Background: The clinical manifestation of Darier-White disease, an autosomal dominant genodermatosis, are greasy hyperkeratotic papules in seborrheic regions with nail abnormalities and mucous membrane changes due to a defective sarcoendoplasmic calcium pump. The clinical appearance and unpleasant odor in some sites of the lesions may cause psychosocial disturbances and pose a major morbidity. Case Illustration: We report a case of a 20-year old female with clinical manifestations of multiple erythematous to hyperpigmented hyperkeratotic papules, multiple flesh-colored keratotic papules with red and white longitudinal bands on dystrophic fingernails, as well as plantar pits. Skin punch biopsy was performed to support the diagnosis. Urea-containing emollients and acitretin at a dose of 0.3 mg/kg/day were prescribed for the patient. Discussion: Our case showed the classic clinical manifestations of Darier’s Disease. The skin punch biopsy result is also consistent with Darier’s disease. We provided the patient with emollients and acitretin, a systemic retinoid, which are found to be the most effective treatment for DD. While no relationship is established between Darier’s disease and other medical problems, the patient developed anxiety and social isolation due to the clinical appearance and odor, creating a negative impact on her quality of life. Conclusion: Comprehensive and holistic management should be the goals for the management of this rare genetic disorder

Background: Kerion celsi is a severe inflamed deep abscesses form of tinea capitis which mostly occurs in children population. Despite good regular treatment with antifungals, the prognosis of kerion celsi is poor with scarring alopecia. Case Illustration: A 5-year-old boy had history of an alopecia with locally large painful oedema on his scalp a month before treatment. From the physical examination, a painful large area with alopecia was found with abscess covered by thick crust. Pull test showed hair breakage and right retro-auricular lymphatic nodes enlargement was also found. Endo-ectothrix spores were positive in potassium-hydroxide examination and the culture showed colony of Trichophyton mentagrophytes. A surgical debridement was performed to remove the thick crust covering the abscess with alopecia and followed by application of normal saline gauze dressing and terbinafine cream on the top of the lesion for 6 weeks. Systemic micronized griseofulvin was also administered for 6 weeks. Combination treatment of debridement-topical and systemic antifungal gave a good result without scarring alopecia. Discussion: Kerion celsi was diagnosed based on clinical findings and mycological examination. From the laboratory examination, a dermatophyte fungal infection was found. Skin debridement was performed to create a good environment for topical antifungal application and wound healing, with 20mg/kg bodyweight of systemic griseofulvin administered as the first line therapy for tinea capitis. A good prognosis was achieved after those treatments combination. Conclusion: In this case, combination between skin debridement with topical and systemic antifungals gave a better result in treating kerion celsi.

Background: Demodicosis is a disease, caused by parasitisation of the opportunistic parasites from the acariasis group – Demodex mites. This article presents a comparative study of two methods (light microscopy of skin scrapings and confocal laser scanning in vivo microscopy) for identification of Demodex mites on the facial skin in acne and rosacea patients. The use of confocal laser scanning in vivo microscopy in dermatology today is considered as one of the most promising methods. Methods: A total of 90 subjects were included in the study, comprising 30 patients with acne and rosacea complicated by demodicosis, 30 patients with acne and rosacea not complicated by demodicosis, and 30 healthy volunteers. All patients were examined by scraping of the skin, eyebrow and/or eyelash epilation and confocal laser scanning in vivo microscopy. Results: The specificity of light microscopy of skin scrapings was 65.5%, while the specificity of confocal laser scanning in vivo microscopy for the diagnosis of demodicosis was 68.8%. Conclusion: The study showed advantages of confocal laser scanning in vivo microscopy compared to the traditional method of investigation.

Background: Vitiligo is a skin pigmentation disorder, affecting approximately 1-2% population worldwide. Currently, there are wide varieties of treatment to achieve re-pigmentation, and phototherapy is one of the effective treatments. Narrowband ultraviolet B (NB-UVB) is administered twice a week according to the phototherapy protocol for vitiligo. Some vitiligo patients have difficulty following this schedule, leading to decrease of patient’s compliance. Therefore, we performed study comparing the efficacy of phototherapy frequency, once a week and twice a week NB-UVB in vitiligo. Methods: This preliminary study divided 10 patients into 2 groups of 5 patients each with randomized, double-blind method. Group A was scheduled for NB-UVB phototherapy twice a week while Group B was scheduled for once a week. All patients received topical desoxymetasone cream once daily. Re-pigmentation were compared using Vitiligo Area Scoring Index (VASI). VASI was graded as good (=25%), moderate (10-24%), and poor (<10 %) responses. Evaluation for melanin index for each lesion was assessed by Mexameter® and cumulative doses of phototherapy were compared. Results: Thirty-seven lesions were treated on face and neck, trunk and extremities. Good responses were obtained in 14.29% group A patients and 13.04% group B patients. The mean of cumulative doses phototherapy in group A was 850 mJ/cm2, whereas group B was 800 mJ/cm2. There was no significant differences (p>0.05) between both groups in terms of re-pigmentation, cumulative doses of phototherapy, and melanin index. Conclusion: In vitiligo, once a week NB-UVB phototherapy appears to be as efficacious as twice a week treatment schedule.

In managing contact dermatitis, identification of the causative agent is essential to prevent recurrent complaints. Patch test is the gold standard to identify the causative agent. Nowadays, there are many patch test standard materials available in the market, but do not include all the materials that potentially cause contact dermatitis. Patch test using patient’s own products or later we refer to as non-standard materials, is very helpful in identifying the causative agents of contact dermatitis. Guidance is needed in producing non-standard patch test materials in order to avoid test results discrepancy.

Background: Cajuputi/Cajeput/Melalueca leucadendron oil is a type of essential oil, widely known and used by Indonesian for infants, children, and elderly. It is also included in telon oil compositions (±42%). Excessive application of cajeput oil and telon oil may lead to skin irritation. Methods: This randomized single-blind control trial was conducted with 10 subjects who met the inclusion criteria. Four areas with diameter of 10 mm each were made on the flexor surface of the upper arm. Area 1 was designated as negative control. Area 2 to 4 were pre-irritated with tape stripping for 40 ± 10 times using Nachitape®, followed by repeated open application test (ROAT) with cajeput oil, telon oil and alcohol (positive control). The skin irritation was examined in 15 minutes after each cycle by measuring transepidermal water loss (TEWL) using Tewameter® TM300 (Courage-Khazaka, Germany) and erythema using Mexameter® MDD4. Data were analyzed using One-way ANOVA with p<0.05 considered significance. Results: The average TEWL and erythema of cajeput oil (15.59; 345.42) were the highest compared to telon oil (12.63; 316.60), alcohol (13.87; 319.06) and negative control (7,48; 296.68). All treatment groups had significant differences in TEWL (p<0.000) and erythema (p<0.002) when compared to the negative control. However, cajeput oil showed the largest difference. Conclusion: Cajeput oil caused the most irritation compared to alcohol and telon oil. Therefore, it should be used with caution.