Introduction: Melasma is a condition of hyperpigmentation of the facial skin that increases in prevalence with ageing. The alleged involvement of reactive oxygen species and antioxidants is the basis of the pathology of melasma. Glutathione is one of the non-enzymatic antioxidants produced by the body and plays a role in melanogenesis. The purpose of this study was to examine serum glutathione levels on the severity of melasma. Methods: This study used a cross-sectional design conducted at the Cosmetic Dermatology Clinic at Sanglah Hospital, Denpasar, from September to October 2016. Serum glutathione was examined through venous blood with ELISA method, and the severity of melasma was assessed using melasma area severity index (MASI). Independent t-test and ANOVA were used to evaluate differences in plasma glutathione levels based on the characteristics of the sample. Pearson correlation test and linear regression were used to assess the relationship between MASI and plasma glutathione. Results: This study involved 47 people with a clinical diagnosis of melasma. There was a significant strong negative correlation between plasma glutathione and MASI (p<0.001; r = −0.624). Mild melasma (1.89 ± 0.28 µmol/L) had higher plasma glutathione levels compared to moderate melasma (1.53 ± 0.13 µmol/L) and severe (1.18 ± 0.20 µmol/L) (p=0.043). Linear regression showed a significant negative linear relationship between MASI scores against plasma glutathione (β = −58.2; p <0.01). Conclusion: Glutathione plasma has a strong negative correlation with the MASI score in person with melasma.

Background: Pemphigus Vulgaris (PV) is an autoimmune bullous disorder that usually affected the middle-aged and elderly. PV management in elderly patients is still a challenge for clinicians because of an increased risk of developing diabetes in the elderly. Corticosteroid is the first-line treatment for PV; however, careful consideration should be taken for diabetes patients due to the risk of disrupting glucose control leading to acute decompensation.Case: A seventy-year-old female with type II diabetes reported to Sanglah General Hospital with multiple painful blisters on the chest, back, and oral mucous. She has been treated with insulin since last year, but the treatment was non-compliant. Dermatological examination showed multiple flaccid bullae containing serous fluid with a positive Nikolsky sign, and multiple skin erosions. Histopathology finding is appropriate with PV. The Tzank smear examination revealed acantholytic cells. She was diagnosed with PV and typed II diabetes; therefore, we treated her with azathioprine, insulin and Lantus injection; sodium chloride 0.9% compress and fusidic acid cream 2% twice daily for topical treatment.Conclusion: Azathioprine is the treatment of choice because it works by blocking DNA replication without increasing blood glucose levels. The selection of appropriate medications can improve patient prognosis.

Vitiligo is an autoimmune disease that causes melanocyte of dysfunction. Cytokines played an important role in the pathogenesis of vitiligo. Interferongamma and TNF- were cytokines that induce apoptosis of melanocyte cell. The increase of cytokine levels affects the clinical course of vitiligo. The stable and progressive phase of vitiligo clinically is not easy to predict. Assessment of vitiligo stability could be used to determine treatment options, duration of therapy and prognosis. This study was a cross-sectional observational study which intended to prove high levels of TNF-α and IFN- serum is a risk factor for vitiligo progression. The demographic, clinical, and laboratory data in active vitiligo subjects (n=30) were compared with stable vitiligo subjects (n=40). The relationship was analyzed with multivariate. Median of the subject age with active vitiligo was 44 years (860) and on the subject with stable vitiligo was 45 years (1566). The most subjects were male (58.5%) and the most common type of vitiligo was non-segmental vitiligo (87.1%). Multivariate analysis showed a high level of TNF- serum increased the risk of vitiligo progressivity (Adjusted PR 390.89; p<0,001) and high level of IFN- serum increased the risk of vitiligo progressivity (Adjusted PR 341.06; p<0,001). The high level of TNF- and IFN- serum as a risk factor for progression of vitiligo could be used to assess the activity of vitiligo disease. The further research about the association between TNF- and IFN- to predict the therapeutic response in vitiligo.

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