Efloresensi Polimorfik dan

Kelainan Pigmentasi
Dr. dr. Linda J Wijayadi Sp.KK FINSDV
MILIARIA
MILIARIA
DEFINITION

• SKIN ABNORMALITY
• SWEAT RETENTION
• MILIARIA VESICLE

Miliaria kristalina
Miliaria rubra
Miliaria profunda
1. Miliaria kristalina
• Predilection : Body
• >> due to blockage at sweat gland
( Heat Rash )
• (-) No Complaint

Therapy

• Avoid Excessive heat

• Cooling Clothing
 2. Miliaria rubra
Predilection : Body that have direct
contact with clothing
Main Problem : Itchy and pain
Lesion : papul eritema / papul
vesikuler ekstra folikuler
PA : vesikel at stratum spinosum

Therapy :
Bedak salisil 2% + mentol ¼ - 2 %
Lotio Faberi
3. Miliaria profunda
Very rare in tropical area
Predilection : Extremity
Complaint : None
Lesion : papul putih 1-3 mm,
keras,

Therapy :
Good Ventilation
Lotio calamin
Vitiligo
What is vitiligo?
1.Vitiligo is a condition that

causes depigmentation of

patches of skin. It occurs

when melanocytes (the cells

responsible for skin

pigmentation) die or are

unable to function.

2.Vitiligo is also called white spot

disease and leukoderma.

What causes vitiligo?
The cause of vitiligo is unknown, but research suggests that it may arise from autoimmune, genetic, oxidative
stress, neural, or vital causes.

Tanning also causes vitiligo!

Signs and Symptoms

The main sign of vitiligo is pigment loss

that produces milky-white patches on
your skin.

Other less common signs include:

-Premature whitening or graying of
the hair on your scalp, eyelashes, eyebrows or
beard.
-Loss of color in the tissues that
line the inside of your mouth (mucous
membranes).
-Loss or change in the color of the
inner layer of your eye (retina).
 Current treatments
• Puvatherapy (psoralen + UVA) no longer used (known carcinogenic
risk)
• UVB narrow band
• For 10 years: unknown risk cancer
• Topical treatments
• Tacrolimus (off label)
• Corticoïd
• Surgery: too invasive technique
• If spot entirely healed, no relapsing
Acne
Definition:
Is a chronic inflammatory disorder of the pilosebaceous apparatus of
certain body area (Face> Torso > rarely the Buttocks), resulting in
greasiness and polymorphic skin eruption.
 Etiology:
1. Genetic Aspect, (Acne runs in
family) other example: the case of
severe acne that is associated with
XXY syndrome.
2. Occupation (Environmental,
Mechanical) e.g. exposure to
acnegenic mineral oil (Pomade
acne), dioxin
3. Drugs Oral and topical
Hydrocortison (Steroid acne),
Lithium, Hydantoin, contraceptives
4. Endocrine Factors (Recalcitrant
Acne, POD/s, MARSH Syndrome) .
Perifollicular Hyperkeratosis
histology
P acne is a potent activator of complement via
classical pathway
Propionobacterium acne lipases act on
sebaceous fatty acid (Triglycrides) to
release irritant free fatty acid and low-
molecular- weight peptide an extra cellular
factor that penetrate the follicular wall and
stimulate Polymorphs and Lymphocytes
initiating inflammation
Open Comedones (Blackheads)

Open Comedones
Closed Comedones (Whitehead)

Closed Comedones
• Inflammatory papules

Inflammatory papules
• Pustules :

Pustules
• Nodule (more than 0.5 cm)

Nodule
• Cystic acne: the cysts are usually large 1-4cm
Topical Keratolytic

• Retinoid ( Retinoic acid 0.025, 0.05,

0.1%)
• Adapalene (Differin 0.1%)
• Salicylic acid
• Benzoyl peroxide (peeling agent and
antimicrobial)
• Azelaic Acid (10, 15, 20 %)
Topical Antibiotic

• Topical clindamycin (Dalacin T)

• Erythromycin
• Mupirocin (Bactroban)
• Sodium Fusidic acid (less
significant in the treatment)
Systemic therapy

• Antibiotic (Macrolides and

Tetracylines)
1. Tetracycline
2. Doxycycline
3. Minocycline (blue grey
discoloration and drug induced
LE)
4. Azithromycin
• Systemic Retinoids :

 Isotretinoin caps (Roaccutane): 0.5 – 1 mg/kg

 The most effective drug for acne.
 Indicated for severe forms (nodulocystic and
fulminant) but also for milder forms associated
with scarring or with significant psychological
impact.
Pityriasis Alba
• Pityriasis alba is an eczematous
dermatosis characterized by
patchy hypopigmentation.
• It is usually seen in children, and is
most noticeable in those with
darkly pigmented skin
• The history will usually reveal
worsening during the summer
• Lesions are usually asymptomatic,
although they can be slightly
pruritic.
• Physical examination :
• Multiple
• 0.5-5–cm
• ill-defined
• finely scaling patches that are
symmetrically distributed.
• found on the face (especially the
cheeks)
• They may be slightly
erythematous early on, then
become hypopigmented.
• Lesions may persist for months to
years, with a chronic relapsing
course, but eventually resolve
spontaneously.
 Woods lamp
• PA
• potassium hydroxide (KOH) preparation
• A punch biopsy

Medical Treatment Physical Modalities

Topical corticosteroids Phototherapy (PUVA)

Tacrolimus 0.1% ointment

Pimecrolimus 1% cream

Topical tretinoin
 Hiperpigmentation and
Hypopigmentation
Melasma

Lentigo

Hyperpigmentation
Iatrogenic Pregnancy mask
hyperpigmentation

Post-acneic or
cicatricial
hyperpigmentation

Hypopigmentation Vitiligo

Vitiligo
 Hyperpigmentation disorders
• Unknown etiologic origin
• High prevalence
• Lentigo: 90% of the population over 70
• Melasma (chloasma): 8.8% of the latino american women
• Alter people’s quality of life

hyperactivation
of the melanin
melanocytes

• Melasma: reemergence of the lesions as soon as the

first exposition to the sunlight
 Melasma

Lentigo
Current treatments
• Old bleaching agents
• Hydroquinone (tyrosinase inhibitor)
• Azelaic acid
• Corticoïd

• Associated with « peeling » / dermabrasion

products
• Vitamin A
• Glycolic acid

• Best treatment: Kligman trio

• Corticoïd (dexamethasone)
• Hydroquinone
• Retinoic acid
 Current treatments (continued)
• Satisfying BUT: - unconstant treatment
- local treatment very long
- numerous Adverse Events : irritation
(hydroquinone (5%), retinoic acid)

• Depigmenting duo: hydroquinone corticoid (hydrocortisone)

less irritant BUT less effective

• => B/R ratio NOT acceptable for skin disorders

• 1st TREATMENT= SOLAR PROTECTION!!!

DERMATITIS
Types of Dermatitis
- Atopic Dermatitis
- Contact dermatitis ( Irritant and Allergy)
- Numularis
- Neurodermatitis / Lichen simplex chronicus
- Perioral Dermatitis
- Stasis Dermatitis
- Napkin Dermatitis
- Perioral Dermatitis