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Abstrak :
ABSTRAK
Latar belakang Psoriasis merupakan penyakit inflamasi kronis pada kulit. Fototerapi menggunakan sinar narrow band ultraviolet B NB-UVB adalah salah satu modalitas terapi yang efektif untuk penyakit psoriasis tipe plak derajat sedang-berat. Dosis inisial fototerapi sebaiknya ditentukan dari dosis eritema minimum DEM , namun belum ada penelitian khusus mengenai DEM pada pasien psoriasis orang Indonesia. Penelitian ini bertujuan mengetahui nilai dosis eritema minimum pada pasien psoriasis dan perbedaannya dengan orang sehat tipe kulit Indonesia. Metode Subyek penelitian terdiri atas 20 pasien psoriasis tipe plakat dan 20 orang sehat yang masing-masing dibagi dalam 2 kelompok tipe kulit Fitzpatrick IV dan V n=10 . Pada regio infraskapula dilakukan penyinaran menggunakan unit fototerapi NB-UVB wholebody Daavlin seri 3 dengan berbagai dosis antara 300-1400 mJ/cm2. Setelah 18-24 jam pasca penyinaran dosis eritema minimum dibaca oleh dua pengamat. Efek samping akibat penyinaran juga dicatat. Hasil Rerata DEM sinar NB-UVB kelompok pasien psoriasis tipe kulit IV 880 SB 181,35 mJ/cm2 dan tipe kulit V 1070 SB 125,16 mJ/cm2. Rerata DEM sinar NB-UVB kelompok orang sehat tipe kulit IV 650 SB 97,18 mJ/cm2 dan tipe kulit V 970 SB 156,70 mJ/cm2. Rerata DEM tipe kulit V lebih tinggi daripada tipe kulit IV p < 0,05 . Rerata DEM kelompok pasien psoriasis lebih tinggi bermakna dibandingkan kelompok orang sehat p < 0,05 . Tidak ditemukan efek samping pasca penyinaran pada semua subyek. Kesimpulan Pada orang Indonesia rerata DEM sinar NB-UVB tipe kulit V lebih tinggi daripada tipe kulit IV. Nilai rerata DEM pasien psoriasis lebih tinggi dibandingkan dengan orang sehat.

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ABSTRACT
Background Psoriasis is a chronic inflammation skin disease. Narrowband ultraviolet B NB UVB has been considered as an effective treatment for moderate and severe psoriasis plaque. Initial dose should be determined from minimal erythema dose MED . However, study of MED in psoriasis patient Indonesian skin type has not been reported. This study aims to compare MED of psoriasis patient and healthy subjects Indonesian skin type. Methods Twenty plaque psoriasis patients dan 20 healthy subjects was divided into 2 skin type groups Fitzpatrick IV and V n 10 . Wholebody NB UVB phototherapy unit Daavlin 3 series was used to irradiate backs with doses ranging from 300 to1400 mJ cm2. After 18 24 hours post exposure, MED was determined by two examiners. Side effects of radiation were documented. Results Mean MED of psoriasis patients group skin type IV was 880 SD 181.35 mJ cm2 and type V was 1070 SD 125.16 mJ cm2. In healthy group, the average of skin type IV was 650 SD 97.18 mJ cm2 and skin type V was 970 SD 156.70 mJ cm2. Skin type V showed higher MED than skin type IV p 0.05 . There was significantly higher mean MED in psoriasis patients compared to healthy subjects p 0.05 . Post radiation side effects were not found. Conclusion Minimal erythema dose of Indonesian skin type V is higher than skin type IV. Psoriasis patients have a significantly higher MED than healthy subjects.

Abstrak :
The skin, the body’s largest organ, is strategically located at the interface with the external environment where it detects, integrates and responds to a diverse range of stressors, including solar radiation. It has already been established that the skin is an important peripheral neuroendocrine-immune organ that is closely networked with central regulatory systems. These capabilities contribute to the maintenance of peripheral homeostasis. Specifically, epidermal and dermal cells produce and respond to classical stress neurotransmitters, neuropeptides and hormones, production which is stimulated by ultraviolet radiation (UVR), biological factors (infectious and non-infectious) and other physical and chemical agents. Examples of local biologically active products are cytokines, biogenic amines (catecholamines, histamine, serotonin and N-acetyl-serotonin), melatonin, acetylocholine, neuropeptides including pituitary (proopiomelanocortin-derived ACTH, b-endorphin or MSH peptides, thyroid stimulating hormone) and hypothalamic (corticotropin-releasing factor and related urocortins, thyroid-releasing hormone) hormones, as well as enkephalins and dynorphins, thyroid hormones, steroids (glucocorticoids, mineralocorticoids, sex hormones, 7-δ steroids), secosteroids, opioids and endocannabinoids. The production of these molecules is hierarchical, organized along the algorithms of classical neuroendocrine axes such as the hypothalamic pituitary adrenal axis (HPA), hypothalamic-thyroid axis (HPT), serotoninergic, melatoninergic, catecholaminergic, cholinergic, steroid/secosteroidogenic, opioid and endocannabinoid systems. Disruptions of these axes or of communication between them may lead to skin and/or systemic diseases. These local neuroendocrine networks also serve to limit the effect of noxious environmental agents to preserve local and consequently global homeostasis. Moreover, the skin-derived factors/systems can also activate cutaneous nerve endings to alert the brain to changes in the epidermal or dermal environments, or alternatively to activate other coordinating centers by direct (spinal cord) neurotransmission without brain involvement. Furthermore, rapid and reciprocal communications between epidermal and dermal and adnexal compartments are also mediated by neurotransmission including antidromic modes of conduction. Lastly, skin cells and the skin as an organ coordinate and/or regulate not only peripheral but also global homeostasis.