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"Latar Belakang: Melasma adalah kelainan hiperpigmentasi yang umum ditemukan pada sebagian besar populasi manusia di dunia. Etiopatogenesis melasma masih belum jelas dan masih menjadi perdebatan. Beberapa hormon diduga berperan pada terjadinya melasma, salah satunya hormon tiroid. Melasma tidak mengancam nyawa, meskipun demikian mampu menimbulkan dampak buruk pada kualitas hidup pasien.Tujuan: Mengetahui proporsi pasien melasma pada pasien hipertiroid dan menilai perubahan mMASI pada pasien hipertiroid sebelum dan sesudah pengobatan hipertiroid selama tiga bulan.Metode: Sebuah penelitian dengan desain studi intervensi (before dan after) dilakukan di Jakarta pada Agustus 2019–Februari 2020. Sebanyak 23 pasien hipertiroid baru ataupun dalam pengobatan hipertiroid dalam 3 bulan terakhir disertai dengan melasma direkrut dan diukur derajat keparahannya menggunakan mMASI dan dermoskopi. Pengukuran derajat keparahan diulang kembali setelah pasien menjalani pengobatan hipertiroid tiga bulan dan dibandingkan saat awal penelitian. Analisis statistik menggunakan software Stata versi 15.0Hasil: Sebanyak 45 dari 69 pasien hipertiroid yang berobat ke Poliklinik Ilmu Penyakit Dalam Divisi Metabolik-Endokrin RSUPN Dr. Cipto Mangunkusumo mengalami melasma. Nilai rerata skor mMASI pada awal penelitian adalah 7,08 (SB 3,88). Nilai rerata skor mMASI pada akhir penelitian adalah 5,59 (SB 3,11). Nilai rerata perbedaan mMASI sebelum dan sesudah pengobatan adalah 0,49 (p>0,05). Gambaran dermoskopi tidak menunjukkan adanya perbedaan antara awal dan akhir penelitianKesimpulan: Proporsi pasien melasma pada pasien hipertiroid di RSUPN Dr. Cipto Mangunkusumo adalah 65,22%. Tidak terdapat penurunan mMASI pada pasien hipertiroid dengan melasma sesudah pengobatan hipertiroid selama tiga bulan.

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Background: Melasma is an acquired and chronic disorder of hyperpigmentation characterized by symmetrical hypermelanoses of the face. The exact pathogenesis of melasma is still unknown. Several hormones are thought to play a role, including thyroid hormone. Although melasma is not life-threatening, it affects greatly on the quality of life of patients.

Objectives: To determine proportion of melasma cases in hyperthyroid patients and to compare severity of melasma before and after medications of three months hyperthyroid therapy using mMASI score.

Methods: An experimental (before and after) study was conducted in Jakarta in August 2019–February 2020. Twenty three newly-diagnosed hyperthryoid patients or had taken hyperthyroid medications of maximum 3 months with melasma were recruited. The severity of melasma were scored with mMASI and dermoscopy of the lesions were collected. The same procedures were done after 3 months of hyperthyroid therapy. The data collected was statistically analyzed using Stata version 15.0

Results: There were 45 out of 69 hyperthyroid patients, who went to the Internal Medicine Polyclinic of the Endocrine-Metabolic Division dr. Cipto Mangunkusumo hospital had melasma. The mean difference in mMASI before and after treatment was 0.49 (p> 0.05). Dermoscopy features didn’t show any difference between the start and end of the study.

Conclusion: The proportion of melasma patients in hyperthyroid patients in Dr. Cipto Mangunkusumo hospital is 65.22%. There was no significant decrease in mMASI in hyperthyroid patients with melasma after three months of hyperthyroid treatment."

"Salah satu peran sistem imunitas terhadap infeksi M.leprae adalah respons makrofag melalui interaksinya dengan vitamin D dan reseptor vitamin D (RVD). Interaksi vitamin D dengan RVD pada berbagai sel imun akan menstimulasi ekspresi katelisidin. Penelitian ini bertujuan untuk menganalisis kadar serum 25-hydroxyvitamin D (25(OH)D) dan kadar plasma RVD serta hubungannya dengan IB pada pasien kusta. Penelitian ini berupa observasional-analitik dengan desain potong lintang. Sebanyak 28 subjek penelitian (SP) menjalani pemeriksaan slit-skin smear kemudian diagnosis kusta ditegakkan berdasarkan tanda kardinal kusta. Penelitian ini juga menilai kecukupan pajanan matahari menggunakan kuesioner pajanan matahari mingguan. Kadar serum 25(OH)D diperiksa dengan metode chemiluminescent immunoassay (CLIA) dan kadar plasma RVD dilakukan dengan metode enzyme linked immunosorbent assay (ELISA). Median kadar serum 25(OH)D adalah 12,68 ng/ml (4,88 – 44,74). Median kadar plasma RVD adalah 1,36 ng/ml (0,26 – 8,04). Berdasarkan analisis regresi multivariat, tidak terdapat hubungan antara IB dengan kadar serum 25(OH)D dan kadar plasma RVD (R square = 0,055). Tedapat korelasi positif kuat antara kadar serum 25(OH)D dengan skor pajanan sinar matahari (r = 0,863; p < 0,001).

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One of many immunity system’s roles against M. leprae infection is macrophage response through its interaction with vitamin D and vitamin D receptor (VDR). The interaction between vitamin D and VDR in various immune cells will stimulate the expression of cathelicidin. The objective is to analyze the serum level of 25-hydroxyvitamin D₃ (25(OH)D) and plasma level of VDR as well as their association with IB in leprosy patients. This observational analytic study was performed with cross-sectional design. A total of 28 subjects underwent a slit-skin smear examination and then the diagnosis of leprosy was made based on the cardinal signs. This study also assessed the patient’s sun exposure with weekly sun exposure questionnaire. Serum 25(OH)D level was assessed with chemiluminescent immunoassay (CLIA) method and RVD plasma level was measured by enzyme linked immunosorbent assay (ELISA). Median serum level of 25(OH)D was 12.68 ng/ml (4.88 – 44.74). Median plasma level of VDR was 1.36 ng/ml (0.26 – 8.04). Based on multivariate regression analysis, there was no significant association between BI and serum level of 25(OH)D and plasma level of VDR (R square = 0.055). There was strong positive correlation between serum level of 25(OH)D and sun exposure score (r = 0.863; p < 0.001)."

"Pendahuluan: Berbagai modalitas terapi yang tersedia untuk melasma belum memberikan hasil yang memuaskan serta kekambuhan sering terjadi setelah terapi dihentikan. Asam traneksamat merupakan penghambat plasmin yang dapat mencegah melanogenesis. Beberpa studi telah membuktikan efek injeksi asam traneksamat (AT) intradermal sebagai terapi melasma, namun belum ada sebuah konsensus yang menentukan konsentrasi injeksi AT intradermal yang paling tepat dan efektif. Di Indonesia, belum pernah dilakukan uji klinis yang membandingkan efektivitas dan keamanan injeksi AT intradermal dengan konsentrsi yang berbeda untuk tata laksana melasma. Tujuan Penelitian: Membandingkan efektivitas dan keamanan injeksi AT intradermal konsentrasi 25 mg/ml dengan 10 mg/ml sebagai terapi ajuvan pada tata laksana melasma. Metodologi penelitian: Penelitian ini merupakan uji klinis acak terkontrol tersamar ganda dengan metode split-face. Sebanyak 30 subjek penelitian (SP) dirandomisasi untuk mendapatkan injeksi AT intradermal 25 mg/ml atau 10 mg/ml pada salah satu sisi wajah. Penelitian dilakukan selama 8 minggu dan terapi injeksi diberikan sejak minggu ke-2 dengan interval 2 minggu. Seluruh SP mendapatkan terapi krim tabir surya SPF 45 dan krim tretinoin 0,05% yang dioleskan sekali sehari malam hari selama 8 minggu. Penilaian skor MASI modifikasi (mMASI) dan pemeriksaan mexameter yang terdiri atas indeks melanin (IM) dan eritema (IE) dilakukan pada setiap kunjungan. Hasil penelitian: Terdapat 27 SP yang menyelesaikan penelitian dengan rerata usia 49,67 tahun dan sebagian besar memiliki melasma tipe campuran. Terdapat penurunan bermakna skor mMASI dan IM pada pemberian terapi ajuvan injeksi AT intradermal 25 mg/ml dan 10 mg/ml, namun besar dan kecepatan penurunan skor tersebut tidak berbeda bermakna pada konsentrasi 25 mg/ml dibandingkan dengan 10 mg/ml. Mayoritas SP tidak mengalami efek samping bermakna akibat injeksi AT. Kesimpulan: Terapi ajuvan injeksi AT intradermal 25 mg/ml dan 10 mg/ml efektif dan aman dalam menurunkan skor mMASI dan IM pada pasien melasma dengan tipe kulit Fitzpatrick IV dan V.

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Background: The various treatment modalities available for melasma have yet to provide satisfactory results, and recurrence often occurs after discontinued therapy. Tranexamic acid (TA), a plasmin inhibitor, can prevent melanogenesis. Several studies have demonstrated the effectiveness of intradermal injections of TA as a treatment for melasma. However, there is no consensus on the most appropriate and effective concentration for these injections. In Indonesia, no clinical trials have been conducted to compare the effectiveness and safety of intradermal TA injections at different concentrations to manage melasma. Research Objective: Comparing the effectiveness and safety of intradermal TA injections at 25 mg/ml and 10 mg/ml concentrations as adjuvant therapy for melasma. Methods: A double-blind, randomized controlled trial was performed with the split-face method. A total of 30 subjects were randomized to receive intradermal TA 25 mg/ml or 10 mg/ml either on the right or the left side of their face. The study research was conducted over eight weeks, with injection therapy administered starting from the second week at 2-week intervals. All subjects received SPF 45 sunscreen and 0.05% tretinoin cream for eight weeks. Assessment for modification MASI (mMASI) score and mexameter examination, which includes melanin index (MI) and erythema index (EI), were performed on every visit. Results: Twenty-seven subjects completed the study, with an average age of 49.67 years, and most had mixed-type melasma. There was a significant decrease in mMASI and MI scores with adjuvant therapy using 25 mg/ml and 10 mg/ml intradermal tranexamic acid injections. However, the score reduction did not significantly differ between the 25 mg/ml and 10 mg/ml concentrations. The majority of subjects did not experience significant side effects from the tranexamic acid injections. Conclusion: Adjuvant therapy with intradermal injection of TA 25 mg/ml and 10 mg/ml effectively and safely reduces the mMASI and MI scores in melasma patients with Fitzpatrick skin types IV and V."

"Hand eczema (HE) adalah peradangan kulit tangan yang umum terjadi pada pekerjaan tertentu, termasuk di pelayanan kesehatan. Insidensi HE pada tenaga medis meningkat di era pandemi Covid-19 akibat peningkatan praktik hand hygiene. Vitamin D merupakan salah satu vitamin larut lemak yang memiliki berbagai pengaruh terhadap kulit, khususnya pada kondisi inflamasi. Vitamin D berperan dalam proses proliferasi dan diferensiasi epidermis serta berkaitan dengan imunitas kulit dan penyembuhan luka. Kadar rendah vitamin D diduga berkaitan dengan HE dan derajat keparahannya. Penelitian ini bertujuan menganalisis korelasi antara derajat keparahan HE dan kadar vitamin D yang diukur dengan 25(OH)D serum pada tenaga medis di RSUPN Dr. Cipto Mangunkusumo (RSCM) Jakarta. Penelitian ini merupakan studi deskriptif analitik dengan desain potong lintang. Populasi target penelitian adalah tenaga medis RSCM dengan HE yang dipilih menggunakan metode consecutive sampling berdasarkan kriteria penerimaan dan penolakan. Penilaian keparahan HE dilakukan dengan instrumen Hand Eczema Severity Index (HECSI) dan pengukuran kadar 25(OH)D serum dilakukan dengan pengambilan darah vena perifer. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian. Nilai p<0,05 dianggap signifikan secara statistik. Di antara 44 sampel tenaga medis dengan HE, 29 orang mengalami HE ringan, 11 orang mengalami HE sedang, dan 4 orang mengalami HE berat. Rerata kadar 25(OH)D serum untuk seluruh SP adalah 17,50 ng/mL yang termasuk ke dalam kategori defisiensi vitamin D. Rerata kadar 25(OH)D serum pada SP dengan HE ringan adalah 17,85 ng/mL, pada HE sedang sebesar 16,45 ng/mL, dan pada HE berat sebesar 17,87 ng/mL. Tidak terdapat korelasi yang bermakna antara kadar 25(OH)D serum dengan derajat keparahan HE yang diukur dengan menggunakan HECSI (r = -0,056; p = 0,359). Pada hasil tambahan, tidak ditemukan korelasi bermakna antara skor HECSI dengan skor Dermatology Life Quality Index (DLQI) (r = 0,113; p = 0,232). Median kadar 25(OH)D serum pada SP dokter didapatkan lebih tinggi dibandingkan tenaga medis nondokter dengan nilai yang bermakna secara statistik (23,00 vs 14,00; p <0,001). Didapatkan pula rerata berat badan dan indeks massa tubuh (IMT) yang lebih tinggi pada kelompok SP dengan status vitamin D defisiensi dibandingkan nondefisiensi yang bermakna secara statistik (60,74 vs 55,00; p = 0,008 dan 23,74 vs 21,83; p = 0,014). Sebagai kesimpulan, tidak ditemukan korelasi yang bermakna antara kadar 25(OH)D serum dengan derajat keparahan HE pada tenaga medis.

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.Hand eczema (HE) is an inflammation of the skin of the hands that commonly occurs in certain occupations, including healthcare services. The incidence of HE in healthcare workers has increased in the era of the Covid-19 pandemic due to increased hand hygiene practices. Vitamin D is a fat-soluble vitamin that has various effects on the skin, especially in inflammatory conditions. Vitamin D plays a role in the process of proliferation and differentiation of the epidermis and is related to skin immunity and wound healing. Low levels of vitamin D are thought to be related to HE and its severity. This study aims to analyze the correlation between the severity of HE and vitamin D levels as measured by serum 25(OH)D in healthcare workers at RSUPN Dr. Cipto Mangunkusumo (RSCM) Jakarta. This is an analytic descriptive study with a cross-sectional design. The target population of the study were RSCM healthcare workers with HE who were selected using the consecutive sampling method based on acceptance and rejection criteria. Assessment of the severity of HE was carried out using the Hand Eczema Severity Index (HECSI) instrument and measurement of serum 25(OH)D levels was done by drawing peripheral venous blood. Appropriate statistical analyzes were performed to prove the research hypotheses. A p-value of <0.05 was considered statistically significant. Among the 44 samples of healthcare workers with HE, 29 people had mild HE, 11 people had moderate HE, and 4 people had severe HE. The mean serum 25(OH)D level for all subjects was 17.50 ng/mL which belonged in the vitamin D deficiency category. The mean serum 25(OH)D level in subjects with mild, moderate, and severe HE was 17.85 ng/mL, 16.45 ng/mL, and 17.87 ng/mL, respectively. There was no statistically significant correlation between serum 25(OH)D levels and HE severity measured using HECSI (r = -0.056; p = 0.359). In additional results, no significant correlation was found between the HECSI score and the Dermatology Life Quality Index (DLQI) score (r = 0.113; p = 0.232). The median level of serum 25(OH)D among physicians was found to be higher than non-physicians healthcare workers with a statistically significant value (23.00 vs 14.00; p <0.001). The average body weight and body mass index (BMI) were also found to be higher in the subject group with vitamin D deficiency status compared to non-deficiency which was statistically significant (60.74 vs 55.00; p = 0.008 and 23.74 vs 21.83; p = 0.014). In conclusion, no statistically significant correlation was found between serum 25(OH)D levels and the severity of HE among healthcare workers as measured by HECSI."