Efektifitas Astaxanthin Oral Disertai Gel Astaxanthin Dibandingkan dengan Astaxanthin Oral Disertai Krim Triple Combination (Hidrokuinon 4%, Tretinoin 0,05%, Fluosinolon Asetonid 0,01%,) dalam Pengobatan Melasma

Abstract

Background : Melasma is a common acquired symmetrical hypermelanosis that occurs on sun-exposed facial areas. Melasma is frequently observed among women. Many modalities of treatment are available but none is satisfactory. Aim : To compare the efficacy and safety of oral astaxanthin combined with astaxanthin gel and oral astaxanthin combined with triple combination cream in the treatment of melasma. Subject and methods : A double blind, randomize, clinical trial design study was conducted from January to May 2011, 54 female patient with epidermal melasma were divided into two groups of 27 each. One group received oral astaxanthin (once daily) combined with a topical astaxanthin (twice daily). The other, a control group, received oral astaxanthin (once daily) combined with a topical triple combination (once daily) for 8 weeks. Evaluation include static global severity assessment (Melasma Severity Scale), Melasma Area and Severity Index (MASI) score, and adverse event. Results : Oral astaxanthin combined with astaxanthin gel was significantly more effective than oral astaxanthin combined with triple combination cream week 4 onwards: lesion were approximately equivalent to the surrounding skin in 23,1% of all oral astaxanthin combined astaxanthin gel, compared to 16,7% of those who used oral astaxanthin combined with triple combination cream (p=0,014). All 54 patients showed marked improvement, as calculated by the MASI score before and after treatment, and the response was highly statistically significant (p=0,0001). Adverse events were observed on oral astaxanthin combined with triple combination cream (22/24, 91,7%). Conclusion : Oral astaxanthin combined with astaxanthin gel was more effective than oral astaxanthin combined with triple combination cream and safe agent in the treatment of melasma.

Latar belakang : Melasma merupakan suatu penyakit kulit hipermelanosis, didapat, dan letaknya simetris pada daerah yang sering terpapar sinar matahari, terutama wajah. Melasma sering ditemukan pada wanita. Banyak modalitas terapi yang ada akan tetapi tidak satupun memberikan hasil pengobatan yang memuaskan. Tujuan : Mengetahui perbedaan efektifitas pemberian astaxanthin oral disertai gel astaxanthin dibandingkan astaxanthin oral disertai krim triple combination terhadap pasien melasma. Subyek dan metode : Penelitian bersifat uji klinis, acak, tersamar ganda. Penelitian dilaksanakan pada bulan Januari – Mei 2011, melibatkan 27 orang penderita melasma yang diobati dengan astaxanthin oral (sekali sehari) disertai gel astaxanthin (dua kali sehari) sebagai kelompok terapi dan 27 orang penderita melasma yang diobati dengan astaxanthin oral (sekali sehari) disertai krim triple combination (sekali sehari) sebagai kelompok kontrol, pengobatan diberikan selama 8 minggu. Terhadap subyek penelitian dilakukan penilaian derajat keparahan melasma (Melasma Severity Scale), pengukuran skor Melasma Area and Severity Index (MASI) dan efek samping obat. Hasil : Astaxanthin oral disertai gel astaxanthin secara statistik lebih efektif bermakna dibandingkan astaxanthin oral disertai krim triple combination dimana lesi melasma hampir sama dengan warna kulit disekitarnya setelah 4 minggu kedepan ditemukan sebanyak 23,1% pada kelompok terapi, dibandingkan 16,7% pada kelompok kontrol (p=0,014). Penurunan skor MASI baik kelompok terapi maupun kelompok kontrol yang diukur mulai mulai minggu ke 0 samping minggu ke 8 secara statistik bermakna (p=0,0001). Efek samping hanya ditemukan pada kelompok kontrol (22/24, 91,7%). Kesimpulan : Astaxanthin oral disertai gel astaxanthin lebih efektif dan aman dibandingkan astaxanthin oral disertai krim triple combination dalam pengobatan melasma.