.png)
_(1).png){kind=logo}
Efektivitas Pengobatan Pasien Melasma dengan Modalitas Kombinasi (Penggunaan Tabir Surya, Obat Topikal, Obat Sistemik, Peeling, Laser, dan Skin Booster): Laporan Kasus
Abstract
Abstrak
Tata laksana melasma masih merupakan tantangan karena sering terjadi rekurensi setelah penghentian pengobatan. Prinsip dasar pengobatan melasma adalah dengan supresi aktivitas melanosit melalui penggunaan tabir surya. Supresi sintesis melanin dilakukan melalui penggunaan obat berbahan depigmentasi. Peeling kimiawi dilakukan untuk mengurangi produksi melanin. Penggunaan laser dapat membantu memecah granul melanin. Skin booster dapat mencegah proses solar elastosis karena aktivitas metaloproteinase dihambat. Dilaporkan tiga kasus melasma tipe campuran. Pada ketiga kasus ini pengobatan melasma dilakukan melalui penggunaan tabir surya, kombinasi bahan depigmentasi (hidrokuinon 4% dan tretinoin 0,025–0,1%) secara bertahap, traneksamid oral 2x250 mg, laser Yellow 577-nm Diode, dan peeling kimiawi asam glikolat 35%, serta non-cross linked asam hialuronat skin booster sebagai terapi lanjutan. Sementara itu, pada pasien melasma yang tidak menunjukkan gejala klinis eritema dan teleangiektasia diberikan pengobatan kombinasi yang sama, tetapi dengan penggunaan laser QS NdYAG. Simpulan, pengobatan melasma menggunakan modalitas kombinasi dengan penggunaan tabir surya, bahan depigmentasi, traneksamid oral, laser, peeling kimiawi, dan skin booster diketahui efektif dan tidak ada tanda rekurensi berdasarkan penurunan skor MASI setelah dua tahun pengamatan.
The Effectiveness of Treatment for Melasma Patients with Combination Modalities (Using Sun Protection, Topical, Systemic Medication, Peeling, Laser, and Skin Booster): A Case Report
Abstract
The management of melasma continues to be challenging due to frequent relapses following discontinuation of the medication. The basic principles of treating melasma include the suppression of the activity of melanocytes by applying sunscreen. Depigmenting agents are used to suppress melanin synthesis. Chemical peeling can decrease melanin production, whereas laser treatment scatters melanin granules. Skin boosters protect against solar elastosis, which can reduce metalloproteinase activity. Reports indicated three cases of mixed-type melasma. In these three cases, we treated melasma using sun protection, a combination of depigmentation (4% hydroquinone and 0.025–0.1% tretinoin) gradually, 2x250 mg oral tranexamic, a 577-nm yellow light diode laser, and chemical peeling glycolic acid (35%), as well as non-cross-linked hyaluronic acid as a maintenance therapy. A patient with clinical symptoms of melasma, who does not exhibit erythema and telangiectasia, receives the same combination therapy but uses QS NdYAG laser. In conclusion, the treatment of melasma using combination modalities with sun protection, depigmentation ingredients, oral tranexamic, laser, chemical peeling, and skin booster is effective, and there is no sign of recurrence based on the reduction of the MASI score after two years of observations.
Keywords
Full Text:
PDF (Bahasa Indonesia)References
Mahajan VK, Patil A, Blicharz L, Kassir M, Konnikov N, Gold MH, dkk. Medical therapies for me-lasma. J Cosmet Dermatol. 2022;21:3707–28.
Goel A, Trivedi N. Current updates on melasma treatment. CosmoDerma. 2023;3(79):1–8.
Kucuk OS. Current treatment approaches for melasma. Bezmialem Sci. 2018;6:54–62.
Maritza I P. The stepwise approach to the treatment of melasma. Cutis. 2005;75:217–22.
Abdallah M. Melasma, novel treatment modalities. J Pigmentary Disorders. 2014;1(4):1–9.
Asditya A, Sukanto H. Studi retrospektif pasien melasma. Berkala Ilm Kesehat Kulit Kelamin. 2017;29(3):220–8.
Freitag FM, Cestari TF, Leopoldo LR, Paludo P, Boza JC. Effect of melasma on quality of life in a sample of women living in Southern Brazil. JEADV. 2008;22:655–62.
Damevska K. New aspects of melasma. Serbian J Dermatol Venereol. 2014;6(1):5–18.
Febrianti T, Sudharmono A, Rata IGAK, Bernadette I. Epidemiologi melasma di Poliklinik Depar-temen Ilmu Kesehatan Kulit Dan Kelamin RS Dr Cipto Mangunkusumo Jakarta tahun 2004. MDVI. 2006;33(1):35–40.
Lapeere H, Boone D, De Schepper S, Verhaeghe E, Gele M, Ongenae K, dkk. Hypomeloneses and hypermelanoses. Dalam: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K., editor. Fitzpatrick’s dermatology in general medicine. Edisi 8. New York: McGraw Hill; 2012. hlm. 804–26.
Tamega AA, Miot LD, Bonfietti C, Gige TC, Marques ME, Miot HA. Clinical patterns and epide-miological characteristics of facial melasma in Brazilian women. J Eur Acad Dermatol Venere-ol. 2013;27(2):151–6.
Kalitema D. Melasma review of current treatment modalities and efficacy assessment of a new resorcinol based topical formulation. Glob Dermatol. 2017;4(3):2–6.
Cassiano DP, Esposito AC. Da silva CN, Lima PB, Dias JA, Hassun K, dkk. Update on melasma part II treatment. Dermatol Ther. 2022;12:1989–2012.
Umborowati MA, Rahmadewi. Studi retrospektif diagnosis dan terapi pasien melasma. Berkala Ilm Kesehat Kulit Kelamin. 2014;26(1):56–63.
Ennes SBP, Paschoalick RC, Mora M. A double blind trial, comparative, placebo controlled study of the efficacy and tolerability of 4% hidroquinon as a depigmenting agent in melasma. J Dermatol Treat. 2000;11:173–9.
Kwatra SG, Loss M. Other topical medication. Dalam: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, dkk., editor. Fitzpatrick’s dermatology. New York: Mc graw Hill; 2019. hlm. 3611–22.
Griffiths CE, Finkel LJ, Ditre CM, Rafa ES, Hamilton TA, Ellis CN, dkk. Topical tretinoin (retinoic acid) improves melasma. A vehicle controlled clinical trial. Br J Dermatol. 1993;129:415–21.
Cho HH, Choi M, Cho S, Lee JH. Role of oral tranexamic acid in melasma patients treated with IPL dan low fluence QS Nd:YAG laser. J Deramolog Treat. 2013;24:292–6.
Wu S, Shi H, Wu H, Yan S, Guo J, Sun Y, dkk. Treatment of melasma with oral administration of tranexamic acid (Chinese). Chin J Aesth Plast Surg. 2008;19:106–10.
Sharma R, Mahajan VK, Mehta KS, Chauhan PS, Rawat R, Shiny TN. Therapeutic efficacy of oral tranexamic acid and that of tranexamic acid local infiltration with microinjections in patients with melasma: a comparative study. Clin Exp Dermatol. 2017;42:728–34.
James WD, Elston DM, Berger TG. Cutaneus laser surgery. Andrew’s disease of the skin. Edisi ke-12. Philadelphia: Elsevier; 2016. hlm. 901–12.
Micek I, Pawlaczyk M, Kroma A, SeraszekJaroz A, Urbanska M, GornowiczPorowska J. Treat-ment of melasma with a low fluence 1064nm Q switched NdYAG laser: laser toning in Cauca-sian women. Lasers Surg Med. 2022;54:366–73.
Saeed MY, Elethawi AMD, Saeed HAH. Efficacy and safety of yellow light diode laser 577nm for treatment of melasma patients in Sulaymaniyah City. Iraqi Postgraduate Med J. 2016;15(3):365–71.
Sharad J. Glycolic acid peel therapy-a current review. Clin Cosmet Investig Dermatol. 2013;6:281–8.
Gang S, Thami GP, Bhalla M, Kaur J, Kumar A. Comparative efficacy and tolerability of glycolic acid, salicylic mandelic acid, and phytic acid combination peels in melasma. Dermatol Surg. 2016;42(3):384–91.
Yusharyahya SN. Mekanisme penuaan kulit sebagai dasar pencegahan dan pengobatan kulit menua. eJournal Kedokt Indones. 2021;9(2):150–9.
Porcheron A, Latreille J, Jdid R, Tschachler E, Morizot F. Influence of skin ageing features on Chinese women’s perception of facial age and attractiveness. Int J Cosmet Sci. 2014;36(4):312– 20.
Ayatollahi A, Firooz A, Samadi A, Evaluation of safety and efficacy of booster injections of hya-luronic acid in improving the skin quality. ResearchGate net. 2020:2–9.
Yi KH, Winayanuwattikum W, Kim SY, Wan J, Vachatimanont V, Putri AI, dkk. Skin boosters: definitions and varied classifications. Skin Res Technol. 2023;30:1–13.
DOI: https://doi.org/10.29313/jiks.v6i2.13687
Refbacks
- There are currently no refbacks.
Jurnal Integrasi Kesehatan dan Sains is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.