Journal of General - Procedural Dermatology & Venereology Journal of General - Procedural Dermatology & Venereology Indonesia
Indonesia
Volume 2
Number 1 August Edition Article 1
8-31-2017
Pattern of pigmentation disorder in Cosmetic Dermatology Clinic Pattern of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik General Hospital, Medan, 2012 - 2015
H. Adam Malik General Hospital, Medan, 2012 - 2015
Nelva Karmila Jusuf
Department of Dermatology and Venereology, Faculty of Medicine,University of Sumatera Utara H. Adam Malik General Hospital Medan, Indonesia
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Recommended Citation Recommended Citation
Jusuf, Nelva Karmila (2017) "Pattern of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik General Hospital, Medan, 2012 - 2015," Journal of General - Procedural Dermatology & Venereology Indonesia: Vol. 2: No. 1, Article 1.
DOI: 0.19100/jdvi.v2i1.46
Available at: https://scholarhub.ui.ac.id/jdvi/vol2/iss1/1
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Original article
Pattern of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik General Hospital, Medan, 2012 - 2015
Nelva K. Jusuf
Department of Dermatology and Venereology, Faculty of Medicine,University of Sumatera Utara H. Adam Malik General Hospital Medan, Indonesia
E-mail: [email protected]
Abstract
Background: Abnormalities of pigmentation is a cosmetic problem which affects the overall appearance of an individual. Pigmentation disorder are caused by the increase (hypermelanosis) or the decrease (hypomelanosis) amount of melanin.
Objective: To determine the pattern of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik General Hospital Medan in 2012-2015.
Methods: A retrospective study using subject’s medical records from the Cosmetic Dermatology Clinic H.
Adam Malik General Hospital Medan in 2012 – 2015, presented descriptively.
Results: In 2012 – 2015 the number of patients who visited the Cosmetic Dermatology Clinic were respectively 210, 228, 211, 142. Hypermelanosis were found respectively in 24.76%, 16.20%, 12.79%, 5.63%. Whereas hypomelanosis were found 18.10%, 9.21%, 8.53%, 8.45%. During 2012 – 2015 melasma was the most common disorder found among hypermelanosis group, followed by post inflammatory hyperpigmentation.
Meanwhile vitiligo was the only diagnosis in hypomelanosis group. Each year most of the pigmentation disorder patients came from the age group 38-48 years old except in 2015. Women were more affected than men.
Conclusion: In 2012-2014, the largest proportion of pigmentation disorder were hypermelanosis, mostly melasma. In 2015, it was hypomelanosis with vitiligo as the diagnosis.
Keywords: pigmentation disorder, cosmetic division, retrospective
Introduction
Pigmentation disorder may be classified to hypermelanosis and hypomelanosis.1 Hypermelanosis is a condition where hyperproduction of melanin is found.
Hypermelanosis is found in melasma, lentigo, ephelides, skin discoloration due to metal, post- inflammatory hyperpigmentation (PIH), ochronosis, etc. Melasma is the most common form of hyperpigmentation.1 Based on the data that were collected from January to December 2009 in H.
Adam Malik General Hospital Medan, out of 5,369 patients who came to the Dermatovenerology Outpatient Clinic H. Adam Malik General Hospital Medan, 22 (0.41%) were diagnosed with melasma.2 Hypomelanosis, on the other hand, is due to decreased amount of melanin production in the skin. This pigmentation disorder were vitiligo,
albinism, post inflammatory hypopigmentation, etc.3
Pigmentation disorders, especially the ones on the face, may affect patients both emotionally and psychologically. These disorders mainly affect women, influence self-confidence, which may worsen quality of life. In a research conducted by Hamdani and Jusuf in 21 Posyandu (Center for pre-post-natal healthcare and information for woman and children < 5 years old) in Medan Labuhan by using Dermatology Life Quality Index (DLQI), it was found that the life quality of those who have pigmentation disorder on the face were greatly affected (54,0%), moderate level were 21.0%, very important level were 15.0%, small effect were 6.0% and no effect level were 3.0%.
Based on the age group, the quality of life were greatly affected at the age 31-40 and 40-51 (17 subjects). Based on the duration off suffering the
most is >1 year with very important effect were 51.0%. Hyperpigmentation affect as many as 54.2% of all the type of facial pigmentation.4 Nair and Jusuf conducted a research to married women who had melasma in Posyandu Kelurahan Tanjung Rejo, Medan city, it was found that these women had middle rate quality of life (69,3%).5
The general objective of this research is to know the pattern of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik General Hospital Medan 2012-2015. Meanwhile, the specific objective is to analyze the proportion of patients with pigmentation disorder based on the type, age, and gender.
Methods
This is a retrospective study using medical records from the Cosmetic Dermatology Clinic H. Adam Malik General Hospital Medan in 2012 – 2015, presented descriptively. Inclusion criteria were medical records with complete information. The use of medical records have been approved by the H.Adam Malik General Hospital.
Results
Table 1. Distribution of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik
Hospital 2012.
n (%)
Pigmentation disorders
Hypermelanosis 52 24,76
Hypomelanosis 38 18,10
Not pigmentation disorder 120 57,14
Total 210 100
Diagnosis of hypermelanosis
Melasma 41 78,85
Post-inflammatory hyperpigmentation
11 21,15
Total 52 100
Diagnosis of hypomelanosis
Vitiligo 38 100
Total 38 100
Age group (years old) of pigmentation disorder patients
5-15 0 0
16-26 17 18,89
27-37 12 13,33
38-48 37 41,11
49-59 17 18,89
> 60 7 7,78
Total 90 100
Gender of pigmentation disorder patients
Men 20 22,2
Women 70 77,8
Total 90 100
The result from the medical record shows that in 2012, there were 210 patients who came to Cosmetic Dermatology Clinic, with 52 of them (24,76%) had hypermelanosis while hypomelanosis only 38 patients (18,10%). The diagnosis of hypermelanosis consist of melasma 41 patients (78,85%) and PIH 11 patients (21,15%). While the diagnosis of hypomelanosis was only vitiligo in 38 patients (100%) . The most patients (41,11%) were found from the age group 38-48 years old. It was found in 20 men (22,2%) and 70 women (77,8 %) (table 1).
In 2013, there were 228 patients who came to Cosmetic Dermatology Clinic, with 37 of them (16,20%) had hypermelanosis while only 21 patients had hypomelanoses (9,21%). The diagnosis of hypermelanosis consists of melasma 31 patients (83,78%), PIH 5 patients (13,52%) and ochronosis 1 patient (2,70%). While the diagnosis of hypomelanosis was only vitiligo in 21 patients (100%). Most patients (50%) were found from the age group 38-48 years old. It was found in 7 men (12%) and 51 women (88%) (table 2).
Table 2. Distribution of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik
Hospital 2013.
n (%) Pigmentation disorders
Hypermelanosis 37 16,20
Hypomelanosis 21 9,21
Not pigmentation disorder 170 74,59
Total 228 100
Diagnosis of hypermelanosis
Melasma 31 83,78
Post-inflammatory hyperpigmentation
5 13,52
Ochronosis 1 2,70
Total 37 100
Diagnosis of hypomelanosis
Vitiligo 21 100
Total 21 100
Age group (years old) of pigmentation disorder patients
5-15 2 3,44
16-26 8 13,79
27-37 6 10,34
38-48 29 50,00
49-59 11 18,96
> 60 2 3,44
Total 58 100
Gender of pigmentation disorder patients
Men 7 12
Women 51 88
Total 58 100
In 2014, there were 211 patients who came to the Cosmetic Dermatology Clinic, with 27 of them (12.79%) had hypermelanosis while only 18 patients had hypomelanoses (8.53%). The diagnosis of hypermelanosis consist of melasma 18 patients (66,67%), PIH 8 patients (29,63%) and ephelides 1 patient (3,70%). While the diagnosis of hypomelanosis was only vitiligo 18 patients (100%). Most patients (28,89%) were found from the age group 38-48 years old. It was found in 10 men (24.4%) and 35 women (75.6%) (table 3).
Table 3. Distribution of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik
Hospital 2014.
n (%)
Pigmentation disorders
Hypermelanosis 27 12,79
Hypomelanosis 18 8,53
Not pigmentation disorder
166 78,68
Total 211 100
Diagnosis of hypermelanosis
Melasma 18 66,67
Post-inflammatory hyperpigmentation
8 29,63
Ephelides 1 3,70
Total 27 100
Diagnosis of hypomelanosis
Vitiligo 18 100
Total 18 100
Age group (years old) of pigmentation disorder patients
5-15 2 4,44
16-26 9 20,00
27-37 10 22,23
38-48 13 28,89
49-59 9 20,00
> 60 2 4,44
Total 45 100
Gender of pigmentation disorder patients
Men 10 24,4
Women 35 75,6
Total 45 100
In 2015, there were 142 patients who came to Cosmetic Dermatology Clinic, with 8 of them (5,63%) had hypermelanosis while only 12 patients had hypomelanosis (8,45%). The diagnosis of hypermelanosis consist of melasma 7 patients (87,50%) and PIH 1 patients (12,50%). While the diagnosis of hypomelanosis was only vitiligo in 12 patients (100%) with. Most patients (45%) were found from the age group 16-26 years old. It was found in 4 men (20%) and 16 women (80%) (table 4).
Discussion
Pigmentation disorder can be classified to hypermelanosis and hypomelanosis group. From 2012 - 2014 in Cosmetic Dermatology Clinic Table 4. Distribution of pigmentation disorder in Cosmetic Dermatology Clinic H. Adam Malik
Hospital 2015.
n (%)
Pigmentation disorders
Hypermelanosis 8 5,63
Hypomelanosis 12 8,45
Not pigmentation disorder
122 85,92
Total 142 100
Diagnosis of hypermelanosis
Melasma 7 87,50
Post-inflammatory hyperpigmentation
1 12,50
Total 8 100
Diagnosis of hypomelanosis
Vitiligo 12 100
Total 12 100
Age group (years old) of pigmentation disorder patients
5-15 1 5,00
16-26 9 45,00
27-37 4 20,00
38-48 2 10,00
49-59 3 15,00
> 60 1 5,00
Total 20 100%
Gender of pigmentation disorder patients
Men 4 20
Women 16 80
Total 20 100
H. Adam Malik General Hospital Medan, the largest proportion of pigmentation disorder was hypermelanosis, with melasma as the most common diagnosis. This situation corresponds with Hamdani and Jusuf research in 2016, who found that there were more pigmentation disorder on the face due to hypermelanosis (65%) compared to hypomelanosis (35%) in 21 Posyandu in Medan Labuhan. 4
Melasma is a cosmetic problem which can affect women’s appearances, social life, and also emotional status.6 This is a chronic disorder and may cause frustration to both the patient and the doctor, as the disorder is very difficult to treat.7 Nair and Jusuf in 2015 found that women with melasma had middle rate quality of life, measured with MelasQol.5
The etiology of melasma has yet to be understood. The factors that have a role in etiopathogenesis of melasma are endocrinologic, genetic predisposition, UV radiation, and others such as certain cosmetic ingredients and medicines that are photosensitive. Out of the many predisposing factors of melasma, UV exposure is the most prominent.1,7
In this research, from the year 2012 to 2014 most of the patients with pigmentation disorder were from the 38-48 years old age group. In 2015, Hamdani and Jusuf found that those with pigmentation on the face were from the age group 31-40 years old and 41-50 years old.4 These is the reproductive age for women, which is often associated to the development of melasma. Nair and Jusuf in 2014 found that those who had melasma were from the age group 31-40 year old.5 UV exposure has been known to worsen melasma. In fact, melasma has been reported to be seen less in winter, as there is less sunlight exposure as well. Furthermore, melasma is most commonly found in women who use hormonal contraception. The usage of cosmetics that contain photosensitizer, oilum bergamot, and perfume were also reported to cause the development of melasma.1,7,8
Ochronosis refers to the brownish-yellow or ochre- colored accumulation of pigment found in the connective tissue of patients with the disease.1 Exogenous ochronosis (EO) manifests as asymptomatic hyperpigmentation in photo-expose region.9 It occurs over sites of chemical contact, like the osseous surfaces of the zygomatic areas of the face, side and back of the neck as well as the extensor aspects of extremities, usually in a symmetrical pattern. The lesions are grey brown or blue-black macules and usually with hyperchromic, pinpoint, caviar-like papules.9 EO can be secondary to the topical application of hydroquinone, resorcinol, or oral administration of antimalarials or mercury.10 EO is a disorder that rarely happen but may be very cosmetically disturbing and may cause psychological disturbance in patients, especially dark skinned patients, also found in Hispanics, Caucasians, and Asians including Indonesians.11 The most common cause of EO is hydroquinone. EO is also found simultaneously with melasma, due to the hydroquinone that is used to treat melasma.11 In this research, ochronosis were only found in one patients in 2013.
Post-inflammatory hyperpigmentation (PIH) is a melanotic hypermelanosis, containing epidermal,
dermal, or the compound type that may happen after a trauma, allergy reaction, inflammation lesions, dermatitis caused by sunlight exposure, or cosmetic procedures (chemical peeling etc). It may happen to all gender, race and age, although mostly happen to those with dark skin.12 In this research from the year 2012-2015, the PIH were found respectively 21,15%, 13,52%, 29,63%, and 12,50%.
Ephelides or freckles are a small hyperpigmented macules on the face, with the size restricted to 2- 4mm. It mostly happens to individuals with fair skin, red or blonde hair, who are mostly Caucasians or Chinese, and usually inherited genetically.12 In this research, ephelides were only found in 1 case in 2014. In RS Dr. Sardjito Yogyakarta ephelides was found among 31 employees and 30 of them (96,8%) were female.13
In this research, from the year 2012-2015, hypomelanosis were found respectively 16,10%, 9,21%, 8,53%, and 8,45% with vitiligo being the one and only diagnosis for hypomelanosis. In the research by Hamdani and Jusuf, it was found that hypomelanosis greatly affect the quality of life (64,2%).4 Vitiligo is a skin depigmentation disorder that can be recognized by the white spots that were caused by the destruction of melanocyte. Vitiligo is chronic and may affect patients cosmetically so that they may have low self-esteem and may affect patients’ life quality.14,15 In Indonesia, the research for this disorder is still very limited. In Dr. M. Djamil General Hospital Padang from 2001-2016, incidents of vitiligo were reported to be at 0,46%.16 Most were sporadic, but about 16-46% of the patients have family histories and inheritance patterns that correspond with polygenic trait.17 Vitiligo may affect anyone at all age.17 However, most cases of vitiligo occur before the age of 20 years old and 70-80% occur before the age of 30 years old.18 This matter corresponds with Rizal’s research, in which it was stated that vitiligo mostly affect those from the age group 21-30 years old.16 Men and women both may be affected with vitiligo.17,18 The etiology of vitiligo is still not known yet. There are some genetic, autoimmune, and biochemistry hypotheses for vitiligo.17,19,20 The presence of genetic susceptibility may trigger a process of autoimmune and with the increment of oxidative stress may cause the destruction of melanocyte which resulted in the emersion of depigmentation lesions.21
Overall in this study between 2012-2015 hyperpigmentation disorders were found
dominantly than hypopigmentation disorders with melasma as the most common diagnosis.
Conclusion
In 2012-2014 the largest proportion of pigmentation disorder were hypermelanosis, most of them are melasma. In 2015, the highest proportion of pigmentation disorder were hypomelanosis and all diagnosed as vitiligo.
Uniformity in diagnosing and complete form filling in medical records needed, so more thorough information may be acquired in evaluating the pattern of pigmentation disorder on the skin.
Acknowledgement
The author wished to thanks dr.Cashtry Meher for support and cooperation. The author has no funding or support to report and no conflict of interest.
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