KULIT

By: dr. Anna Linda Siagian, Dipl. CIBTACT

Fakta Kulit

Organ terbesar tubuh

Berat 16 -20% dari BB , luas permukaan 1,8-2 m2
Tubuh kehilangan air 1L per hari
Tebal 1-4 mm (variasi)dalam 1tubuh
Typically ,one square centimetre of skin contains:
3,000,000 cells of different types ,3 blood
vessels ,10 hairs ,12 nerves ,15 sebaceous
glands(minyak) ,199 sudiferous glands( keringat )
Terdiri dari bagian :Epidermis, dermis,hipodermis
KETEBALAN EPIDERMIS, DERMIS,HIPODERMIS
BERBEDA TIAP BAGIAN EPI PLG TEBAL
DITELAPAK KAKI, DERMIS PLG TEBAL DI
PUNGGUNG

FUNGSI KULIT

Fungsi pertahanan
Pengaturan suhu tubuh
Fungsi persepsi
Fungsi absorbsi
Fungsi ekskresi
Keratinisasi
Pembentukan pigmen
Pembentukan vit D
Sweat production
Sebum production

Cara Pandang Kulit

A. Skin Featuring
str. Corneum/corneosit (hexagonal atau pentagonal)
Di dalam korneosit di stratum corneum inilah terdapat
NMF (Natural Moisturising Factor)
NMF terdiri dari amino acid, PCA (pyrolidone Carboxyclic
Acid), Laktat, Urea
skin surface lipid film (acid mantle) gabungan
produksi kelenjar minyak, keringat dan emulsifier
berupa minyak yang dihasilkan oleh celah sel korneosit
untuk memperbaiki acid mantle ini diperlukan :
ceramide, omega 3, niacinamide dan lactic acid.
fine wrinkle
hair (hair folikel & valous hair/terminal hair)

Anatomy kulit

B. Skin Layer
Epidermis
Corneum
Lucidum
Granulosum
Spinosum
Basale

Dermis
Hipodermis

C. Cellular Level / Skin Sel

Berdasarkan sel_sel hidup di:
a. epidermis

Sel keratosit (merupakan komponen utama

epidermis)
Dalam proliferasi dan diferensiasinya keratosit
melibatkan : Ca, phospor, retinol dan aktivasi
vitamin D
Diantara keratosit terdapat lipid bilayer yang
terdiri dari :
Ceramide (terdapat 22 jenis ceramide, namun pada

dry skin yang sering hilang adalah ceramide 3)

fatty acid
kolesterol
trigliserid

Melanosit (memiliki tentakel / dendrit)

Langerhans (menyerupai star cell)
Marker cell

b. dermis
Fibroblas (merupakann komponen utama
dermis)
Endotel vaskular
Mast cell
histiosit

c. hipodermis
Adiposa
Fibroblas hipositik
Endotel vaskular

Lapisan Epi

Dermis

Hipo

Fungsi

Proteksi

Penunjang

Isolator

Komponen
Utama

Keratin

Colagen

Lemak

PH

4,5 6,5

7,1 7,3

Tebal

0,3 mm

3,5 mm

Variatif

Kandungan
Air
Pembuluh
darah

10 25 %

60 70 %

>>

Glands

Keringat &
sebacceus

Pengaruh tiap lapisan kulit

akan membentuk

Epidermis = Warna Kulit

Dermis = Teksture Kulit
Hipodermis = Countur Kulit

Faktor-faktor yang menjaga agar tidak

banyak air yang keluar dari kulit adalah:
Lipid bilayer
NMF
Sebum
Thight membran junction
Aqua glisophorin AQP3

Periode kulit

Adalah proses naiknya keratinosit dari

stratum basale ke stratum korneum
Disebut juga proses keratinisasi
Mengetahui periode kulit penting untuk
rentang waktu kita melakukan terapi
1 periode kurang lebih 28 hari pada usia
25 tahun dan bertambah 2-3 hari setiap 5
tahun

Skin Barier

1. NMF
2. lipid bilayer
3. Acid mantle

Yang dapat mengganggu barier

kulit

1. NMF

NMF dapat menurun dikarenakan:

Mencuci muka dengan sabun atau detergen
Kadar air dalam udara kecil (low humidity).

pada humidity <10 % kering, hal ini

menyebabkan filagreen tdk menjadi NMF
(filagreen adalah protein di epidermis yang
mencegah keluarnya air)
Usia
Atopi (5 rhinitis alergi, asma,dermatitis atopi,
urtikaria, ptiriasis alba)
Exposure UV

2. Lipid Bilayer
Usia
Seasonal effect
Atopi
Genetik
Diet (berkaitan dengan ketersediaan omega 3)
Glucocorticoid (stres hormon menghambat
terbentuknya lipid bilayer)

3. Acid mantle
Lipid lowering drugs (contoh golongan -statin)
dehidrasi
scrub berlebihan
exfoliate agent
electricity home device
sabun
low estrogen (menopause, haid)
UV & x-radiation
usia (elderly dan neonatus)
stres
kulit tipe 1 fitzpatrick
Testosteron
increased bacteria

Catatan:

Barier disruption diperbolehkan pada

acute inflamasi karena akan merangsang
pembentukan kolagen yg kemudian
merangsang skin rejuvenation

feel oily skin VS true oily skin

Klien feel oily tidak berarti true oily skin

bila kita temukan :
o
o

anisotropik yg tdk nyata

Wood lamp berwarna ungu

Udara panas sebum meningkatfeel oily

Bila klien kita feel oily, dapat kita berikan
additional treatment misalnya scrub atau
masker 3hr sekali.

Proses Perusakan Sel

1. Oxidatif Stress

2. Lipid Peroksidase

Yg mengatasi vit larut lemak

3. Mitokondria damage

Yang mengatasi vitamin larut air vit C

Glutation dan SOD

4. Cellular senescence

MELANOSIT

Ada tentakel (tentakel berfx utk

mentransfer melanin dr lapisan bawah ke
atas)
Tiap 10 desmosome, 1 melanosit
Menghasilkan melanin

Fungsi melanin

Absorbsi UV
Photoproteksi (menyerap free radikal)
Menangkap radikal bebas
Mencegah peroksidase lipid
Mencegah oksidatif stres
Mencegah fotoaging
Mencegah fotokarsinogenesis
Membantu sintesis vitamin D

Innactive of Cell

FREE RADICALS
ROS (Reactive Oxygen Species)
Oxidatife stress, lipid
peroxidase,mitocondrial damage,cellullar
scenescene.
Antioksidan

Mechanisme of Human Body

agains free RADICAL(ROS)

Enzim : SOD, glutation, peroxidase,

catalase
Scavengers : tocopherol, ascorbic acid,
lipoic acid, uric acid
Quencher : Beta caroten, melanin, xantin,
Chelator

Quick reference :cause and effect

using structure and function
UVR may cause :
-Free radicals
-Vitamin C oxidisation
-Incactivate vitamin A receptors
-Peroxidation of lipids in cell membranes can demage cell membranes by
disruption fluidity and permeability . Lipid peroxidation can also
adversely affect the function of membrane bound proteins such as
enzyme and receptors.
-Langerhan cell dendrite shortening and cell migration
-Melanogenesis (formation of pigment granules eumelanin and
pheomelanin)
-Keratinocyte proliferation (to pick up melanosomes)
-Increase collagenase / elastase enzymes of MMP family
-Venous / lymphatic capillary demage due to loss structural support of
loose connective tissue (areolar)
-Impair cellular replication trought DNA demage
-Cellular senescense
-Vitamin D synthesis

Other skin conditions caused by

UVR :
-Loss of resiliency and adhesion /
recoil of elastin fibrils
- loss of structural integrity and skin
density of collagen fibrils
- loss of of strengh of superficial fascia
septa
- hyper-pigmentasi skin conditions
- vascular skin conditions
- reduced immune system
- excess immune system

Yang merangsang melanosit

menghasilkan melanin:

Pituitary gland (MSH)

Keratinosit
Fibroblast
Endokrin
Hormonal (estrogen, tiroid, insulin)
Inflamasi (ada prostaglandin terbentuk
pigmen tampak luka menghitam)
Chemical
Heavy metal (merkuri di kosmetik)
Tetrasiklin
Antimalaria, amiodarone dll

Dalam menghasilkan melanin

diperlukan:

Aktivasi dan sintesis enzim tirosinase

Peroksidase

Tirosin +(tirosinase) dopa +

(peroksidase)produksi melanin

Transfer ke keratinosit

Melanin:
Eumelanin (true melanin coklat , pada org
Asia)
Pheomelanin (merah/ kuning cerah, pd org
Eropa)

Bila tirosin terbentuk tidak sempurna, yang

akan terbentuk adalah pheomelanin

Faktor-faktor yang
mempengaruhi warna kulit

Hemoglobin
Karotenoid
Blood circulation
Melanin
Kolagen

DEJ
Dermal epidermal junction
Berisi kolagen (jar.ikat) dan cairan intersel
(matrix)
Suatu bahan harus melewati DEJ sblm ke
endotel vaskular (DEJ mrpkn filter pada nano
kosmetik)
<500 nano dapat menembus DEJ sehingga
akan berpengaruh ke sistemik
Bila DEJ rusak, melanin dapat terperangkap yg
menyebabkan pigmentasi sulit untuk kita
hilangkan.

Untuk membentuk kolagen dan

GAGs, fibroblas membutuhkan:

Vit C (Magnesium Ascorbyl Phosphate)

Vit A (beta karoten, retinol, retinyl
palmitate)
Asam amino essensial (proline, glisine,
lysine)
Cooper peptides
Mg dan Ca
Bioflavonoid
Growth factor (eGF-epidermal growth
factor dan TGF3 (sitokin)
Hormon estrogen like (soy extract)

Zinc dan Fe (kofaktor sintesis kolagen)

Essensial fatty acid (omega 3)
Hyaluronic acid
Glucosamine
DMAE (dimetilamine etanol)antioksidan
SOD

WOUND HEALING
Coagulation phase (contoh cauter)
2. Inflamation (peeling)
3. Lag phase di hari 3-5 (fibroblast
mensintesis kolagen, 50% kolagen
terbuat)
4. Fibroplastic phase (hr 5-4 minggu)
5. Maturative phase (4 mg-2 tahun)
Catatan:
Acute skin inflamation dibutuhkan utk skin
rejuve/skin health (2 minggu)
1.

Inflammatory & lag

phase 1-5 Days
Wound Healing

Nutrition
Suplemmen
t
Omega 3
Vitamin A & E
Colostrum
Vit. C
Calcium

Topical Applied
Anti Oxidant
Alpha Lipoic
Vit A, C & E
Omega 3
Gluthatione
Resveratrol

Clinical
Interventi
on
Lymph
Drainage
Photo
Modulation

Fibroplastic phase
5 14 Days
Wound healing

Nutrition
Supplement

Omega 3
Vit. A & E
Colostrum
Vit. C
Calcium
Minerals
Iron
Zinc
Copper
Amino acids

Topical Applied
Anti Oxidant
Growth Factors
Sun protection

Alpha lipoic
Vit. A, C & E
Omega 3
Gluthatione
Resveratrol
Colostrum
Copper peptides

Broad spectrum
Sun protection
290 400 nm

Clinic
Interventio
n

Lymph
drainage
Photo
modulation

Maturative phase
14 28 days 2 years
Wound healing

Nutrition
Supplement

Omega 3
Vit. A & E
Colostrum
Vit. C
Calcium
Minerals
Iron
Zinc
Copper
Amino acids

Topical Applied
Anti Oxidant
Growth Factors
Sun protection

Alpha lipoic
Vit. A, C & E
Omega 3
Gluthatione
Resveratrol
Colostrum
Copper peptides

Broad spectrum
Sun protection
290 400 nm

Clinic
Interventio
n

Lymph
drainage
Photo
modulation

Penetration
Ionthoporesis
Sonophoresis

Yang mempengaruhi wound

healing

Sistemic factor (Diabetes Melitus)

Drugs
Steroid
Antineoplastic agents
Penicilamin
NSAID
Vit A oral
Trace mineral
Cooper
Mg

Hipodermis
1.

Apikal

2.

3.

Pembuluh darah
Limfatik (membuang zat-zat yang tidak terbuang dr
vena)
nerve

Mantle layer (tidak ada di eyelid, nailbed, bridge

of nose n penis)
Deeper layer
tergantung dari jenis kelamin dan area anatomis
selulit
di area muka bisa atrofi
meningkat di area yang dipengaruhi hormon

Hormon-hormon yang
berpengaruh ke kulit

Tiroid
Paratiroid
Estrogen
Testosteron
Insulin
Growth hormon
Androgen

Skin Type

Glogau
Fitzpatrick
Bowmann

Glogau (photoaging scale)

1.
2.
3.
4.
5.

Parameter kita mengasses aging sesuai

umur
Kerut (statis dan dinamis)
Skin discoloration
Keratosis seboroik
Telangiectasis
Scar

glogau

Tipe
Tipe
Tipe
Tipe

I
II
III
IV

:
:
:
:

no
(<35 thn)
mild (40 thn)
moderate (50 thn)
severe (60-70 thn)

Fitzpatrick

1.

2.
3.
4.
5.
6.

Berdasarkan reaksi terhadap sang

eksposure dan berdasarkan genetik
Terbakar tapi tidak pernah tanning
(hitam) (blue n green eyes, blonde
europe)
Selalu terbakar, kadang hitam
Kadang terbakar tp selalu hitam
Tidak pernah terbakar, selalu hitam
Lebih hitam
Hitam

Baumann

1.
2.

3.
4.

Untuk mengasses kulit sensitif:

Parameter:
Jerawat (pimples and comedo)
Rosasea (merah bila ada pemicu, cth:
makan sambal)
Flush (hot, itchy, wlpun tdk merah)
DKI

Tanda-tanda keganasan
kulit

A
B
C
D
E

:
:
:
:
:

Asimetris
Border
Colour
Diameter (>6 mm)
Enlargement (vertikal n horizontal)

BDD

Body dismorfik disorder

Ada pada 1-3 % populasi estetik
Cth:
Klien
Klien
Klien
Klien

merasa
merasa
merasa
merasa

gemuk
banyak jerawat
hitam
pesek

Ciri kepribadian:
Narsistik
Window shopping dokter
Kapasitas psikiatrik tdk usah ditangani

Jenis kulit
1.Kulit Berminyak
Lemak bekerja berlebihan sehingga terlihat
Mengkilat,Tebal,Tonus kuat,Pori besar dan biasanya
Berjerawat.
2.Kulit Normal
Tidak berminyak dan tidak kering sehingga terlihat
segar dan bagus,pori nyaris tidak terlihat
3.Kulit Kering
Kelenjar lemak kurang aktif,kulit kusam,tipis
,bersisik,halus,lebih cepat timbul keriput.
4.Kulit Kombinasi
Normal berminyak di bagian tengah wajah dan normal
kering di bagian lainnya,biasanya usia di atas 35 th
keatas

Dry SKIN
dark purple with black light

Oily ( T
zone,neck,decolate)
yellow in Black light

Difuse redness
dark purple black light

LIPID DRY
Secretion
Matt , showing minimal oil
over majority of the face and
neck. Viewed with black light
there will be no or minimal
indication of yellow/orange
pin points of sebum over the
Texture
Surface may be rouht and
flaky , with open or closed
comedones around the nose
wing. Premature ageing and
wringkles. When viewed with
black light there will be with
flacky patches in odd areas
like the zygomatic/cheeks

Colour
Skin appears blotchy
and dull in appearance.
Igmentation and
diffused redness ,easily
aggressed or sensitised
when placed under
duress

OILY

DIFFUSED
REDNESS

Secretions

Colour

Sebasceous scretations will

be excessiv trought T
zone , neck , decollete and
between shoulder blades.
Slick to touch . Viewed with
black light, yellow or
orange pin points of sebum
will be

Permanent high colour or

blotchy with flushing
tendecy. Nose, chin,
cheeks are the first areas
to be affected. If chin has
permanent diffused
redness it is an exellent
diagnostic clue

Texture
Scarring may be
evident , and be
slightly thickned with
open pores. Open &
closed comedones ,
may have pustules
Colour
Sallow , tired with a
sheen. May have
underlying diffused
redness due to over
treatment with harsh
skin care

Texture
Looks fine textured and
may mark and scars easily.
Ages quickly and can be
congested and blemished.

Colour
Often minimal, but
may be oily. Could
have an impaired acid
mantle and be easily
aggressed.

Environment agent cause DRY

skin

Hot water
Air conditioning
Pollutan
Friction from clothing
Frequent air travel
Other chemical

Clinical protocol for lipid

dry skin
1. Use cleanser & toner for
dry skin
2. Maintain acid mantle at all
times
3. Use cream or oil based
masks
4. Do not use drying alcohol
or clay based masks
5. Do not use harsh abrasive
exfoliants
6. Extream care with
chemical peels
7. Moderate use of vapor
zone
8. Massage with essential
fatty acids or high emolient
slip cream
Clients protocol for lipid
9. Complate
treatment with
dry skin
an
occulusive
cream
1.
Use cleanser
& toner for
10. Minimal
use
of
exfoliation
dry skin
modalities
2.
do not use drying alcohol

PROTOCOLS OF DAILY CARE ; CLINICAL &Clinical

CLIENT
protocol for

3.
4.
5.
6.
7.
8.

or clay based masks

do not harsh abrasive
exfoliants
use creams designed for
lipid dry skins to maintain
acid mantle
minimal sun exposure
with sun protection at all
times
avoid artifical
atmospheres
take essential fatty acids
03 & 06
take vitamin supplements
for epidermis

Clinical protocol for oily

skin
1. Use cleanser & toner for
oily skin
2.
if acneic use cleanser &
toner without fragrance
of colour.
3.
maintain acid mantle at
all times
4.
only use masks for oily
skin on oily areas
5. Do not use harsh
abrasive exfoliants
6. Moderate use vapor
zone machine
7. Moderate use of vapor
zone machine

Clients protocol for oily

skin
1. Use cleanser & toner for
oily skin, if acneic use
cleanser & toner without
fragrence or colour
2.
maintain acid mantle at
all times
3.
only use masks for oily
skin on oily areas
4.
do not use harsh
abrasive exfoliants
5.
do not wear skin drying
agents when in the sun
6.
minimal sun exposure
with sun

1.
2.
3.
4.
5.
6.
7.
8.
9.

1.
2.
3.
4.
5.
6.
7.
8.

diffused redness
Use cleanser & toner with
no fragrance or colour
avoid extremes of hot &
cold & over vaso-dilation
of capillaries
maintain acid mantle at
all times
use non drying masks
do not use harsh abrasive
exfoliants
extreme care with
chemical peels (if at all)
use cool spray or lucas
massage with essential
fatty acids
complate treatment with
an occlusive cream
Clients protocols for diffused
redness
Use cleanser & toner with
no fragrance or colour
avoid extremes of hot &
cold & over vasodilation of
capillaries
no AHAs for home care
avoid hot spicy foods
do not use harsh abrasive
exfoliants
Avoid alcohol or coffe
Minimal sun exposure with
sun protection at all times
avoid artificial atmospheres

normal

berminyak

kering

kombinasi

pori

kecil /
medium

besar

Kecil ketat

T-zone
besar, pipi
pori
kecil/sdng

kelembapan

bagus

Sangat
tinggi

Tidak bagus T-zone sngt

tinggi, klt
kering tdk
bgs

Teksture
kulit

halus

Kasar / tebal Kasar / tipis

kulit tampak
berpetak2
kecil &
berserpih

kelainan

Komedo,
pustule,
papul, milia

Bmnyk
tampak
tebal, krng
nampak
tipis

Sensitive,
T-zone
penuan dini, pustule
bintik-bintik papule, krng
milia &
pmblh kplr
rusak

MENENTUKAN DIAGNOSA KULIT

Hal yang perlu di Anamnesa :
Jenis Kulit, Tipe Kulit
Tonus & Turgor
Pori Pori
Lipatan & Garis Kulit
Kelainan Kelainan kulit
Bentuk wajah
Penentuan Tindakan
Bahan kosmetik yang dipakai
Cara perawatan atau Pengobatan

Tonus dan Turgor

Tonus : Dg mencubit Kulit pipi
Turgor : Dg Menekan Kulit pipi di bawah tulang pipi

Pori Pori
Tergantung dari jenis kulit

Lipatan garis Kulit

Kerutan biasa: Antara alis,sekitar mata,lipatan hidung
dan bibir
Kerutan usia : pada kening,leher,mulut

UJUD KELAINAN KULIT

Cara Analisa Kulit

Magnifying Lamp

Magnifying lamp (lampu dan kaca

pembesar) merupakan alat yang penting
bagi therapist saat menganalisa kulit,
memberikan kemapuan untuk melakukan
pemeriksaan hingga hal yang kecil.
Dengan magnifying lamp ini akan
memperjelas jenis keadaan dan problem
kulit.

Magnifying Lamp

Penggunaan alat ini akan meyakinkan

klien ketika dilakukan pengamatan pada
kulitnya.
Karena dengan pemeriksaan yang
intensif ia akan merasa lebih yakin akan
menerima perawatan yang tepat sesuai
dengan problem dan kondisi kulitnya.

Magnifying Lamp

Magnifying lamp sangat membantu

ketika melakukan extraction ( extrasi )
black head, white head dan
membersihkan jerawat.
Menggunakan magnifying lamp akan
memberikan kesan yang professional
pada salon / klinik perawatan dan
bertanggung jawab.

Magnifying Lamp

Ketika hendak mengarahkan magnifying

lamp pada wajah klien, sebelumnya
lindungi mata klien dengan eye pads
( kapas lembab penutup mata ), baru
nyalakan lampu, jangan menyalakan
lampu di atas wajah klien. Nyalakan
dahulu baru diarahkan ke wajah klien.

Loop (Kaca Pembesar)

Sama dengan magnifying lamp tetapi

lebih sederhana.
Lampu sebagai penerangan di pasang
external (tersendiri).

Woods Lamp

Woods lamp ini diciptakan oleh Robert

Williams, seorang dokter Amerika.
Alat yang digunakan pada medical
professional ( dunia kedokteran ) untuk
membantu mendiaknosa kondisi kulit,
misalnya ringworm.
Woods lamp ini juga digunakan
aesthetician untuk membantu menganalisa
kulit.

Woods Lamp

Alat ini bekerja dengan prinsip, bahwa

perbedaan kondisi kulit akan tampak
dengan warna yang berbeda di bawah
sinar UV dari lampu ini.
Lampu wood ini bekerja lebih baik
ditempat yang gelap.
Dengan analisa ini, maka theraphist
dapat menganalisa keadaan kulit.

Woods Lamp

Perhatikan : Woods lamp jangan sampai

terlalu panas, hindari kontak langsung
pada sinar ketika lampu dinyalakan baik
dengan mata klien maupun aesthetician.
Bila diperlukan : Gunakan penutup mata
pada klien.

Woods Lamp

Skin Analizer

Ada yang portable

Bisa di hubungkan dengan TV atau
Komputer.
Prinsip : pemampakan di perbesaran
Baik untuk mensugesti klien.
Di praktekkan.

Dry SKIN
dark purple with black light

Oily ( T
zone,neck,decolate)
yellow in Black light

Difuse redness
dark purple black light

Microcomedones become non-inflamed

skin blemishes called comedones--either
a whitehead or a blackhead:

A blackhead occurs when the pore opens to the surface,

and the sebum, which contains the skin pigment melanin,
oxidizes and turns a brown/black color. It is not dirt and
can not be washed away. Blackheads can last for a long
time because the contents very slowly drain to the
surface.

A papule occurs when there is a break in the follicular

wall. White blood cells rush in and the pore becomes
inflamed.

A pustule forms several days later when white blood cells

make their way to the surface of the skin. This is what
people usually refer to as a "zit" or a "pimple".

An inflamed lesion can sometimes completely collapse or explode, severely

inflaming the surrounding skin, and sometimes engulfing neighboring follicles.
These lesions are called nodules or cysts:

Nodule
When a follicle breaks along the bottom, total collapse
can occur, causing a large, inflamed bump that can be
sore to the touch
Development: A nodule occurs when the follicle wall
ruptures deep within the dermis. Contaminated debris
from the follicle empties into the dermis and infects
adjoining follicles. A nodule is a severe form of an acne
lesion.
Cyst
Sometimes a severe inflammatory reaction can result in
very large pus filled lesions.
Development: Like nodules, cysts begin as a deep
break in the follicle wall. A membrane develops around
the infection in the dermis. As a cyst works its way to
the surface, it damages healthy skin tissue, destroying
the follicle. The likelihood of scarring is very high.

Loss of stuctural integrity and

skin density

Vit C defisiency

Collagen loss of structural

integrity

Loss of resilience and adhesion

milia

Histologically, milia are retention cyst of

pilocebaseous follicle, usually seen in
term infants and scattered in nose, chin
and forehead. They exfoliate and
disappear within first few weeks of life.
No treatment is required.

Sebaceus hiperplasia

Epidermal cyst
kecil-kecil. kalo dipencet keluar yang putih2
panjang kayak benang.

siringoma

syringoma

Syringomas are harmless sweat duct

tumors, typically found clustered on
eyelids, under the eyes and zygomatic,
although they may also be found in other
areas of the body. They are skin-colored
or yellowish firm rounded bumps, 1-3 mm
in diameter, and are often confused with
xanthelasma.

They start to appear in adolescence and

are more common in women than men.
Always remember to ask if there is any
other member of the family with this
disorder because it has been shown to
have a genetic link.
These really can be a bother in high
humidity.

glication

glikasi

Gula murni akan membuat proses glikasi

yang mendegradasi kolagen
AGE (advanced Glicasi End Product)
free radical membuat inflamasi
gambaran pillow like app pd kelopak
mata

Foods that contain AGE

Orange juice 600

Tea
2025
Coffee
2200
Clasic coke 8500
Diet coke 9500

Age unit /250ml

Age unit/100 gr

1 . Cereal
2. Pastry
3. Cake
4. Duck skin

193,400
426,740
838,400
6,259,000

Non Pharmacological
therapy

Dietary consideration
minimize intake of food high in AGE such
as meat, cheese, egg yolk
Decreased cooking temperature
broilling and frying can lead to increased
amount of AGEs

Anti Glycation Nutrient

Carnosine 2000 mg
Lipoic acid 400-600 mg
Chromium 300 microgram
Vit E 400 IU

xantelasma

Under the microscope, Xanthelasma can be

seen to be composed of lipid-laden
macrophages (histiocytes) which have engulfed
low density lipoproteins (LDLs) by endocytosis,
these cells then become known as foam cells.
It has been suggested that increased plasma
lipid peroxidation (derived from the oxidized
low-density lipoprotein LDLs) may lead to
accumulation of cholesterol in macrophages and
formation of foam cells

This LDL lipid material is stored within the

cytoplasm (intracellular), and has accumulated
in an area like capillaries.
How do these lipids arrive in the dermis? It
appears that the LDLs had crossed the
endothelial cell barrier of the capillary and
became oxidized by ROS (reactive oxygen
species of radical) it was after that event the
macrophages came into play.

Melasma

Hiperpigmentasi melanotik, penyebab:

kehamilan, pil antihamil, kosmetika
obat-obatan, genetik, defisiensi gizi
metabolik, endokrin, makanan, UV
infeksi, peradangan kulit, keganasan
disfungsi hati

ocronosis

Grading Melasma (MASI score)

O= normal skin colour without evidence

of hiperpigmentation
1=barely visible hiperpigmentation
2=mild hiperpigmentation
3=moderate hiperpigmentation
4=severe hyperpigmentation

Tipe melasma

Malar
Mandibular
Centrofacial

Efelid/sproten/freckles

Lentigo/lentigo senilis

Bercak ukuran 0,5-1 cm

Warna coklat kehitaman, berbatas tegas
Daerah terpajan/tidak
Dewasa usia lanjut

Lentigo/senilis

PIH post inflamantory

hiperpigmentation

Dermatosis papulo nigra (varian

keratosis seboroik)

SELAMAT
PRAKTEK