testing (warm detection, cold detection, vibration, pain and sensation) on the ulnar area of the hand. Liposuction was done and adipose tissue was processed into SVF with a closed system and injected to the ulnar area of the hand at the dorsal and palmar side. Evaluation of sensory testing was done after 3 days, 1 week, 1 month and 3 months following SVF injection. SVF was also characterized using flow cytometry, cell counting, sterility and presence of mycobacteria. RESULTS: The results showed that leprosy patients had a low count of mesenchymal cells and a high amount of CD34/CD45 positive cells. One patient was positive for mycobacteria from his adipose tissue and SVF. Sensory examination after SVF injection showed an improvement in temperature and pain sensation in the palmar and superficial branch. Meanwhile, touch sensation improved on the dorsal branch, and there was no improvement for vibration in all patients. CONCLUSIONS: The results showed that SVF had a potential to improve sensory loss in leprosy patients.

Herpes vegetans, an atypical herpes lesion in HIV patient: A case report.

Herpes vegetans is a rare form of Herpes simplex virus (HSV) infection in immunocompromised patients that clinically presents as a verrucous and hypertrophic lesion. In this case, we present a 36-year-old man with exophytic verrucous masses in the genital area that was initially suspected as a malignancy. Difficulty to properly diagnose the patient resulted in a few failed attempts at treating the lesion. After excluding other differential diagnoses, the atypical lesion proved to be caused by vegetative herpes infection due to a good response to HSV therapy. Reevaluation of biopsy also showed signs of HSV etiology. Atypical presentation of herpes simplex in immunocompromised patients still proves to be a challenge to diagnose and treat. Proper clinical identification and workup are needed to diagnose and to choose proper regiments.

Acne Vulgaris Mimicking Cutaneous Lupus Erythematosus in an Adolescent: Report of a Rare Case.

Acne vulgaris is a chronic and self-limiting disorder of the pilosebaceous unit which is primarily seen in adolescents. Acne vulgaris presents as polymorphic lesions, consisting of comedones, papules, pustules, cysts, nodules, scarring, and dyspigmentation. Acneiform presentation of cutaneous lupus erythematosus (CLE) is extremely rare. The presentation of CLE is notoriously diverse and often mimics a broad range of unrelated skin disorders. We present a case by referring to American College of Rheumatology (ACR) criteria for systemic lupus erythematosus (SLE); our patient's conditions did not meet any of the clinical criteria of the Systemic Lupus International Collaborating Clinics (SLICC) for SLE. Subsequent to thorough history-taking, physical examination, and laboratory evaluations, the diagnosis of acne vulgaris was established, and a diagnosis of CLE was excluded. As acneiform presentation of CLE is rare, we here present a case which resembled both acne vulgaris and CLE. We describe our experience in establishing the diagnosis of severe acne vulgaris accompanied by scars in a 12-year-old boy with a malar rash and scars on his frontal and malar area who had initially been misdiagnosed as having CLE. This unusual case highlights the broad spectrum of adolescent acne and the importance of clinical identification of the disease so that unnecessary workups might be avoided.

The diagnostic conundrum of Riehl melanosis and other facial pigmentary disorders: a case report with overlapping clinical, dermoscopic, and histopathological features.

Riehl melanosis (RM) is a form of pigmented contact dermatitis that often poses a diagnostic challenge due to overlaps in its clinical, dermoscopic, and histopathological features with other pigmentary disorders. This report highlights significant findings and the proper approach for diagnosis. We present the case of a 47-year-old female with progressive facial hyperpigmentation (irregular, blotchy, grayish patches on the forehead, cheeks, and around the mouth) that acknowledged applying a lightening product before her complaint. Dermoscopy revealed brownish-gray dots and pseudonetwork pigmentation. The histopathological findings were comprised of hypergranulosis, interface dermatitis, and pigment incontinence. The patient's history and clinical, dermoscopic, and histopathological examination results showed features consistent with-but not exclusive to-RM, such that it was not possible to rule out lichen planus pigmentosus (LPP) and ashy dermatosis (AD). We finally diagnosed the patient with RM and treated her with medications consisting of alpha hydroxy acid, tretinoin, hydroquinone, and sunscreen. Patch testing might help because higher positivity rates were found in RM patients compared to LPP and AD. However, positive patch testing favors RM, and, regardless of diagnosis, provides a basis for substance avoidance in the treatment plan.

Purpuric nail striae as the initial manifestation in multisystem Langerhans cell histiocytosis.

Nail involvement in Langerhans cell histiocytosis (LCH) is very uncommon. We describe a 9-month-old boy with longitudinal purpuric bands, onychodystrophy, and paronychias on his fingernails and toenails, which antedated manifestations of recurrent bilateral spontaneous pneumothorax and elevated transaminases. The diagnosis of nail LCH was then confirmed by immunohistochemistry demonstrating positive S100 and CD1a staining in the epithelium of nail bed tissue. This case report affirms that nail involvement may be the initial manifestation of multisystem LCH and could portend an unfavorable prognosis.

Correlation of CD4 counts with clinical and histopathological findings in disseminated histoplasmosis: a 10-year retrospective study.

BACKGROUND: Disseminated cutaneous histoplasmosis (DCH) is one of the manifestations of systemic histoplasmosis infection in HIV-positive patients. Interaction between host immune status and histoplasmosis infection is still poorly understood. It is thought that immune status, represented by CD4 counts, may be correlated with clinical and histopathological findings. OBJECTIVE: To correlate the CD4 counts with the different clinical and histopathological findings in cutaneous histoplasmosis. METHODS: This was a serial case report of seven HAART-treated HIV positive patients with disseminated histoplasmosis observed within the period of January 2004 through December 2014 from the Dermatology and Venereology Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The patients came with different complaints and clinical findings. CD4 counts were recorded prior to lesion biopsy. RESULTS: The CD4 counts were independent from clinical morphology and distribution of lesions. Lower CD4 counts were associated with the presence of intraepidermal yeast-like cells, whereas there is the ability of forming granulomas at higher CD4 counts. CONCLUSION: CD4 count correlates to histopathological findings of cutaneous histoplasmosis.

Correlation between maximum bite force and craniofacial morphology of young adults in Indonesia.

The present study was conducted to evaluate the relationship between maximum bite force and craniofacial morphology. Sixty-four Indonesian female dental students aged 19-27 years with normal occlusion served as the subjects. The Dental Prescale System was used to measure the maximum bite force using a pressure sensitive sheets while craniofacial morphology measurements were determined from conventional lateral radiograms. The antero-posterior and right-left position of the occlusal load centre (the OLC) were measured also. Stepwise multiple regression analysis was performed to evaluate the relationship between bite force and craniofacial morphology while correlation analysis was used to evaluate the antero-posterior position of the OLC related to craniofacial morphology. Fifty-five per cent of the bite force could be explained by variations in the posterior facial height, gonial angle, antero-posterior size of the maxilla, and posterior length of the cranial base. The result showed a larger bite force implies a greater posterior facial height, smaller gonial angle, larger maxilla and straighter posterior length of the cranial base. This study suggests that among Indonesians, maximum bite force could be explained by craniofacial morphology as found in Caucasians. In addition, we proposed a clinical standard of the OLC for the comprehensive evaluation of occlusion.

Occlusal force distribution on the dental arch during various levels of clenching.

The purpose of this study was to explore the occlusal force distribution on the dental arch in the intercuspal position and to evaluate the relationship between the clenching strength and the occlusal force distribution. These variables were recorded using the Dental Prescale System in 16 healthy young adults. The number of tooth contacts, occlusal force and occlusal contact area increased linearly as clenching strength increased. The distribution of the occlusal force was greatest at the molar region followed by the premolar and anterior teeth region. The proportion of occlusal force (occlusal force at each region/total occlusal force) on molar regions increased as clenching strength increased. On the contrary, the proportion of occlusal force on the premolar and anterior teeth regions decreased as clenching strength increased. These findings suggest that control of occlusal force is important in diagnosis of the nature of occlusal contacts.