Background: In recent years, antifungal resistance in dermatophytosis has escalated, observed not only in the endemic regions of India but also across East Asia, the Americas, and Europe. The inappropriate use of antifungal drugs has the potential to drive the development of drug resistance. Purpose: This literature review aims to present an overview of antifungal resistance in dermatophytosis and to examine the mechanisms underlying resistance to the principal antifungal classes. Review: The reported mechanisms of terbinafine resistance include point mutations in the squalene epoxidase (SQLE) gene, most commonly the F397L and L393F substitutions. Reduced azole susceptibility appears to be mediated predominantly by overexpression of genes encoding ATP-binding cassette (ABC) transporters, although CYP51B overexpression has been implicated in Trichophyton indotineae, suggesting that mechanisms differ between species. Griseofulvin resistance has been associated with mutations in the TUB2 gene encoding β-tubulin, together with efflux-mediated mechanisms analogous to those described for azoles. Conclusion: Most reports identify terbinafine resistance as the principal cause of treatment failure. Although reported cases and studies of azole resistance in dermatophytes remain limited, the documented increase in itraconazole minimum inhibitory concentrations (MICs) among terbinafine-resistant strains, together with the similarities between Indonesia and India in economic development, population density, geography, and hygiene levels, warrants vigilance toward this phenomenon.
Background: Syphilis is a global burden of sexually transmitted infection caused by Treponema pallidum sub. pallidum with high epidemiology worldwide, including Indonesia. Syphilis in pregnancy is the second-leading cause of stillbirth. Syphilis can cause perinatal consequences for a developing fetus if left untreated. Case: We found an incidental case of untreated secondary syphilis in a 21-year-old primigravida woman. She had multiple erythematous, hyperpigmented maculopapular rashes on her trunk and extremities, as well as condylomata lata on her vulva. The Treponema pallidum-rapid (TP-rapid) test was reactive. During her pregnancy, she never received antenatal care or any treatment for her condition. The patient underwent caesarean section. The baby showed no clinical sign of congenital syphilis but tested reactive for TP-rapid. In a single dose, both the patient and her baby received a benzathine-penicillin G intramuscular injection in single dose. The baby was referred back to primary health care for close monitoring of its growth and development. Discussion: This is a missed case of typical secondary syphilis. Due to the failure of early diagnosis, early treatment for the patient was not possible. The baby was also at high risk of congenital syphilis. In a limited resource area, primary healthcare facilities play a key role in solving the problem through updated data collection of pregnant women, comprehensive antenatal care, education about sexually transmitted infection, early screening, and treatment.
Background: Pemphigus is a chronic autoimmune blistering disease characterized by acantholysis. Assessing disease activity is vital for optimizing therapy. While anti-desmoglein ELISA is the standard marker, its cost limits routine use in developing countries. Systemic inflammation drives the pathogenesis of pemphigus, suggesting that hematological indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), and systemic immune-inflammation index (SII)—may serve as accessible biomarkers. Purpose: To evaluate the correlation between these indices and disease severity, measured by the Pemphigus Disease Area Index (PDAI), in an Indonesian population. Methods: This cross-sectional study analyzed pemphigus patients at Dr. Sardjito General Hospital, Yogyakarta. Correlations between hematological markers and PDAI scores were assessed using Spearman’s test, and diagnostic performance was evaluated via receiver operating characteristics (ROC) analysis. Result: Sixty subjects were included (68.3% female; mean age 50.17 ± 14.75 years). Pemphigus vulgaris (60%) and pemphigus foliaceus (35%) were the main subtypes; the median PDAI was 37, indicating severe disease. Significant positive correlations were observed between PDAI and NLR (r=0.467), SII (r=0.430), and PLR (r=0.275), with a negative correlation for PNR (r=–0.371). Subtype analysis showed that NLR, PNR, and SII were significantly correlated with severity specifically in pemphigus foliaceus. Furthermore, NLR demonstrated the highest predictive value. Conclusion: Simple hematological indices such as NLR, PLR, PNR, and SII show promise as non-invasive markers for assessing pemphigus severity. These parameters support cost-efficient clinical evaluation, bridging the diagnostic gap in settings where specific serological testing is inaccessible.
Background: Condyloma acuminatum (CA), caused predominantly by Human Papilloma Virus (HPV) types 6 and 11, remains a frequent sexually transmitted infection with malignant potential. Immune dysregulation and viral oncogenic proteins contribute to this risk. Cimetidine, an H2-receptor antagonist with immunomodulatory properties, has been proposed as an adjunctive therapy. Purpose: To evaluate the efficacy of oral cimetidine supplementation on FOXP3+ Treg cells and pRB expression in CA. Methods: An experimental pre-post test study was conducted in CA patients attending the Dermatovenereology Outpatient Clinic of Dr. Moewardi General Hospital, Surakarta, Indonesia, from October 2022 to March 2023. Subjects were allocated into two groups: one received oral cimetidine 400 mg for three months, while the control group did not. Both groups received standard therapy, including chemical cautery and cryotherapy, for four weeks. Immunohistochemical staining was performed on skin biopsy specimens before and after treatment to evaluate FOXP3+ Treg cells and pRB expression at the Department of Anatomical Pathology, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia. Data were statistically analyzed, and p<0.05 was considered significant. Result: Thirty-six patients with CA were included in this study, comprising 20 subjects who received oral cimetidine and 16 subjects as controls. The subjects were predominantly male (68.75%). The Mann-Whitney test showed a significant difference of pRB expression between both groups (p=0.004), while the FOXP3+ Treg cell analysis was not statistically significant (p=0.072). Conclusion: Oral cimetidine supplementation increases pRB expression and may help prevent the development of CA but not FOXP3+ Treg cell expression
Background: Skin health is influenced by hydration, pH balance, and environmental exposures. The skin’s barrier protects against irritants, pathogens, and moisture loss, while pH imbalances can lead to dryness, irritation, and inflammation. Research on atopic dermatitis is comprehensive, but little is known about how daily habits affect skin acidity in individuals without atopic conditions. Understanding these factors is key to improving skincare recommendations. Purpose: This study investigates the relationship between skin pH and personal habits such as handwashing, soap type, hot water use, chemical exposure, and air conditioning. By identifying influencing factors, this study arranges comprehensions into how daily routines impact skin health. Methods: A cross-sectional study was conducted with 37 non-atopic individuals (18–60 years) at Universitas Airlangga, Faculty of Medicine. Skin pH was measured on the left forearm using a Courage-Khazaka® pH meter. Data were analyzed using SPSS 26.0 with independent t-test. Ethical approval was granted (296/EC/KEPK/FKUA/2023). Result: Older individuals had higher skin pH (6.28±0.48). Mean pH was 6.19±0.48 in females and 6.13±0.89 in males. Dry skin and frequent hot water use significantly increased skin pH (p<0.05), while other factors showed no significant differences. Conclusion: Skin pH rises with age, potentially impairing barrier function. Sex differences may be hormone-related. Hot water use increases skin pH and dryness. Maintaining an acidic pH is essential for skin health, warranting further research into long-term effects.
