KULIT

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 Keratin Colagen Lemak

Utama
PH 4,5 – 6,5 7,1 – 7,3 -

Tebal 0,3 mm 3,5 mm Variatif

Kandungan Air 10 – 25 % 60 – 70 % -

Pembuluh - >> -
darah
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 anisotropik yg tdk nyata
o Wood lamp berwarna ungu
Udara panas sebum meningkatfeel oily

Bila klien kita feel oily, dapat kita berikan additional treatment
misalnya scrub atau masker 3hr sekali.
Proses Perusakan Sel
• 1. Oxidatif Stress
• Yang mengatasi vitamin larut air  vit C
• 2. Lipid Peroksidase
• Yg mengatasi vit larut lemak
• 3. Mitokondria damage
• 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
• Thermoregulasi
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, α 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
GAG’s, 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 factβor dan TGFβ3
(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
1. 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)
 Inflammatory & lag phase 1-5
Days
Wound Healing

Nutrition Topical Applied Clinical

Suplemment Anti Oxidant Intervention

Omega 3 Alpha Lipoic

Lymph Drainage
Vit A, C & E
Vitamin A & E Photo Modulation
Omega 3
Colostrum Gluthatione
Vit. C Resveratrol

Calcium
 Fibroplastic phase
5 – 14 Days
Wound healing

Topical Applied
Anti Oxidant Clinic
Nutrition
Growth Factors Intervention
Supplement
Sun protection

Omega 3 Alpha lipoic Lymph

Vit. A & E Vit. A, C & E
Omega 3
drainage
Colostrum Gluthatione Photo
Vit. C Resveratrol modulation
Calcium Colostrum
Copper peptides

Minerals
Iron
Zinc Broad spectrum
Copper
Amino acids Sun protection
290 – 400 nm
 Maturative phase
14 – 28 days – 2 years
Wound healing

Topical Applied
Anti Oxidant Clinic
Nutrition
Growth Factors Intervention
Supplement
Sun protection

Omega 3 Alpha lipoic Lymph

Vit. A & E Vit. A, C & E
Omega 3
drainage
Colostrum Gluthatione Photo
Vit. C Resveratrol modulation
Calcium Colostrum
Copper peptides

Minerals
Iron
Penetration
Zinc
Copper
Broad spectrum Ionthoporesis
Amino acids Sun protection Sonophoresis
290 – 400 nm
Yang mempengaruhi wound
healing
• Sistemic factor (Diabetes Melitus)
• Drugs
• Steroid
• Antineoplastic agents
• Penicilamin
• NSAID
• Vit A oral
• Trace mineral
• Cooper
• Mg
Hipodermis
1. Apikal
 Pembuluh darah
 Limfatik (membuang zat-zat yang tidak terbuang dr vena)
 nerve
2. Mantle layer (tidak ada di eyelid, nailbed, bridge of nose n
penis)
3. 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)
• Parameter kita mengasses aging sesuai umur
1. Kerut (statis dan dinamis)
2. Skin discoloration
3. Keratosis seboroik
4. Telangiectasis
5. Scar
glogau
• Tipe I : no (<35 thn)
• Tipe II : mild (±40 thn)
• Tipe III : moderate (±50 thn)
• Tipe IV : severe (±60-70 thn)
Fitzpatrick
• Berdasarkan reaksi terhadap sang eksposure dan berdasarkan
genetik
1. Terbakar tapi tidak pernah tanning (hitam) (blue n green
eyes, blonde  europe)
2. Selalu terbakar, kadang hitam
3. Kadang terbakar tp selalu hitam
4. Tidak pernah terbakar, selalu hitam
5. Lebih hitam
6. Hitam
Baumann
• Untuk mengasses kulit sensitif:
• Parameter:
1. Jerawat (pimples and comedo)
2. Rosasea (merah bila ada pemicu, cth: makan sambal)
3. Flush (hot, itchy, wlpun tdk merah)
4. DKI
Tanda-tanda keganasan kulit
• A : Asimetris
• B : Border
• C : Colour
• D : Diameter (>6 mm)
• E : Enlargement (vertikal n horizontal)
BDD
• Body dismorfik disorder
• Ada pada 1-3 % populasi estetik
• Cth:
• Klien merasa gemuk
• Klien merasa banyak jerawat
• Klien merasa hitam
• Klien merasa 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
Secretions
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
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
DIFFUSED REDNESS
Colour
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
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
 PROTOCOLS OF DAILY CARE ; CLINICAL & CLIENT
Clinical protocol for lipid dry skin Clinical protocol for oily skin Clinical protocol for diffused redness
1. Use cleanser & toner for dry skin 1. Use cleanser & toner for oily 1. Use cleanser & toner with no
2. Maintain acid mantle at all times skin fragrance or colour
3. Use cream or oil based masks 2. if acneic use cleanser & toner 2. avoid extremes of hot & cold &
4. Do not use drying alcohol or clay without fragrance of colour. over vaso-dilation of capillaries
based masks 3. maintain acid mantle at all 3. maintain acid mantle at all times
5. Do not use harsh abrasive times 4. use non drying masks
exfoliants 4. only use masks for oily skin 5. do not use harsh abrasive
6. Extream care with chemical peels on oily areas exfoliants
7. Moderate use of vapor zone 5. Do not use harsh abrasive 6. extreme care with chemical
8. Massage with essential fatty acids exfoliants peels (if at all)
or high emolient slip cream 6. Moderate use vapor zone 7. use cool spray or lucas
9. Complate treatment with an machine 8. massage with essential fatty
occulusive cream 7. Moderate use of vapor zone acids
10. Minimal use of exfoliation machine 9. complate treatment with an
modalities occlusive cream

Clients protocol for oily skin

Clients protocol for lipid dry skin
1. Use cleanser & toner for oily Clients protocols for diffused redness
1. Use cleanser & toner for dry skin
2. do not use drying alcohol or clay
skin, if acneic use cleanser & 1. Use cleanser & toner with no
toner without fragrence or fragrance or colour
based masks
colour 2. avoid extremes of hot & cold &
3. do not harsh abrasive exfoliants
2. maintain acid mantle at all over vasodilation of capillaries
4. use creams designed for lipid
times 3. no AHA’s for home care
dry skins to maintain acid mantle
4. avoid hot spicy foods
5. minimal sun exposure with sun 3. only use masks for oily skin on
5. do not use harsh abrasive
protection at all times oily areas exfoliants
6. avoid artifical atmospheres 4. do not use harsh abrasive 6. Avoid alcohol or coffe
7. take essential fatty acids 03 & exfoliants 7. Minimal sun exposure with sun
06 5. do not wear skin drying agents protection at all times
8. take vitamin supplements for
when in the sun 8. avoid artificial atmospheres
epidermis
6. minimal sun exposure with
sun
 normal berminyak kering kombinasi

pori kecil / besar Kecil ketat T-zone

medium besar, pipi
pori
kecil/sdng
kelembapan bagus Sangat Tidak bagus T-zone sngt
tinggi tinggi, klt
kering tdk
bgs
Teksture halus Kasar / tebal Kasar / tipis B’mnyk
kulit kulit tampak tampak
berpetak2 tebal, krng
kecil & nampak
berserpih tipis
kelainan Komedo, Sensitive, T-zone
pustule, penuan dini, pustule
papul, milia 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).
Wood’s Lamp
• Wood’s lamp ini diciptakan oleh Robert Williams, seorang dokter
Amerika.
• Alat yang digunakan pada medical professional ( dunia kedokteran )
untuk membantu mendiaknosa kondisi kulit, misalnya ringworm.
• Wood’s lamp ini juga digunakan aesthetician untuk membantu
menganalisa kulit.
Wood’s 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.
Wood’s Lamp
• Perhatikan : Wood’s 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 193,400
2. Pastry 426,740
3. Cake 838,400
4. Duck skin 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