Hot and humid countries such as Indonesia have a higher prevalence of acne vulgaris (AV). The activity of skin microbes, not only Cutibacterium acnes, contribute to the formation of AV. Topical and oral antibiotics are routinely prescribed to treat AV. As antimicrobial resistance rates increase globally, there are concerns about decreased efficacy. This study intends to systematically evaluate the microbiomes isolated from AV lesions and their antibiotics susceptibility in Indonesia. The data were retrieved through PubMed, EMBASE, Google Scholar, and ScienceDirect searches for articles published until July 2022 using three multiword searches. Sixteen studies published between 2001 and 2022 were identified from which the data were pooled using a random effects model. The pooled prevalence estimates demonstrated that C. acnes, Staphylococcus epidermidis, and Staphylococcus aureus were the three common microbes associated with AV in Indonesia. Tetracyclines had lower resistance rates compared to those of macrolides and clindamycin, with C. acnes showing a resistance rate that is as high as 60.1% against macrolides. C. acnes resistance against minocycline showed an increasing trend, whereas the resistances to doxycycline, clindamycin, and macrolides stagnated. The high resistance prevalence and trends signify a public health concern. The results of this study call for the development of antibiotic stewardship programs in Indonesia, which may lead to improved acne outcomes.

Background Leprosy, or Hansen’s disease, is a chronic infectious disease that primarily affects the skin and peripheral nervous system, often leading to disabilities, including trophic ulcers (TU). The role of vitamin D and vitamin D receptor ( VDR ) gene polymorphisms in the development of TU among leprosy patients remain unclear. Objective This study aims to investigate the differences in serum 25-hydroxyvitamin D [25(OH)D] levels and the frequency of VDR gene FokI polymorphism between leprosy patients with and without TU, and to evaluate their association with the occurrence of TU. Methods This Institutional Review Board-approved, single-center, observational, analytic case-control study will enroll adult leprosy patients from the Dermatology and Venereology Clinic at Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia. Participants will be divided into cases (patients with TU) and controls (patients without TU). Serum 25(OH)D levels will be measured using a chemiluminescence immunoassay, and FokI polymorphism detection is conducted through polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. A total of 82 participants (41 cases and 41 controls) will be recruited. Statistical analysis will be performed to evaluate the differences and associations. Results Data collection commenced in March 2024 and was completed in September 2024, during the Indonesia’s dry season. Data analysis and reporting are expected to be finalized by January 2025. Discussion The findings of this study will enhance the current understanding of the role of the vitamin D axis in the development of TU among leprosy patients. This could lead to new therapeutic strategies, such as vitamin D supplementation or personalized medicine based on genetic profiling, potentially reducing the burden of TU among leprosy patients.

Background: Alterations in the vitamin D axis have been implicated in chronic wounds, but their role in leprosy-related trophic ulcers (TU) is unclear. This study compared serum vitamin D levels and VDR FokI (rs2228570) polymorphism between leprosy patients with and without TU, assessed their association with ulcer presence, and examined the correlation between vitamin D levels and ulcer severity. Methods: This case-control study involved 82 adult leprosy patients (41 with TU, 41 without) treated at a tertiary referral hospital in Jakarta, Indonesia. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using chemiluminescence assay, and FokI polymorphism was analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Ulcer severity was evaluated using the Pressure Ulcer Scale for Healing (PUSH). Associations were assessed through bivariate and multivariate analyses. Results: Patients with TU had significantly lower mean serum 25(OH)D levels than those without TU (13.14 vs. 20.18 ng/mL, p < 0.001). The homozygous mutant FokI genotype ( ff ) was more frequent in the TU group ( p = 0.043). In multivariable analysis, both low vitamin D status (adjusted odds ratio [aOR] 4.15; 95% confidence interval [CI] 1.41–12.24; p = 0.010) and the FokI polymorphism (aOR 7.86; 95% CI 1.80–34.36; p = 0.006) remained independently associated with TU. Vitamin D levels showed a weak inverse correlation with PUSH scores ( r = –0.312, p = 0.047). Conclusions: Lower serum vitamin D status and the FokI polymorphism were independently associated with TU in leprosy, and a weak inverse correlation was observed between serum vitamin D levels and ulcer severity. While genetic variation is non-modifiable, vitamin D status represents a potentially modifiable factor; hence, these findings suggest that assessment of vitamin D status may be considered as part of comprehensive ulcer care in leprosy.

Generalized pustular psoriasis (GPP) is a rare, severe form of psoriasis that may be associated with monogenic autoinflammatory disorders such as deficiency of interleukin-36 receptor antagonist (DITRA). We report 2 Indonesian siblings with infantile-onset erythrodermic GPP caused by homozygous IL36RN c.115 + 6T>C mutations, representing the first genetically confirmed familial DITRA cases from Indonesia. The elder sister developed recurrent pustular flares from early infancy that progressed to chronic erythroderma with acrodermatitis continua of Hallopeau (ACH). The younger sibling presented at 8 months of age with widespread pustular eruptions and early ACH. Genetic testing confirmed homozygosity for the pathogenic variant in both siblings, while their parents and brother were heterozygous carriers. Both patients demonstrated hallmark features of DITRA, including early onset, acral pustulosis, and chronic relapsing disease. Conventional systemic therapies provided only partial control, highlighting therapeutic limitations in resource-limited settings where biologics such as secukinumab remain inaccessible. These cases add to the limited reports of DITRA from Southeast Asia and underscore the importance of genetic testing in early-onset GPP for accurate diagnosis, family counseling, and consideration of targeted therapy.

Porokeratosis is a group of chronic dermatoses characterized by the presence of cornoid lamellae. Disseminated superficial actinic porokeratosis (DSAP) is a common subtype, presenting as multiple small annular scaly lesions primarily in sun-exposed areas. While previous studies have documented DSAP in prostate cancer patients, the association with androgen deprivation therapy (ADT) has not been reported. In this report, we describe an elderly patient with advanced prostate cancer, who developed DSAP subsequent to undergoing ADT. We present the clinical, dermoscopic, and histopathological evaluations, and discuss the potential role of ADT in the pathogenesis of DSAP.