Indonesian Journal of Biomedicine and Clinical Sciences

Response of narrowband ultraviolet-B phototherapy in pityriasis lichenoides-like mycosis fungoides: a case report

Silvia Rakhmadani — 2026-05-12

Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that often mimics other dermatological conditions, particularly in early stages. One rare subtype is pityriasis lichenoides-like mycosis fungoides (PL-like MF), which clinically resembles pityriasis lichenoides but demonstrates the histopathological features of MF, sometimes with overlapping characteristics. The management of MF varies according to disease stage, with skin-directed therapies, including narrowband ultraviolet B (NB-UVB) phototherapy, frequently used in early stages. A case is reported of a 28-year-old woman who presented with papules and erythematous patches on the trunk, arms, and legs that had worsened over two years. Histopathological examination of the skin biopsy confirmed PL-like MF. Initial treatment with topical corticosteroids for two months resulted in suboptimal improvement. The patient subsequently underwent 37 sessions of NB-UVB phototherapy with a cumulative dose of 58,764 mJ/cm². Pityriasis lichenoides-like MF is a rare variant of MF that poses diagnostic challenges. The management of MF is tailored to the disease stages. In early stages, skin-directed therapies (SDTs) are preferred, whereas in advanced or refractory MF, systemic therapy combined with SDTs is required. Narrowband UVB phototherapy is considered a safe and effective therapeutic option for early-stage MF, with mechanisms involving immunomodulation and induction of apoptosis in atypical lymphocytes. In this case, the patient demonstrated 87% clinical improvement following NB-UVB therapy, consistent with reports. Long-term follow-up is necessary to assess sustained remission and potential relapse.

Trained immunity in tuberculosis infection: a systematic review

Salma Rasiani — 2026-05-12

Tuberculosis (TB) is considered a major contributor to death resulting from pathogenic bacteria; specifically, Mycobacterium tuberculosis (Mtb) spreads through droplets from individuals with active TB. Both the innate and adaptive immune systems collaborate to control the infection, with innate immunity potentially playing a role in eliminating Mtb. Vaccination, early diagnosis, and treatment can reduce the severity of the infection, but new strategies are still needed to address TB. Research suggests that trained immunity may assist in combating pathogens, including Mtb, and could open new opportunities for treatment. A systematic review was conducted following the eight-step Cochrane methodology and adhering to PRISMA guidelines. An initial automated search identified 157 articles published between 2020 and 2025. Following duplicate removal and evaluation of titles and abstracts, 92 articles remained. After further screening, 52 articles were excluded, and 40 articles were identified for in-depth review. As a result, 8 publications satisfied all eligibility standards and were incorporated into the systematic review. Vaccines (e.g., BCG and TB-MAPS) and adjuvants (e.g., β-glucan) exploit trained immunity to enhance protection. BCG reprograms hematopoietic stem cells (HSCs) via chromatin remodeling, inducing long-term functional alterations in neutrophils, monocytes, and macrophages through epigenetic modifications (e.g., H3K4me3). TB-MAPS generated strong, long-lasting T cell and antibody responses and protected against Mtb infection in both lungs and spleen, matching BCG efficacy. When combined with BCG, it showed synergistic effects, further lowering lung bacterial load. Protection relied partly on IL-12p40 signaling, with IFN-γ and IL-17A pathways driving systemic and lung immunity. β-glucan operates via IL-1 signaling, epigenetically upregulating IL-1 family genes and enhancing proinflammatory responses via the PI3K/Akt/mTOR pathway. These interventions boost myelopoiesis and strengthen both innate and adaptive immune memory, providing stronger protection against TB and opening avenues for new therapeutic approaches.

Rapid improvement of guttate psoriasis following inadequate response to prior systemic therapy using 311 nm narrowband ultraviolet B (NB-UVB) phototherapy

Rizka Fauziyah — 2026-05-20

Guttate psoriasis (GP) is a variant of psoriasis commonly affecting children and young adults, often triggered by infection. Although most cases respond to topical therapy, some patients show inadequate response to prior treatment. Narrowband ultraviolet B (NB-UVB) phototherapy is considered a safe and effective therapeutic option in such cases. A 12-year-old boy presented with multiple erythematous papules with fine scales distributed over the trunk and extremities. Laboratory findings revealed elevated antistreptolysin-O titers. Based on the clinical and histopathology features, the patient was diagnosed with GP. The patient had previously received low-dose methotrexate therapy (2.5 mg/week) for approximately six months with inadequate clinical response. NB-UVB phototherapy was initiated three times weekly with gradual dose escalation. Marked clinical improvement was observed after 18 sessions, achieving PASI90. NB-UVB phototherapy exerts therapeutic effects through immunomodulation and reduction of keratinocyte proliferation. The rapid response observed in this case may be related to lesion characteristics and the appropriate selection of therapy following subtherapeutic methotrexate dosing. Based on this case, it can be concluded that NB-UVB phototherapy may be an effective and well-tolerated treatment option for GP with inadequate response to prior therapy, particularly in pediatric patients.

Diagnostic accuracy of clinical and laboratory tests in scabies: A systematic review

Stefanie Kusuma — 2026-05-22

Scabies is a highly contagious parasitic skin disease with significant global morbidity. Accurate diagnosis is essential for effective treatment and control; however, clinical manifestations are often nonspecific, and the performance of available diagnostic methods varies considerably. This systematic review synthesizes evidence on the diagnostic accuracy of clinical and laboratory-based tests for scabies. It followed PRISMA 2020 guidelines. A search of PubMed, Embase, and Web of Science was conducted between 2007 and December 2025 for studies evaluating the diagnostic accuracy of clinical diagnoses.skin scraping, adhesive tape testing, dermoscopy, and polymerase chain reaction (PCR). Eligible studies included human participants and reported sensitivity and/or specificity. Reference standards varied (clinical diagnosis, microscopy, skin scraping, dermoscopy). Two reviewers independently screened studies, extracted data, and assessed quality using QUADAS-2. When sufficient 2×2 data were available, specificity and predictive values were calculated. Due to heterogeneity, a narrative synthesis was conducted. Ten studies (2007–2025) involving 1,054 participants across Africa, Asia, Europe, and the Middle East were included. Skin scraping and adhesive tape testing demonstrated consistently high sensitivity, reaching up to 100% in studies using clinical diagnosis as the reference. Dermoscopy showed variable sensitivity (46–86%), influenced by operator expertise and patient factors. In studies with extractable data, dermoscopy versus microscopy yielded a specificity of 80.95%, with positive and negative predictive values of 84.0% and 85.0%. PCR showed high but heterogeneous sensitivity (74–100%), with improved performance using standardized sampling. Specificity reporting was inconsistent, limiting evaluation of false-positive rates. Skin scraping and adhesive tape testing remain the most sensitive diagnostic methods when mite material is present. Dermoscopy and PCR are useful complementary tools, though performance varies. An integrated diagnostic approach is recommended, and findings should be interpreted cautiously due to heterogeneity and variable reference standards.