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"Avian influenza A (H5N1), or highly pathogenic avian influenza (HPAI), has become the world's attention because of possibility of global pandemic. This review describes the features of human infection, pathogenesis, transmission, and clinical management of avian influenza A (H5N1)."

"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."

"Latar belakang: Melasma merupakan kelainan hiperpigmentasi didapat yangdisebabkan disfungsi melanogenesis, berupa makula coklat kehitaman simetris,terutama mengenai area wajah. Patogenesis melasma belum diketahui dengan jelas,beberapa faktor yang diduga berperan, di antaranya disfungsi tiroid dan defisiensi seng.Tujuan: Mengetahui kadar seng serum pada pasien melasma dan nonmelasma dengandan tanpa disfungsi tiroid.Metode: Sebuah penelitian dengan desain potong lintang dilakukan di Jakarta padaSeptember-Desember 2019. Terdapat 60 pasien melasma dan 60 pasien nonmelasma.Kedua kelompok dilakukan matching usia dan jenis kelamin. Atomic absorptionspectrophotometry digunakan untuk mengukur kadar seng serum. Laboratorium darahuntuk memeriksa fungsi tiroid (TSH dan FT4). Analisis statistik menggunakan softwareSPSS.Hasil: Rerata kadar seng serum pada kelompok melasma 10,25±1,89 μmol/L dannonmelasma adalah 10,29±1,46 μmol/L (p <0,901). Rerata kadar seng serum padapasien melasma dengan disfungsi tiroid 8,77±0,69, melasma tanpa disfungsi tiroid10,33±1,89, nonmelasma dengan disfungsi tiroid 10,48±2,4, dan nonmelasma tanpadisfungsi tiroid 10,27±1,4 (p <0,184).Kesimpulan: Tidak didapatkan perbedaan bermakna antara kadar seng serum padakelompok melasma dan nonmelasma dengan dan tanpa disfungsi tiroid.

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Background: Melasma is an acquired hyperpigmentation disorder, clinically as

asymmetrical blackish brown macules, especially on the facial area. Several factors are

thought to play a role, including thyroid dysfunction and zinc deficiency.

Objective: To determine serum zinc levels in melasma and non-melasma patients with

and without thyroid dysfunction.

Methods: A cross-sectional study was conducted in Jakarta in September-December

2019. There were 60 melasma patients and 60 non-melasma patients. The two groups

were matched for age and sex. Atomic absorption spectrophotometry was used to

measure serum zinc levels. Blood laboratory was used to check thyroid function (TSH

and FT4). Statistical analysis was done by SPSS software.

Results: The mean serum zinc level in the melasma group was 10.25 ± 1.89 μmol / L

and non-melasma was 10.29 ± 1.46 μmol / L (p <0.901). The mean serum zinc level in

melasma patients with thyroid dysfunction was 8.77 ± 0.69, melasma without thyroid

dysfunction 10.33 ± 1.89, non-melasma with thyroid dysfunction 10.48 ± 2.4, and nonmelasma

without thyroid dysfunction 10.27 ± 1.4 (p <0.184).

Conclusions: There was no significant difference between serum zinc levels in the

melasma and non-melasma groups with and without thyroid dysfunction."

"Latar belakang: Melasma adalah kelainan kulit hiperpigmentasi simetris, didapat, umumnya ditandai oleh makula coklat hingga coklat gelap pada daerah kulit yang terpajan sinar matahari. Patogenesis melasma masih belum diketahui dengan jelas. Berdasarkan perkembangan terkini, interaksi antara vaskularisasi kulit dan melanosit diduga memiliki peranan pada lesi melasma. Tujuan: Untuk megetahui proporsi telangiektasis pada pasien melasma dan menilai korelasi skor telangiektasis dengan derajat keparahan pigmentasi lesi melasma. Metode: Sejumlah 48 wanita dengan melasma diikutsertakan apada penelitian observasional potong lintang ini. Mereka dipilih berdasarkan metode consecutive sampling. Wajah dari masing-masing subyek penelitian (SP) diperiksa dan kemudian dibagi dalam 4 area: dahi, malar kiri, malar kanan, dan dagu. Keparahan pigmentasi lesi melasma dievaluasi menggunakan skor pigmentasi berdasarkan Melasma Area and Severity Index (MASI). Skor telagiektasis dinilai menggunakan 5-point dermoscopic scale yang telah tervalidasi, dengan bantuan alat dermoskopi. Analisis statistik dilakukan untuk menilai hubungan antara skor telangiektasis dengan derajat keparahan pigmentasi lesi melasma. Hasil: Dengan bantuan dermoskopi, ditemukan telangiektasis pada 35,4% (n=17/48) SP. Dari total 192 area wajah yang diperiksa, 124(64,5%) di antaranya memilik lesi pigmentasi. Derajat pigmentasi 1 sejumlah 64,8%, derajat 2 sebanyak 26,4%, dan derajat 3 sejumlah 8,8%. Dari 124 lesi pigmentasi didapatkan 29(23,3%) lesi dengan telangiektasis. Skor telangiektasis 1 pada 7,2% lesi, skor 2 pada 13,6% lesi, dan skor 3 pada 2,4% lesi pigmentasi. Berdasarkan analisis statistik, terdapat korelasi positif bermakna antara derajat pigmentasi dengan skor telangiektasis melasma (r = 0.474, p < 0.0001).

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Background: Melasma is a common acquired symmetrical hypermelanosis characterized by irregular light to dark brown macules and patches on sun-exposed areas of the skin. The pathogenesis of melasma is still poorly understood. Recently, interaction between skin vascularity and melanocytes has been proposed to have influence in melasma pigmentation.

Purpose: To investigate the proportion of telangiectases in melasma and its correlation with pigmentation severity of melasma.

Methods: A total of 48 woman with melasma were included in this cross-sectional observational study. They were selected based of consecutive sampling method. The face of each subject were examined and divided into 4 regions: forehead, left malar, right malar, and chin area. Pigmentation severity of facial melasma skin was evaluated using the pigmentation score of Melasma Area and Severity Index (MASI). Telangictases score was assessed using a validated 5-point dermoscopic scale with the aid of a hand-held noncontact polarized dermoscope. Statistical analyses were performed to assess the association between pigmentation severity and telangiectases score.

Results: Using dermoscope, we found telangiectases with various severity in 35.4%(n=17/48) of the subjects. Of the total 192 facial areas examined, 124(64,5%) of which, have melasma pigmentation. The percentage of pigmentation degree is 64,8% for grade 1, 26,4% for grade 2, dan 8,8% for grade 3. Of these area with pigmentation, 29(23,3%) had telangiectases. Telangiectases score of 1, 2, and 3 present in 7,2%, 13,6%, dan 2,4% of pigmentation lesion, respectively. There was significant relationship between telangiectases and pigmentation in melasma, as increased pigmentation was correlated modestly with telangiectases score (r = 0.474, p < 0.0001)."

"Latar Belakang: saat ini belum ada kuesioner yang dapat dipakai untuk menilai kualitas hidup pasien melasma perempuan di Indonesia. Penelitian ini bertujuan untuk mengadaptasi kuesioner spesifik berbahasa Inggris yaitu MELASQOL dan menilai kesahihan dan keandalan kuesioner hasil adaptasi tersebut. Tujuan: penelitian ini bermaksud mendapatkan kuesioner MELASQOL berbahasa Indonesia yang diadaptasi dari kuesioner MELASQOL berbahasa Inggris untuk menilai kualitas hidup pasien melasma perempuan di Indonesia. Metode: rancangan studi menggunakan potong lintang. Penelitian ini dibagi menjadi dua tahap, tahap awal adaptasi lintas budaya dan bahasa dan tahap akhir uji kesahihan dan keandalan. MELASQOL asli berbahasa Inggris diadaptasi ke dalam bahasa Indonesia dengan mengikuti pedoman adaptasi lintas budaya dan bahasa. Pengambilan subjek penelitian dilakukan di Poliklinik Kulit dan Kelamin Rumah Sakit Dr. Cipto Mangunkusumo Indonesia dan di sebuah pabrik di Tangerang. Analisa kesahihan menggunakan kesahihan konstruksi dan keandalan menggunakan konsistensi internal dengan Cronbach ?. Hasil: tahap awal diperoleh 30 subjek penelitian dan tahap akhir 32 subjek penelitian. Hasil uji kesahihan MELASQOL berbahasa Indonesia dengan nilai koefisien korelasi setiap pertanyaan dengan skor total adalah 0,712-0,935. Hasil uji keandalan MELASQOL berbahasa Indonesia diperoleh Cronbach ? total 0,962 Simpulan: MELASQOL berbahasa Indonesia merupakan kuesioner yang valid dan reliabel untuk menilai kualitas hidup pasien melasma perempuan di IndonesiaKata kunci: MELASQOL, bahasa Indonesia, kualitas hidup, kesahihan, keandalan.

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Background Until now, there is no questionnaire that are used to assess the quality of life women with melasma. The aim of this study to adapt english questionnaire, MELASQOL, and to assess validity and reliability of adaptation questionnaire.Objective This study aims to obtain an Indonesia MELASQOL questionnaire adapted from English MELASQOL questionnaire to assess the quality of life female patient with melisma in Indonesia. Method design of this study used cross sectional. There are two stage, the initial stage is cross cultural and language adaptation. The final stage are validity and reliability test. The original MELASQOL questionnaire in English is adapted into bahasa Indonesia by according cross cultural and language adaptation guideline. The research subjects from Dr. Cipto Mangunkusumo hospital and factory in Tangerang. Validity analysis used construct validity. Internal consistency using Cronbach were used for reliability analysis. Results the initial stage administered 30 research subjects and final stage 32 research subjects. Validity of MELASQOL bahasa Indonesia with analysis item total score correlation coefficient is 0,712 0,935. Reliability of this quetionnaire with Cronbach score is 0,962.Conclusion MELASQOL bahasa Indonesia is a valid and reliable instrumen for assessing the quality of life of female melasma patients in Indonesia.Keywords MELASQOL, bahasa Indonesia, quality of life, validity, reliability."

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Latar Belakang: Melasma merupakan bercak hiperpigmentasi yang sebagian besar terdapat pada wajah. Penelitian sebelumnya menunjukkan bahwa kadar hormon tiroid secara bermakna lebih tinggi pada pasien melasma. Akan tetapi, belum terdapat penelitian yang menjelaskan perbedaan kadar hormon tiroid pada gradasi derajat keparahan melasma.

Tujuan: Mengetahui perbandingan kadar hormone tiroid pada derajat melasma yang berbeda yaitu pada melasma ringan atau sedang-berat yang dinilai dengan mMASI dan Janus II facial analysis system.

Metode: Empat puluh delapan perempuan disertakan sebagai subjek penelitian potong lintang ini. Sampel dipilih menggunakan metode consecutive sampling. Subjek dinilai derajat keparahan melasma secara subjektif menggunakan skor mMASI di Poliklinik Kulit dan Kelamin RSUPN Cipto Mangunkusumo setelah diagnosis ditegakkan. Pemeriksaan dikonfirmasi menggunakan alat Janus II facial analysis system di RSPAD Gatot Subroto. Subjek penelitian kemudian diperiksa hormon tiroid FT4 dan TSH.

Hasil: Berdasarkan skor mMASI, 24 pasien (50%) didiagnosis sebagai melasma derajat ringan dan 24 pasien (50%) didiagnosis sebagai melasma derajat sedang. Sebanyak 2 pasien (4%) juga didiagnosis dengan hipertiroid subklinis dan 1 pasien (2%) didiagnosis dengan hipotiroid subklinis. Tidak ditemukan hubungan yang bermakna antara derajat melasma berdasarkan mMASI dengan kadar TSH dan FT4 serum. Pemeriksaan Janus menggunakan modalitas cahaya polarisasi memiliki korelasi positif dengan kadar FT4 serum (r = 0,3, p = 0,039) dan skor mMASI (r = 0,314, p = 0,03).

Kesimpulan: Tidak terdapat perbedaan kadar TSH serum antar berbagai derajat melasma berdasarkan penilaian mMASI dan Janus II facial analysis system. Kadar FT4 serum memiliki korelasi positif dengan hasil penilaian Janus II facial analysis system menggunakan modalitas cahaya polarisasi.

 

 

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Background:

Melasma is characterized by hypermelanosis manifested mostly on facial area. Previous studies have shown that thyroid hormone level was significantly higher in melasma patient. However, no studies has defined comparison of thyroid hormone level on varying severity of melasma yet.

Aim

To study comparison of thyroid hormone level across varying severity of melasma, between mild and moderate-severe melasma, evaluated using mMASI and Janus II facial analysis system.

Metode:

Forty eight women included in this cross-sectional study. Samples were included using consecutive sampling method. The severity of melasma was measured subjectively using mMASI score in Dermatology and Venereology Outpatient Clinic of Cipto Mangunkusumo General National Hospital after the diagnosis of melasma has been made. The measurement was confirmed using Janus II facial analysis system in Gatot Subroto General Army Hospital. Lastly, we measured the level of FT4 and TSH of each patients.

Results:

Based on mMASI score, 24 patients (50%) were diagnosed as mild melasma and 24 patients (50%) were diagnosed as moderate-severe melasma. As many as two patients (4%) were also diagnosed with subclinical hyperthyroidism and one patient (2%) with subclinical hypothyroidism. There is no assosciation between severity of melasma and level of TSH and FT4. Janus examination using polarisasi light modalities has weak positive correlation with level of FT4 (r = 0,3, p – 0,039) and darkness score of mMASI (r = 0,3, p = 0,03).

Conclusion:

There is no association between TSH and varying severity of melasma. Using mMASI and Janus. FT4 level has weak positive correlation with Janus facial analysis system examiniton results on polarisasi light modalities.

 

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"Melasma merupakan penyakit pigmentasi wajah yang menimbulkan hendaya psikososial. Penurunan kualitas hidup pasien tidak selalu terbukti berkorelasi dengan keparahan klinisnya. MELASQoL-INA adalah instrumen evaluasi kualitas hidup pasien melasma adaptasi Bahasa Indonesia yang tervalidasi, sedangkan modified melasma severity index (mMASI) adalah skoring derajat keparahan melasma. Penelitian ini bertujuan untuk mengetahui apakah perbaikan derajat keparahan melasma pascaterapi krim triple combination (flucinolon acetonide 0,01%, hydroquinone 4%, dan tretinoin 0,05%) berkorelasi dengan peningkatan kualitas hidup. Subjek dengan melasma menjalani terapi krim triple combination selama 12 minggu dalam penelitian one group pretest-posttest. Skor MELASQoL-INA dan mMASI dinilai setiap 4 minggu. Tiga puluh perempuan berusia 30-60 tahun, bertipe kulit IV atau V, tanpa penyakit kulit lain di wajah, menyelesaikan seluruh rangkaian penelitian. Pada kunjungan awal, median skor mMASI dan MELASQoL-INA adalah 4,45 (1,3–13,9) dan 37 (10-70). Pada minggu ke-12 terjadi penurunan median skor mMASI menjadi 1,80 (0,60-6,30; p<0,001) dan skor MELASQoL-INA menjadi 17 (10-59; p<0,001). Skor mMASI pascaterapi tidak terbukti berkorelasi dengan skor MELASQoL-INA (r=0,029; p=0,879), namun perbaikan skor mMASI terbukti berkorelasi positif lemah dengan perbaikan skor MELASQoL-INA (r=0,397; p=0,03). Terapi krim triple combination selama 12 minggu memperbaiki keparahan melasma dan kualitas hidup pasien secara bermakna. Terdapat korelasi bermakna antara perubahan skor keduanya.

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Melasma is a common facial pigmentary disorder. Despite causing psychosocial distress, the reduced quality of life (QoL) was not consistently shown to correlate with clinical severity. MELASQoL-INA is a validated instrument adapted into Indonesian for evaluating the QoL of melasma patient, while modified melasma area and severity index (mMASI) was a tool for assessing melasma severity. Aim: To determine if clinical improvement after triple combination cream therapy (flucinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%) correlated with increased QoL. Subjects with melasma were treated with triple combination cream for 12 weeks in a one-group pretest-posttest study. MELASQoL-INA and mMASI assessments were carried out every 4 weeks. Thirty females aged 30-60 year-old, skin type IV or V, and devoid of other facial skin problems had completed the study. At the initial visit the median of mMASI and MELASQoL-INA score were 4.45 (1.3–13.9) and 37 (10–70). At week-12, the median of mMASI score was reduced to 1.80 (0.60-6.30; p<0.001) and MELASQoL-INA score to 17 (10-59; p<0.001). While there was no correlation between posttreatment mMASI and MELASQoL-INA scores (r=0.029; p=0.879), a weak positive correlation was found between the change of mMASI and MELASQoL-INA scores (r=0.397; p=0.03). Twelve-week course of triple combination cream alleviated melasma severity and patient’s quality of life significantly. There was a significant, but weak, correlation between the improvement in severity and quality of life."