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5/2/2011

Treatment
Suncreen
Phenol 40%
Disorders of Pigmentation Laser Photoselective

David Sudarto Oeiria,


Spesialis Kulit & Kelamin ,
Konsultan Bedah Kulit Kosmetik
Dermatologist(JPN)
Plastic Surgeon(JPN)

Disorders of Pigmentation Melasma


Hyperpigmentation Synonym: chloasma/ mask of pregnancy
-Freckles
-Melasma Acquired hypermelanosis : face
-Caf-au-lait spots No sign of inflammation
-Lentiginosis
-Lentigo Senilis Symmetry, forehead, malar, nose, skin
-Post Inflammatory hyperpigmentation above the upperlip and chin
Hypopigmentation Genetically predisposition, pregnancy or
-Vitiligo
-Post inflammatory Hypopigmentation
oral contraceptive
-Piebaldism

Freckles Aetiology
Synonym: Ephelides UV exposure
Small light brown macules on the sun Hormonal : Estrogen, Progesteron and MSH,
Oral contraceptive and pregnancy
exposed skin
Genetic predisposition
Face, arm and back
Race
Autosomal dominant trait Cosmetic : coloring, parfum or others that cause
photosensitivity
Medication:Cytostatic etc
Idiopathic

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5/2/2011

Clinical Classification Caf-au-lait spots


Centro-facial (63%) : forehead, nose, Pale brown Macules that varies in size from 0.5-
medial side of cheek and chin 20 cm
Found in any cutaneous surface
Malar (21%) : Nose and lateral side of
cheek May present at birth, increase in number and
size with age
Mandibular (16%): mandibular region Children older than 5 years, have 6 or more
macules bigger than 1.5 cm are presumptive
evidence of Neurofibromatosis
Do not response with Hydroquinone

FACTS Caf-au-lait spots


Increase number and activity of
melanocyte in the epidermis
Increase number of melanophages in the
dermis
Type : epidermal, Dermal and mixed type
The epidermal type response to topical
depigmentating agents

Treatment LEOPARD SYNDROME


Avoid Sun exposure L entigines
Use sunscreen E kg abnormality
O cular defect
Depigmenting agents : Hydroquinone2-4%
P ulmonary stenosis
alone or combination with Tretinoin,
Azelaic Acid A bnormal genitalia
R etarded growth
Chemical Peeling
D eafness-sensory
Many case respons well to I2PL, second
generation IPL

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5/2/2011

LEOPARD SYNDROME Lentigo Senilis


L entigines
E kg abnormality
O cular defect
P pulmonary stenosis
A bnormal genitalia
R etarded growth
D eafness-sensory

Lentigo Senilis Lentigo Senilis


Brown macular spot on the chronic sun
exposed skin (photo aging skin) Cryotherapy
Do biopsy on the Irregular pigmentation,
highly irregular border, localized increase
in pigmentation lentigo senilis to rule out
Lentigo Maligna. Laser Photoselective thermolysis

Post inflammatory
Lentigo Senilis
Is a solar lentigine, due to excessive sun exposure
Hyperpigmentation

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5/2/2011

Post inflammatory
Penyebab Vitiligo
Hyperpigmentation
Genetic
TREATMENT: Auto antibody, auto toxicity :
-Sun avoidance seringkali berkaitan dengan penyakit
-Costicosteroid Topical. autoimun seperti
Hashimotos disease,
Graves disease,
anemia pernisiosa,
Addisons disease

Klasifikasi Vitiligo berdasarkan


VITILIGO
area yg terkena
Acquired loss of pigmentation, absence of lokalisata :
Epidermal melanocyte fokal
Cause: Not Clear, May have autoantibody segmental : dermatomal
against melanocyte. mukosal : bibir, anogenital
Many have family history generalisata
akro-facial
vulgaris

Vitiligo VITILIGO segmental


Macula atau patch
depigmentasi
(berwarna putih
gading) yang timbul
secara tiba-tiba dan
biasanya melebar
Patogenesa :
penghancuran
melanosit

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5/2/2011

Post Inflammatory
VITILIGO Tx:Melanocyte
Hypopigmentation Transplantation

PUVA 1-2 kali sebulan, Kdg 1 kali


Piebaldism
dalam 2 bulan, total 5 kali
Congenital
Autosomal Dominant
They are sisters
Genodermatosis
Partial or localized
albinism

VITILIGO Caf Au Lait Macules


Treatment tanda lahir yang
berupa bercak/patch
- PUVA yang berwarna seperti
kopi susu
- Narrow band UVB
identifikasi adanya
- Normal UVB neurofibromatosis
(bila terdapat 6 atau
- Ecximer laser lebih caf au lait
- Systemic Steroid in rapid progression case macules)
Penatalaksanaan :
- Melanocyte grafting dibiarkan

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