Handling
Melasma is an aberration in a difficult therapy. Pigment in melasma increased gradually, and it also requires a long time. Cases and chronicles recurrent and may often occur in people who are often exposed to sunlight exposure. All light waves from the sun, including visible spectrum can cause the occurrence of melasma.
Hiperpigmentasi treatment in general and in particular melasma, usually because of cosmetics, for never giving lesi subjective complaints.
Some of the actions of prevention are:
a. Avoid the sun. This is usually done with conventional ways, such as wearing a hat with a wide or paying or using screen sun (sunscreen)
b. Stop the use of contraceptives.
In addition to the curtain and use the sun to prevent melasma, the use of cream containing tretinoin, kojik acid and acid azeleat has showed improvement of melasma. Sometimes recommended for chemical peels or use a steroid cream topical. In the case of a heavy, laser treatment can be used to eliminate hiperpigmentasi.
Pandhi research conducted to evaluate the comparative treatment topikal in melasma treatment. Melasma from 50 patients taken at random, divided into 5 group (10 people per group). Evaluation of drug treatment of clobetasol propionate 0.05%, 0.025% tretinoin, hydroquinone 2%, benzoil peroxide 5% and glycolic acid 10% show the effectiveness of each drug. Effectiveness of drugs is highest clobetasol (80%).
Research other states that have the alpha hydroxyl acid is the right choice in the treatment of melasma suitable for Asian and Latin skin. Research that is conducted Satiti success kojik acid cream 2% can be used as alternative therapy melasma. Melasma can be difficult cured, melasma pigment form slowly and it is slowly.
Topikal range of treatment for melasma, including:
a. Hidroquinon
Hidroquinon is a chemical that impedes hydroxyphenolic so tyrosinase conversion decreased DOPA into melanin. Hidroquinon can be applied in the form of a cream or mixed with a solvent solution. Concentration allowed in the United States is 2%, without a prescription that is used for concentration of 4% or higher again. Hidroquinon related to the effectiveness of the degree of concentration but the side effects that occur along the increased concentration increased.
Other mechanisms that may be the way destructs, melanosit, melanosom degradation, and prevent DNA and RNA synthesis.
Hidroquinon used in the form of a cream-colored with a concentration of 2-50%. Cream is used at night, with the curtain in the afternoon sun. Generally appear to improvements in 6-8 weeks and followed up to 6 months.
Concentration that causes excessive skin irritation, reaction phototoksik with hiperpigmentasi post inflamasi and okronosis eksogen irreversible. Monobenzil ether causes vitiligo-like leukoderma a good lokalisata and general.Selain that, in hipopigmentasi can occur around the treated area. After the termination of the use hidroquinon, often relapse.
b. Retinoat acid (retinoic acid / tretinoin)
Acid retinoat 0.1% mainly used as additional therapy or a combination. Cream is also used at night, because during the day can occur fotodegradasi. Now retinoat acid is used as monoterapi and obtained a clinical improvement, although it take a while.
Retinoid trusted to work by increasing the turnover limit keratinosit and delivery melanosom to keratinosit. Major side effects of tretinoin is skin irritation, deskuamasi, photosensitive temporary and hiperpigmentasi paradoksikal. Combination with or without tretinoin corticosteroid topical has been promoted.
0,05-0,1% tretinoin pigmentasi with the transcript tirosinase hamper the functioning sintesis melanin. Tretinoin melasma can be effective in reducing the duration of 24 weeks. Tretinoin have any side effects, namely hiperpigmentasi secondary, and eritema irritation. Retinoid that can be used, among other adaphalen, tazarotene and isotretinoin topikal.
c. Azeleat acid (azeleic acid)
Azeleat acid is a drug that is safe to use. Azeleat acid treatment with 20% for 6 months to give good results. Side effects that can happen is feeling hot and itchy. There are no reports fototoksik reaction and fotoalergik on the use of acid azeleat.
Azeleat acid mechanism of action is not fully understood. Reduction DNA synthesis and cellular energy production mitokondria is the resistor in melanosit. Unlike hidroquinon, acid azeleat only work on melanosit the hiperaktif skin and does not affect the normal function melanositnya.
In a research report azeleat acid is as effective as with the hidroquinon 4% and without side effects. Acid azeleat combination with tretinoin or 0:05% 15-20% glikolat acid can accelerate the skin bleaching. Side effects that can happen is pruritus, eritema lightweight, and taste burnt.
d. Acid kojik
Kojik acid produced by fungus Aspergillus oryzae, and can prevent tirosinase. In the research found that a combination of acid kojik 2% with hidroquinon 2% more effective than the acid glikolat combined with hidroquinon 2%. Other research comparing glikolat acid 5% with 4% or hidroquinon acid kojik 4% for 3 months. -Combination before the combination is effective to reduce the hiperpigmentasi in 51% patients. Acid kojik can help patients hiperpigmentasi that does not fit with the other therapy.
e. Agent depigmentasi other
Depigmentasi other agents that have been examined in the treatment melasma is a 4-N-butylresorcinol, phenolic-thioeter, 4-isopropylcatechol and acid askorbat.
f. Combination therapy
Combination therapy is more effective than the use of one type of product. The cause of melasma is not fully known, so that combination therapy can be more effective for different degrees of therapy hiperpigmentasi one kind of product that is only effective on one hiperpigmentasi degrees.
The addition of tretinoin can increase the pigmentasi and keratinosit proliferation by preventing the oxidation of hidroquinon and improve epidermal penetration. Furthermore, the addition kortikosteroid topikal can reduce irritation and prevent melanin synthesis because cell metabolism will decrease. Combination hidroquinon 5%, tretinoin 0.1% and 0.1% had dexamethason known since 1975, with the name and formula Kligman. This formula is often used as combination therapy for melasma in the world.
Of a multicenter study, using random and double blind control trial showed that a combination of new hidroquinon 4%, tertinoin 0.05% and fluosinolon asetonid 0.01% (Tri-Luma, Galderma) that the result is better than other combinations with 2 or more products / agencies where 77% patients showed total recovery. The clinical, indicated a significant increase in the minimum and maximum of 4 weeks for 8 weeks. Side effects that is common is a mild local irritation, eritem.
g. Specific therapy in pregnancy
Melasma therapy in pregnant women should be done after the birth. This is because, melasma to be more resistant to treatment because of factors such as spark hormones during pregnancy is still high. Then, therapy is also beneficial because it does not become predileksi occurrence melasma also increased after birth and the most important therapy for melasma is kontraindikasi pregnancy.
In addition to the treatment used topikal, the systemic treatment can also be done include:
a. Askorbat acid (vitamin C)
Vitamin C has the effect of oxidation of melanin into the form of a reduction of melanin color is bright and prevent the formation of melanin to alter DOPA into DOPA quinon.
b. Glutation
Glutation form of reduction is sulfhidril compound (SH) that can potentially prevent the formation of melanin to the road to joining Cuprum (Cu) from tirosinase.
Special measures for melasma therapy can also be used as therapy options, among others:
a. Peel chemical
Peel chemical treatment can help hiperpigmentasi aberration. peel chemical smear done with acid glikolat 50-70% for 4-6 minutes should be done every 3 weeks for 6 times. Before the chemical peel, first given sour cream glikolat 10% for 14 days.
b. Surgical laser
Surgery using the laser Q-switched Ruby laser and Argon. relaps can occur. Hiper-treatment techniques pigmentasi with laser Qight amplification by stilulated emition of radiation) is a development of the current. Laser work monokromik emit high intensity, coherent source of energy that diabsorpsi by water, hemoglobin and melanin in the skin, to the kromophor. Absorpsi energy kromophor damage. Wavelength laser and set the lead in penetration and target kromophor.
Based on the spectrum absorpsi melanin, laser Q-switched ruby (694 nm) laser is an appropriate treatment for lesi hiperpigmentasi. Side effects of laser treatment including not feeling comfortable, redness, swelling, and hiperpigmentasi post-inflamasi. Patients should always be a spot test before treatment is done in full.
c. Intense Pulse Light (IPL)
Derivat of treat laser is Intense Pulsed Light (IPL), in pulsasi berintensitas with high wavelength (515 -1200 nm), which emanated by the light energy delivered to the skin. IPL energy is released to the dermis and diabsorpsi by kromophor. IPL has shown that work well for medical treatment for lentigines but melasma is not yet appropriate expectations. IPL treatment side effects are pain, local irritation and hiperpigmentasi post-inflamasi.
Prognosis
Melasma often disappear after a few months termination contraceptives, hormonal replacement therapy or after the birth. Melasma may relapse again if pregnant or use drugs that can spur melasma.
Melasma type dermis may take longer than the type of repair for epidermis because there is no effective treatment for the pigment in the dermis. Source of pigment from the epidermis is the dermis. Therefore, if the melanogenesis epidermis can blocked for some time, not pigment dermis and fill will slowly peter out. resisten cases and relapse often occurs and has been the prevention of contact with the clear sunlight to total no more needed.
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