Incidence and Sociodemographic Characteristics of Allergy,

Autoinflammatory, and Autoimmune Skin Disease Patients in

Allergy-immunology Clinic of Dermatovenerology Department of

Cipto Mangunkusumo General Hospital in 2014-2017

Windy Keumala Budianti

, Mutiara Ramadhiani

, Endi Novianto

, Evita Halim Effendi

, Retno Widowati

Soebaryo

Department of Dermato and Venereology Faculty of Medicine Universitas Indonesia/dr Cipto Mangunkusumo National

General Hospital, Jakarta, Indonesia

Keywords: Incidence, allergy, autoinflammatory, autoimmune

Abstract: Allergy, autoinflammatory and autoimmune diseases are some of the diseases often found in individuals

with certain predisposing genetic susceptibility hence not all individuals have the same risk of allergy and

autoimmune diseases. Despite not being included in the top ten fatal diseases, the impact of allergy and

autoimmune diseases may severely affect patients’ morbidity and quality of life. Allergy and autoimmune

diseases itself are complex in terms of its etiopathogenesis, clinical symptoms, and management. Studies

regarding the incidence of allergy, autoinflammatory, and autoimmune skin diseases in Cipto

Mangunkusumo General Hospital has never been conducted in the past 10 years thus warrant collection of

most current data. A retrospective study is needed to calculatethe incidence of allergy, autoinflammatory,

and autoimmune diseases along with patients’ sociodemographic characteristics in the Allergy-Immunology

Clinic, Dermatovenerology Department of Cipto Mangunkusumo General Hospital. Cipto Mangunkusumo

General Hospital that has been accredited by Joint Commission International in 2016 is a national top

referral hospital providing tertiary medical services equipped with 1033 beds. Therefore, cases such as

allergy, autoinflammatory, and autoimmune diseases, including those in dermatovenerology are ubiquitous.

A study was conducted to determine the incidence and sociodemographic characteristics of allergy,

autoinflammatory, and autoimmune patients in Allergy-Immunology Clinic of Cipto Mangunkusumo

General Hospital. Chronic urticaria was the leading incidence in 2014, 2015, and 2017. In 2016, contact

irritant dermatitis became the leading diagnosis followed by chronic urticaria. Within the last 4 years, the

visiting patients were dominated by females with range aged 19-59-year-old.

1 INTRODUCTION

Skin allergy is a bodily reaction induced by

allergenic substances and may affect the immune

system and may manifest as erythema, swelling,

scaling, and itch (Mukesi et al, 2017). Allergies may

affect all age groups in various parts of the world.

Such condition may be contributed by multifactors

including genetics, climate, occupation, sanitation,

and personal hygiene El-Khateeb et al, 2011).

Meanwhile, autoimmune diseases is a pathological

condition marked by tissue damage caused by

diminished self-tolerance (Moreira et al, 2017).

Autoinflammatory diseases are a number of diseases

that occurred as recurrent episodes of systemic

inflammation and there are many cytokines that

increase without detectable autoantibodys or auto-

reactives T cells (Ray et al, 2012).

Skin involvement is common in allergy,

autoinflammatory, and autoimmune diseases.

Hypersensitivity reaction (allergy) is the underlying

mechanism of several skin diseases such as urticaria,

atopic dermatitis, irritant contact dermatitis, allergic

contact dermatitis, and cutaneous drug eruption.

Several autoimmune diseases with skin

manifestations include psoriasis, bullous

autoimmune disease, cutaneous lupus

erythematosus, scleroderma, and dermatomyositis.

Meanwhile, one of autoinflammatory diseases that

can be found in Allergy and Immunology Clinic is

100

Budianti, W., Ramadhiani, M., Novianto, E., Effendy, E. and Soebaryo, R.

Incidence and Sociodemographic Characteristics of Allergy, Autoinﬂammatory, and Autoimmune Skin Disease Patients in Allergy-immunology Clinic of Dermatovenerology Department of

Cipto Mangunkusumo General Hospital in 2014-2017.

DOI: 10.5220/0008151701000103

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 100-103

ISBN: 978-989-758-494-7

Behcet disease. Currently in Indonesia, there is an

increasing trend in numbers of cases of allergy,

autoinflammatory, and autoimmune diseases.

Therefore, with the growing concern regarding this

matter, active participation of competent medical

personnel and primary, secondary, and tertiary

health care facilities is essential as the management

of diseases requires comprehensive approach.

Nowadays, there has yet to be a national registry of

dermatological allergy, autoinflammatory, and

autoimmune diseases. Since 2014, care and

treatment of atopic dermatitis and psoriatic patients

aged 18-59 has been reassigned from the General

Dermatovenereology Clinic to the

Dermatovenereology Allergy and Immunology

Clinic which resulted in a significant increase in

numbers of cases compared to the previous year.

The results of this study will provide a baseline

data for other studies concerning the disease, patient

sociodemographic, and reviews of the management

of allergy, autoinflammatory, and autoimmune

patients in Indonesia. This study would also provide

opportunities for improvement of care provided by

Cipto Mangunkusumo General Hospital for its

patients and for the general public.

2 METHODS

This study is a descriptive observational study. Data

collection begun after the approval from The

Research Ethics Committee of Fakultas Kedokteran

Universitas Indonesia-Cipto Mangunkusumo

General Hospital. Data was collected from paper-

based medical records and electronic health record

of patients that visited the Dermatovenereology

Allergy-Immunology Clinic within 2014-2017. Data

were then recorded and compiled in a provided

study form. Validated data will be analyzed using

Statistical Programme for Social Science (SPSS)

20.0 and presented as tables according to each

indicator. Descriptive analysis of the data is done by

categorizing each diagnosis according to gender and

age groups. Data analysis will also determine the top

ten diagnoses of each year.

3 RESULTS

The number of new patients in Dermatovenereology

Allergy-Immunology Clinic Cipto Mangunkusumo

General Hospital patients were 648, 563, 515, and

526 in 2014-2017, respectively. The number of new

patients were dominated by females with the

percentage of 58.8%, 62.2%, 61.2%, and 54.9% in

four consecutive years. In terms of age groups, most

of the patients’ age between 19 and 59 comprising of

83.3%, 84.4%, 87%, 81.6% of the total group in

each year, respectively. Data analysis also revealed

the top ten diseases of first visits in each year. Data

are presented in the following chart.

Table 1. Percentages by Gender Category in

Dermatovenereology Allergy-Immunology Clinic Cipto

Mangunkusumo General Hospital, 2014-2017

Year

Gende

Male Female

2014 41.2 % 58.8 %

2015 37.8 % 62.2 %

2016 38.8 % 61.2 %

2017 45.1 % 54.9 %

Other autoinflammatory and autoimmune skin

diseases that are not in the top ten diagnoses such as

vesiculobullous disease has the incidence rate of

0.35% – 0.70% and Behcet disease has the incidence

rate of 0.05% – 0.10 % in 4 years.

4 DISCUSSION

According to the data from Dermatovenereology

Allergy-Immunology Clinic Cipto Mangunkusumo

General Hospital in 2014-2017 based on gender and

age groups, chronic urticaria is the diseases with the

highest incidence in almost every year. This finding

was similar to a study by Sánchez-Borges (2012)

that revealed urticaria as a highly prevalent disease

in the world with the rate of 0.3-11% (Sánchez-

Borges et al, 2012). Other diseases that are always in

the top ten diagnoses each year include irritant

contact dermatitis, allergic contact dermatitis,

psoriasis vulgaris, atopic dermatitis, acute urticaria,

maculopapular type allergic drug eruption, and

acneiform eruption. A study by Mukesi (2017)

revealed that the top three prevalent allergic skin

diseases in Namibian adults were atopic dermatitis

with 43.4%, contact dermatitis with 31.3%, followed

by urticaria with 13.3% (Mukesi et al, 2017).

Atopic

dermatitis cases in Cipto Mangunkusumo General

Hospital are not only be found in

Dermatovenereology Allergy-Immunology Clinic,

but are distributed to Geriatric Dermatology Clinic

and Pediatric Dermatology Clinic according to the

patient’s age thus may explain the lower incidence

of atopic dermatitis in this study compared to other

studies.

Incidence and Sociodemographic Characteristics of Allergy, Autoinﬂammatory, and Autoimmune Skin Disease Patients in

Allergy-immunology Clinic of Dermatovenerology Department of Cipto Mangunkusumo General Hospital in 2014-2017

101

Figure 1. Percentages by Disease Category in Dermatovenereology Allergy-Immunology Clinic Cipto Mangunkusumo

General Hospital,2014-2017

Entity of Dermatoses

Figure 2. Top Ten Allergy, Autoinflammatory and Autoimmnune in DermatovenereologyAllergy-Immunology Clinic Cipto

Mangunkusumo General Hospital, 2014-2017

There is an increase in the incidence of psoriasis

vulgaris from 2016 to 2017. This may be partially

explained by the lack of systemic medications such

as methotrexate in other health facilities which

causes a surge of psoriasis vulgaris patients in Cipto

Mangunkusumo General Hospital. There was also a

significant number of syphilis patients that came

into the Allergy-Immunology Clinic. Despite not

being one of allergy, autoinflammatory, and

autoimmune diseases, syphilis patients were often

referred to the clinic for penicillin intradermal

testing.

Looking at the diseases incidence distribution, it

can be inferred that most of the patients were

28,37%

56,88%

0,49%

14,25%

Autoimmune

Allergy

Autoinflammatory

Others

incidence

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

102

between 19 to 59 years old and were females.

Similarly, Sánchez-Borges (2012) also found that

urticaria were more common in female patients

within the age range of 35 to 60 years old. Rosa

(2013) also revealed that prevalence of psoriasis

risen with age up until the age of 39 years old. The

prevalence then fell in the age group of 40-49 years

old but came increasing back in patients aged 50-59

years old (Parisi et al, 2013).

Accordant to the

findings of this study, other studies by Mukesi et al.

(2017) discovered that the prevalence of allergic

diseases comprises of female patients with 58.7%

and male patients with 41.3% (Mukesi et al, 2017).

Autoimmune diseases include more than 70 chronic

diseases and are significantly more common in

females.

Several theories that have been suggested

to explain the correlation of gender and autoimmune

disease incidence include sex hormone fluctuation

that accompanies menstrual cycle, pregnancy, and

menopause. Several autoimmune diseases would

show clinical signs only during pregnancy or after

menopause (Markle et al, 2014).

Other studies have

shown that testosteroid have protective effects while

estrogen have stimulant effects to the immune

system by its direct stimulating mechanism of

macrophages through estrogen alpha receptors

(ERα) (Calippe et al, 2014).

From 2014 to 2016,

there has been a decline of in the number of new

patients. This may be explained by the enactment of

National Health Coverage (BPJS Kesehatan).

Therefore patients are redistributed from Cipto

Mangunkusumo General Hospital to be managed in

primary and secondary healthcare facilities.

5 CONCLUSION

Allergy, autoinflammatory, and autoimmune

diseases of the skin should be a major health concern

as it has a high incidence rate in both Indonesia and

worldwide. In the Dermatovenereology Allergy-

Immunology Clinic Cipto Mangunkusumo General

Hospital in the year of 2014-2017, the top 5 most

common diagnoses were chronic urticaria, contact

dermatitis, psoriasis vulgaris, and atopic dermatitis.

The number of female patients were significantly

higher compared to male and majority of patients

were aged 19 to 59 years old. The results of this

study are essential in the evaluation of allergy,

autoinflammatory, and autoimmune patients’

management. This study would also provide

opportunities for improvement of care provided by

Cipto Mangunkusumo General Hospital for its

patients and for the general public.

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Allergy-immunology Clinic of Dermatovenerology Department of Cipto Mangunkusumo General Hospital in 2014-2017

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