BackgroundAtopic dermatitis (AD) is a common skin condition among Asians. Recent studies have shown that Asian AD has a unique clinical and immunologic phenotype compared with European/American AD.ObjectiveThe Asian Academy of Dermatology and Venereology Expert Panel on Atopic Dermatitis developed this reference guide to provide a holistic and evidence-based approach in managing AD among Asians.MethodsElectronic searches were performed to retrieve relevant systematic reviews and guidelines on AD. Recommendations were appraised for level of evidence and strength of recommendation based on the U.K. National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidelines. These practice points were based on the consensus recommendations discussed during the Asia Pacific Meeting of Experts in Dermatology held in Bali, Indonesia in October 2016 and April 2017.ResultsThe Expert Panel recommends an approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity, while topical steroids are recommended only for flares not controlled by conventional skin care and moisturizers. Causes of waning efficacy must be explored before using topical corticosteroids of higher potency. Topical calcineurin inhibitors are recommended for patients who have become recalcitrant to steroid, in chronic uninterrupted use, and when there is steroid atrophy, or when there is a need to treat sensitive areas and pediatric patients. Systemic steroids have a limited role in AD treatment and should be avoided if possible. Educational programs that allow a patient-centered approach in AD management are recommended as an adjunct to conventional therapies. Recommendations on the use of phototherapy, systemic drugs, and emerging treatments are also included.ConclusionThe management of AD among Asians requires a holistic approach, integrating evidence-based treatments while considering accessibility and cultural acceptability.
Psoriasis merupakan peradangan kulit kronik dengan dasar genetik. Untuk mencapai remisi dan kualitas hidup yang baik, pilihan terapi disesuaikan dengan kebutuhan perorangan pasien. Tipe dan derajat keparahan psoriasis perlu ditentukan guna memilih tata laksana yang sesuai karena memengaruhi keberhasilan terapi, masa remisi, serta tingkat morbiditas. Penelitian ini bertujuan menilai kesesuaian tata laksana psoriasis berdasarkan derajat keparahan dengan menggunakan Panduan Praktik Klinis (PPK) RSUPN dr. Cipto Mangunkusumo (RSCM) dan Persatuan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI). Studi retrospektif ini mengambil subjek seluruh pasien baru psoriasis di Divisi Alergi Imunologi, Departemen Ilmu Kesehatan Kulit dan Kelamin RSCM periode Oktober 2017 – Oktober 2018. Keparahan psoriasis dinilai dengan skor body surface area (BSA) dan psoriasis area severity index (PASI). Sebanyak 32 di antara 35 pasien (91,4%), skor BSA dan/atau PASI terdokumentasi pada rekam medis, dan 30 di antara 32 pasien (93,8%), mendapatkan pilihan terapi sesuai dengan tipe psoriasis atau skor BSA dan/atau PASI. Kepatuhan pasien sangat penting sehingga pemilihan tata laksana psoriasis perlu mempertimbangkan kenyamanan pasien terkait efek samping pengobatan, kemudahan pasien untuk mengakses fasilitas, dan aspek ekonomi. Kesesuaian terapi tidak mencapai 100% karena kontraindikasi pemberian terapi standar, penolakan pasien, dan ketidaktersediaan obat misalnya metotreksat. Sebanyak 93,8% pasien psoriasis di RSCM telah ditata laksana sesuai dengan PPK RSCM dan PERDOSKI.Kata Kunci: BSA, PASI, psoriasis, tata laksana
Pruritus merupakan sensasi tidak nyaman yang mencetuskan keinginan untuk menggaruk. Sensasi tersebut disebabkan oleh berbagai hal, misalnya penyakit kulit, penyakit sistemik, atau idiopatik, gangguan psikiatri, serta penyakit neurologis. Pruritus menjadi masalah kesehatan karena dapat memberi dampak negatif terhadap kualitas hidup pasien. Pendekatan tata laksana pruritus diberikan secara bertingkat mulai dari terapi dasar, terapi target, dan terapi simtomatik. Pada kasus pruritus kronik yang refrakter maupun pruritus tanpa sebab yang diketahui, terapi simtomatik berperan besar dan dapat diberikan pada pasien tersebut. Tata laksana pada pruritus kronik saat ini banyak diteliti seiring dengan ditemukan berbagai mekanisme yang mendasari terjadinya pruritus. Sesuai dengan patofisiologi dari pruritus, terapi sistemik yang dikembangkan menargetkan pada reseptor spesifik di sistem saraf dan sistem imunitas yang berperan pada jalur sinyal pruritus. Berbagai terapi terbaru yang masih diteliti dalam uji klinis menunjukkan hasil yang menjanjikan dan berpotensi menjadi pilihan terapi pada pasien dengan pruritus kronik.
Erythrodermic psoriasis (EP) is characterized by generalized erythema and desquamation affecting more than 75% of body surface area and usually accompanied by systemic symptoms. The triggers are medication withdrawal, drugs reactions, and systemic infections including coronavirus disease 2019 (COVID-19). A 46-year-old man with plaque psoriasis suffered from EP following the sudden discontinuation of medications. He was diagnosed with COVID-19 one month before erythroderma appeared. The body surface area involvement was 96% and psoriasis area severity index was 49.8. His general condition and laboratory examination were within normal limits. He was treated with cyclosporine-A for one month after being healed from COVID-19 with significant improvement. Excessive production of proinflammatory cytokines in COVID-19 plays a role in the pathogenesis of psoriasis. This condition should be managed appropriately to minimize the complication. Cyclosporine-A is the first-line therapy for EP because of its effectiveness and good safety profile. It is also shown a beneficial effect in COVID-19 infection in vitro .
Ultraviolet (UV) radiation has been applied to treat many chronic skin diseases. Based on the wavelength, UV radiation consists of three types, namely ultraviolet C (UVC), ultraviolet B (UVB), and ultraviolet A (UVA). The types of UV that are widely used in dermatology are narrowband ultraviolet B (NB-UVB), broadband ultraviolet B (BB-UVB), UVA1, and psoralen combined with UVA (PUVA). The interaction between UV and the skin determines the effectiveness of phototherapy. The biological effects of UV are used in the management of inflammatory skin diseases, malignancies, and various rare dermatoses. Apart from these benefits, UV increases the risk of photoaging and skin cancer. Therefore, further researches are necessary to enhance the effectiveness and safety of phototherapy. This literature review discusses the role of phototherapy in various dermatoses other than psoriasis and vitiligo. ABSTRAKRadiasi sinar ultraviolet (UV) telah digunakan untuk pengobatan penyakit kulit kronik. Berdasarkan panjang gelombangnya, radiasi UV dibedakan dalam tiga jenis yaitu ultraviolet C (UVC), ultraviolet B (UVB), dan ultraviolet A (UVA). Jenis UV yang digunanakan secara luas dalam dematologi adalah narrowband ultraviolet B (NB-UVB), broadbrand ultraviolet B (BB-UVB), UVA1, dan psoralen dikombinasikan dengan UVA (PUVA). Interaksi antara UV dan kulit menentukan efektivitas fototerapi. Efek biologi UV digunakan dalam pengelolaan penyakit kulit inflamasi, malignansi, dan berbagai penyakit kulit yang jarang. Terlepas dari manfaatnya, UV meningkatkan risiko fotoaging dan kanker kulit. Oleh karena itu, penelitian lanjut diperlukan untuk meningkatkan efektivitas dan keamanan fototerapi. Kajian pustaka ini membicarakan peran fototerapi dalam berbagai penyakit kulit selain psoriasis dan vitiligo.
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