Tesis

Korelasi kualitas hidup (MELASQoL-INA) pasien melasma dengan perbaikan klinis (mMASI) pascaterapi krim triple combination = Correlation between quality of life improvement as measured by MELASQoL-INA and reduction of modified melasma area and severity index (mMASI) following triple combination cream therapy.

Latar belakang: Melasma merupakan penyakit pigmentasi kulit wajah yang sering menimbulkan hendaya psikologis dan sosial. Namun, penurunan kualitas hidup pasien tidak selalu terbukti berkorelasi dengan keparahan klinisnya dalam penelitian. MELASQoL-INA adalah instrumen evaluasi kualitas hidup pasien melasma adaptasi Bahasa Indonesia yang tervalidasi, sedangkan modified melasma severity index (mMASI) adalah skoring untuk mengukur derajat keparahan penyakit. Penelitian ini ingin mengetahui apakah perbaikan derajat keparahan melasma pascaterapi krim triple combination (flucinolon acetonide 0,01%, hydroquinone 4%, dan tretinoin 0,05%) berkorelasi dengan peningkatan kualitas hidup. Metode: Subjek dengan melasma menjalani terapi krim triple combination selama 12 minggu dalam penelitian one group pretest-posttest. Penilaian skor MELASQoL-INA dan mMASI dilakukan pada kunjungan awal, minggu ke-4, ke-8, dan ke-12. Hasil: Sebanyak 30 perempuan berusia 30-60 tahun, bertipe kulit Fitzpatrick IV atau V, tanpa penyakit kulit lain di wajah, menyelesaikan seluruh prosedur penelitian. Pada kunjungan awal, median skor mMASI adalah 4,45 (1,3–13,9), sedangkan median skor MELASQoL-INA adalah 37 (10-70). Aspek kualitas hidup yang paling terdampak adalah emosi (penampilan, malu, dan frustrasi) serta kehidupan sosial (hubungan dengan orang lain). Pada minggu ke-12 terjadi penurunan median skor mMASI menjadi 1,80 (0,60- 6,30; p < 0,001) dan median skor MELASQoL-INA menjadi 17 (10-59; p < 0,001 ). Skor mMASI pascaterapi tidak terbukti berkorelasi dengan skor MELASQoL-INA (r=0,029; p=0,879), namun perbaikan skor mMASI terbukti berkorelasi positif lemah dengan perbaikan skor MELASQoL-INA (r=0,397; p=0,03). Kesimpulan: Terapi krim triple combination selama 12 minggu memperbaiki keparahan melasma dan kualitas hidup pasien secara bermakna. Terdapat korelasi bermakna antara perubahan skor keduanya, meskipun lemah.
Kata kunci: kualitas hidup, melasma, MELASQoL-INA, mMASI, terapi


Background: Melasma is a common facial pigmentary disorder. Despite causing distress to the patient, the reduced quality of life was not consistently shown in studies to correlate with clinical severity. MELASQoL-INA is a validated instrument adapted into Indonesian for evaluating the quality of life of melasma patient, while modified melasma area and severity index (mMASI) was a tool for assessing the disease severity. This study aimed to determine if clinical improvement after triple combination cream therapy (flucinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05%) correlated with increased quality of life. Methods: Subjects with melasma were treated with triple combination cream for 12 weeks in a one-group pretest-posttest study. MELASQoL-INA and mMASI assessments were carried out at the initial visit, weeks-4, -8, and -12. Results: Thirty females aged 30-60 year-old, Fitzpatrick skin type IV or V, and devoid of facial skin problems other than melasma had completed the study. At the initial visit the median mMASI score was 4.45 (1.3–13.9) and median MELASQoL-INA score was 37 (10–70). The most negatively affected quality of life aspects were related with emotion (appearance, embarrassment, and frustration) and social life (desire to be with other people). At week 12 median mMASI score was reduced to 1.80 (0.60-6.30; p < 0.001) and median MELASQoL-INA score to 17 (10-59; p < 0.001). While there was no correlation between posttreatment mMASI and MELASQoL-INA scores (r=0.029; p=0.879), a weak positive correlation was found between the change of mMASI and MELASQoL-INA scores (r=0.397; p=0.03). Conclusion: Twelve-week course of triple combination cream therapy alleviated the severity of melasma and patient’s quality of life significantly. There was a significant, but weak, correlation between the improvement in severity with the quality of life.
Keywords: melasma, MELASQoL-INA, mMASI, quality of life, treatment