Background: Mycoplasma hominis and Ureaplasma urealyticum are commonly involved in pathogenesis of bacterial vaginosis and non-specific genital infection, while doing vaginal douching also already known as predisposing factor. Methods: To evaluate the prevalence of Mycoplasma hominis and Ureaplasma urealyticum infection in female sex workers and its association with vaginal douching, we conducted a study through 180 female sex workers in East Jakarta, Indonesia. Vaginal fluid samples were collected from these women. It was revealed that most of the women used betel soap, baby soap, tooth paste, or herbal medicine as vaginal douching materials. The association of vaginal douching and prevalence of Mycoplasma hominis and Ureaplasma urealyticum was analyzed using cross sectional statistical methods. Results: There is a high prevalence of Mycoplasma hominis and Ureaplasma urealyticum infection (72%), but there are no association between vaginal douching practice and infection of Mycoplasma hominis and Ureaplasma urealyticum. Conclusions: The high prevalence of Mycoplasma hominis and Ureaplasma urealyticum infection in female sex workers in East Jakarta warrants a routine screening of these infections. Unusual1 materials used for vaginal douching in this study might cause the negative association between high prevalence of these bacteria with vaginal douching.

Burns are often seen in clinics or hospitals. Majority of burns are minor burns, which can be managed in outpatient setting with satisfactory result. The healing outcome depends on physician’s knowledge and competencies in burn pathogenesis and basic principles of burn care. Initial treatment of burns consists of emergency evaluation, assessment of depth and severity of burns and considerations for referral. The principles of minor wound therapy include cooling, cleansing, pain management, and topical therapy. Recently, many topical agents are available and indicated for first to second degree burn. Silver sulfadiazine (SSD) is the standard treatment; however, it has some limitations. Scientific evidences showed that topical antibiotics do not reduce the incidence of local infection, invasive infection, and mortality of infection. Burns heal faster with hydrogel dressings and some other dressings compared to SSD. There are insufficient evidences to support the use of aloe vera, honey, and negative pressure wound therapy in burns. Moist exposed burn ointment (MEBO®) has been demonstrated to have equal efficacy to SSD.

Introduction: Systemic contact dermatitis (SCD) is a systemic reactivation of a previous allergic contact dermatitis. The initial exposure may usually be topical, followed by oral, intravenous or inhalation exposure leading to a systemic hypersensitivity reaction. A case of a 27 year-old male with SCD due to nickel is reported Case Report: A 27 year-old male presented with recurrent pruritic eruption consist of deep seated vesicles on both palmar and left plantar since 6 months before admission. This complaint began after patient consumed excessive amounts of chocolate, canned food, and beans. The patient worked as a technician in a food factory. History of allergy due to nickel was acknowledged since childhood. The clinical presentation was diffuse deep seated vesicles, and multiple erythematous macules to plaques, with collarette scale. Patch test using the European standard showed a +3 result to nickel. The patient was diagnosed as systemic contact dermatitis due to nickel. The treatments were topical corticosteroid and patient education of avoidance of both contact and systemic exposure to nickel. The patient showed clinical improvement after 2 weeks. Discussion: SCD was diagnosed due to the history of massive consumption of food containing nickel in a patient who had initial sensitization to nickel, with clinical features and the patch test result. Advice to be aware of nickel and its avoidance is important in SCD management.

Background: Reticulate acropigmentations of Kitamura (RAPK) is an autosomal dominant inherited disorder characterized by pigmented, angulated, irregular freckle-like lesion with atrophy on the surface, arranged in a reticulate pattern on the dorsa of the hands and feet. It was first described by Kitamura and Akamatsu in Japan in 1943. The usual age of onset is the first and second decades of life. Palms and soles reveal pits and breaks in the epidermal ridge pattern. The histopathological examination show epidermal atrophy, digitate and filiform elongated rete ridges with clumps of heavy melanin pigmentation at their tips. Case: A 59-year-old male presented with asymptomatic and progressive brownish-black discoloration in a reticulate pattern on the dorsal aspect of his hands and feet. The lesions initially appeared when the patient was 45 years old. It was not preceded by any erythema or inflammation. There was no similar case in the family. Laboratory findings were within normal limits. Discussion: Skin biopsy taken from the dorsal of the hand and foot revealed hyperkeratosis, thinning of epithelium, filiform elongation of the rete ridges, increased melanocyte numbers in the basal layer, and lymphocyte infiltration in the dermis. Based on the clinical and histological findings he was diagnosed as RAPK. From some reports, sporadic cases without the involvement of other family members may occur, like our patient. Palms and soles involvement in RAPK is still debated, some considered it as a characteristic sign of this disorder while others refuted it.

Introduction: Juvenile xanthogranuloma (JXG) is an uncommon benign cutaneous fibrohistiocytic, self-healing, class II non-Langerhan’s cell histiocytosis (NLCH). JXG accounts for 80-90% of cases of NLCH. It occurs most commonly on the head and neck of infants and young children and resolves spontaneously. Case: A one year-old boy presented with asymptomatic, multiple yellowish, shiny, and firm nodules with telangiectasia on the surface, measuring around 1 centimeter in diameter, on the face, the trunk, the arms, and lower extremities. The first lesion appeared on the face 8 months prior to consultation then spread gradually to other areas. He was referred from another hospital and was diagnosed as molluscum contagiosum (MC) with differential diagnosis of syringoma. Enucleation had been performed but failed to produce the molluscum bodies. Initial histopathological examination provided the diagnosis of syringoma. The second histopathological examination showed dermal inflammatory cells consisting of eosinophils, lymphocytes, and histiocytes with marked foam cells and giant cells. Eccrine sweat glands were normal. Some lesions decreased in size at subsequent follow-ups; observation was advised until 3-6 years. Discussion: JXG should be suspected in cases with multiple yellowish nodules appearing in the first year of life. MC usually presents with whitish papules, whereas syringoma is more rarely appeared, presenting with yellow-to-brownish papules. Histopathological examination can easily differentiate the suspected diagnoses; however, selection of lesion, timing and complete clinical information was crucial in reaching the final diagnosis. In this case there was a good clinicopathological correlation that the diagnosis of JXG was made with certainty. There was no eye and other organ abnormalities.

Background: Atypical mycobacterium infection occurs under certain skin conditions, namely the disruption of skin integrity and mucous membranes accompanied by the reduction of cellular immunity. However, atypical mycobacterial infection in elderly patients is rarely reported. Case: A 64 years old male patient, complained of red lumps on the upper-backfor a month, accompanied by mild fever and minimal pain. Three months before, the patient had accupuncture on the neck and upper back. Physical examination showed multiple miliar to lenticular sized papules and pustules on an erythematous-violaceus base with hard and immobile palpable nodes and infiltrate. After clinical and laboratory workup, the patient was diagnosed withcarbuncle with Candida spp colonization. The treatment consisted of systemicantibiotics and topical antifungals. There was no clinical improvement after 3 weeks. Histopathology and laboratory results suggested atypical mycobacterium infection. Discussion: Atypical mycobacterium infection should be considered in elderly patients with skin and soft tissue infections that show no clinical improvement tostandard therapy.