Kulit
Kulit
Fakta Kulit
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:
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 :
Topical Applied
Anti Oxidant Clinic
Nutrition
Growth Factors Intervention
Supplement
Sun protection
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
Minerals
Iron
Zinc
Penetration
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 OILY DIFFUSED REDNESS
Secretion
Secretions Colour
Matt , showing minimal oil over
Sebasceous scretations will be Permanent high colour or blotchy
majority of the face and neck.
excessiv trought T zone , neck , with flushing tendecy. Nose, chin,
Viewed with black light there will be
decollete and between shoulder cheeks are the first areas to be
no or minimal indication of
blades. Slick to touch . Viewed affected. If chin has permanent
yellow/orange pin points of sebum
with black light, yellow or orange diffused redness it is an exellent
over the
pin points of sebum will be diagnostic clue
Texture Texture
Surface may be rouht and flaky , Texture
with open or closed comedones
around the nose wing. Premature Scarring may be evident ,
and be slightly thickned with Looks fine textured and may
ageing and wringkles. When viewed mark and scars easily. Ages
with black light there will be with open pores. Open & closed quickly and can be congested and
flacky patches in odd areas like the comedones , may have
blemished.
zygomatic/cheeks pustules
Colour Colour
Colour
Skin appears blotchy and dull
Sallow , tired with a sheen. Often minimal, but may be
in appearance. Igmentation
May have underlying oily. Could have an impaired
and diffused redness ,easily
diffused redness due to over acid mantle and be easily
aggressed or sensitised when
treatment with harsh skin
placed under duress
care 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
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
• 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
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