Tesis

Efektivitas kombinasi asam traneksamat oral 500 mg dan krim hidrokuinon 4% dibandingkan dengan kapsul plasebo dan krim hidrokuinon 4% untuk pengobatan melasma = Comparison of the effectivity of combined oral tranexamic acid 500 mg and topical hydroquinon 4% vs. placebo and topical hydroquinone 4% in the treatment of melasma.

Latar belakang: Melasma merupakan kelainan pigmentasi yang menyebabkan gangguan kosmetik serta berdampak negatif pada kualitas hidup, kesehatan emosi, dan interaksi sosial. Terdapat berbagai modalitas terapi melasma, namun efektivitas dan keamanan masing-masing terapi masih belum memuaskan. Asam traneksamat diketahui memiliki kemampuan menghambat inflamasi, faktor pertumbuhan melanosit, dan aktivitas tirosinase, sehingga dapat berperan dalam terapi melasma. Belum pernah dilakukan penelitian mengenai efektivitas asam traneksamat oral sebagai terapi melasma di Indonesia. Tujuan: Menilai efektivitas asam traneksamat oral dalam kombinasi terapi topikal pada tata laksana melasma. Metode: Uji klinis acak terkontrol tersamar ganda. Lima puluh subjek penelitian dibagi menjadi dua kelompok, satu kelompok mendapatkan intervensi terapi topikal melasma berupa krim hidrokuinon 4% dan tabir surya SPF 30 ditambah asam traneksamat oral, sedangkan kelompok lainnya mendapatkan terapi topikal melasma dan kapsul plasebo selama 3 bulan. Evaluasi dilakukan dengan menggunakan skor MASI modifikasi dan mexameter. Hasil: Nilai efektivitas kombinasi asam traneksamat dengan terapi topikal hidrokuinon dan tabir surya terhadap perbaikan klinis berdasarkan skor MASI dan mexameter berturut-turut sebesar 72% dan 52% sedangkan terapi topikal saja sebesar 4% dan 0%. Simpulan: Kombinasi asam traneksamat oral 500 mg dengan terapi topikal hidrokuinon 4% lebih efektif dibandingkan dengan terapi topikal saja untuk perbaikan klinis melasma.
Kata kunci: melasma, asam traneksamat oral, mMASI, mexameter


Background: Melasma is a pigmentary disorder that cause not only cosmetic impairment but also gives negative impact in the quality of life, emotional health and social interaction. There are different theurapeutic modalities for melasma, but none of those have the best satisfactory effectivity and safety yet. Tranexamic acid is known to have the abitily to inhibit inflamation, melanocyte growth factor, and tyrosinase activation, thus may have a role in the treatment of melasma. Until recently, there is no study about the effectiveness of oral tranexamic acid as a treatment of melasma in Indonesia. Objective: To assess the effectiveness of oral tranexamic acid in combination with topical therapy in the treatment of melasma. Methods: A double-blinded controlled randomized clinical trial. Fifty subjects were divided into two groups, one group received a topical therapy of 4% hydroquinone and sunscreen SPF 30 with oral tranexamic acid, while the other group received topical therapy with placebo capsules for three months. Evaluation is done by using a modified MASI score and mexameter. Results: The effectiveness of oral tranexamic acid in combination with topical hydroquinone and sunscreen for melasma clinical improvement based on the modified MASI score and mexameter respectively are 78% and 52%, whereas the topical therapy alone are 4% and 0%.
Conclusion: Combination of oral tranexamic acid 500 mg with topical 4% hydroquinone is more effective than topical therapy alone for clinical improvement of melasma. Keywords: melasma, oral tranexamic acid, mMASI, mexameter