Melasma is a common disfiguring condition involving acquired hyperpigmentation especially on the face, for which the pathogenesis is still uncertain, however histopathological studies showed that there is not only hyperpigmentation in the epidermis, but also solar elastosis or photo-aging due to abnormality of dermal extracellular matrix which contributes to clinical wrinkles. This study aimed to examine a link between the severity of melasma and facial wrinkles as a manifestation of photoaging in a tropical area. This study was an observational study with crosssectional design, conducted in Yogyakarta, Indonesia involving 51 patients with melasma aged 30-50 years who had fulfilled the inclusion and exclusion criteria. The melasma severity was measured clinically with the modified Melasma Severity Index (mMASI), and objectively with the Melanin Index (MI) and Erythema Index (EI) assessed with Mexameter Courage Khazaka. The wrinkle severity was measured clinically by scoring from forehead horizontal lines, crow’s feet, glabellar and nasolabial lines, and total scores were obtained from all of them. The correlation analysis was done statistically with Spearman’s rank tests. The results showed a weak positive but not significant correlation between the mMASI score and total facial wrinkle score (r: 0.165), and a weak positive non-significant correlation between EI and total facial wrinkle score (r: 0.06). There were significant positive moderate correlations between MI and total facial wrinkle score (r: 0.441), due to significant positive moderate correlations between MI and glabella wrinkle (r: 0.392), and between MI and nasolabial wrinkle (r: 0.339). In conclusion, a positive moderate correlation was found between MI and total facial wrinkle score, especially relating to glabellar and nasolabial wrinkles. However, there was no correlation between mMASI score and total facial wrinkle score.

Chronic leg ulcer can caused morbidity and decreased quality of life. Previous study reported leg ulcer affect up to 3% of adult population worldwide Mini punch graft is one of therapeutic options of chronic leg ulcer. This surgical method aimed to include epidermal and dermal tissue with an absence of terminal hair follicles. Previous study mentioned that this procedure stimulated healing in many cases of chronic leg ulcers with total reepithelialization.In this article, the application of multiple mini punch grafts onto two case of extensive leg ulcers caused by burn injury and diabetic ulcer are reported. Split thickness skin graft with mini punch graft require skin donor from inguinal area. The donor were placed onto the ulcer. After several weeks, the ulcer area that had been mini punch grafted show reepethelialization.

Metotreksat (MTX) merupakan antagonis asam folat yang umum digunakan sebagai terapi pada berbagai kelainan kulit, namun data mengenai penggunaan MTX pada anak masih sangat terbatas. Berdasarkan studi literatur yang telah kami lakukan, MTX menimbulkan respons klinis yang bagus dan efek samping minimal pada beberapa dermatosis anak, yaitu psoriasis, dermatitis atopik, vaskulitis, skleroderma lokalisata, dermatomiositis juvenilis, pitiriasis likenoides, sarkoidosis, penyakit bulosa autoimun, alopesia areata, dan lupus eritematosus. Secara umum toleransi anak terhadap MTX baik, dan jarang terjadi efek samping serius. Intoleransi gastrointestinal dapat terjadi, dan berespons baik terhadap pengurangan dosis obat. Berbagai pertimbangan harus dilakukan sebelum memulai terapi dengan MTX, antara lain pemeriksaan darah lengkap, fungsi hati, dan fungsi ginjal. Pemantauan terapi berupa biopsi hepar dan pemeriksaan serum type III pro-collagen aminopeptide belum rutin dilakukan. Pada telaah pustaka ini akan diulas tentang farmakologi dan farmakokinetik, mekanisme aksi, efek samping, interaksi, dan pemantauan obat MTX pada dermatosis anak. Diharapkan telaah pustaka ini akan membantu klinisi untuk mempertimbangkan pemilihan MTX dalam menatalaksana kasus-kasus dermatologi anak.Kata kunci: metotreksat, antagonis asam folat, dermatosis anak