Background: Melasma is an acquired chronic hyperpigmentation mostly affecting women. The pathogenesis of melasma is uncertain but it predominant related to ultraviolet (UV) exposure. Due to chronic and relapsing nature, melasma is challenging to treat. The current available treatment often has undesirable side effects and suboptimal results. The principal of treatment includes protect from UV radiation, inhibit melanin synthesize and increase pathway to remove melanin. Objectives: To define available treatments for melasma and determine advantages and disadvantages including topical, oral and procedural. Method: Medline, Cochrane library and PubMed database were searched for articles from January 2011 to June 2020. Only RCTs, comparative, prospective, retrospective and systematic reviews focusing on melasma treatments were extracted, analyzed and discussed. Results: We found 197 studies that met the inclusion and exclusion criteria with 2314 participants included in this review. The treatments included topical, oral and procedural. In several studies, hydroquinone alone or combination remains the most effective treatment for melasma. Oral and topical tranexamic acid have been found to be a useful adjuvant treatment in refractory melasma with minimal adverse effects. Procedural treatment such as chemical peels, laser and light-based therapies, and microneedling have a mixed and unpredictable result. Overall, the side effects tend to be mild and affect few of the subject.Conclusions: The current state of the evidence suggests that some treatments with multiple modalities have their respective advantages and disadvantages. The choice of treatment modality must be adjusted according to the type of melasma such as its severity, extent and location. A better understanding of melasma through the further research may improve the therapy options with the least adverse effects.

Background: Pyoderma is a skin infection caused by bacteria Staphylococcus, Streptococcus, or both of it. Pyoderma often experienced by children which caused he skin resistance against the invasion of pathogenic germs, which not perfect as ts. Pyoderma morbidity in pediatric patients still occurs, especially in developing countries with tropical climates. This study aims to determine the pyoderma profile among children 0-14 years old at Sanglah General Hospital, Denpasar, in June 2015-2016 period.Methods: A cross-sectional descriptive design using a retrospective approach was conducted in this study. Samples were determined using total sampling technique and this sample using pediatric patients aged 0-14 years in Sanglah General Hospital periods June 201 5to June 2016 who had pyoderma. The data obtained in this study were analyzed descriptively using SPSS version 17 for Windows.Results: The results founded that there were 347 admissions, 53 patients suffering from pyoderma in Sanglah General Hospital. The majority of patients aged ≤ 4 years were 31 patients (58.5%), followed by the sex of the male as many as 34 patients (64.2%), diagnosis of bullous impetigo 27 patients (50.9%) and the location of lesions on the head of 32 patients (60.4%). Positive results of gram-positive coccus examination were 28 patients (52.8%) followed by the majority of patients getting a combination of topical and systemic antibiotics were 42 patients (79.2%).Conclusion: According to the data analysis and discussion, it can be concluded that the incidence of pyoderma in children is still quite a lot happening in Sanglah General Hospital during June 2015-2016 period. Latar Belakang: Pioderma merupakan infeksi kulit yang disebabkan oleh kuman staphylococcus, streptococcus, atau oleh keduanya. Pioderma sering dialami anak-anak, karena daya tahan kulit terhadap invasi kuman pathogen belum sesempurna orang dewasa. Angka morbiditas pioderma pada pasien anak masih cukup terjadi terutama di negara berkembang dengan iklim tropis. Tujuan dari penelitian ini adalah ntuk mengetahui profil pioderma pada anak usia 0-14 tahun di Rrumah Sakit Umum Pusat Sanglah Denpasar periode Juni 2015- Juni 2016.Metode: Penelitian ini menggunakan studi potong lintang deskriptif dengan desain penelitian retrospektif. Sampel ditentukan dengan menggunakan teknik total sampling, dalam sampel ini yang digunakan adalah pasien anak yang berusia 0-14 tahun di Rumah Sakit Umum Pusat Sanglah Denpasar periode Juni 2015- Juni 2016 yang mengalami pioderma. Data yang diperoleh dalam penelitian ini dianalisis secara deskriptif menggunakan SPSS versi 17 untuk Windows.Hasil: Hasil penelitian secara deskriptif menunjukan bahwa dari 347 kunjungan, 53 pasien yang menderita pioderma di Rumah Sakit Umum Pusat Sanglah Denpasar. Sebagian besar pasien berusia ≤ 4 tahun sebanyak 31 pasien (58.5%), diikuti dengan jenis kelaminl laki-laki sebanyak 34 pasien (64.2%), diagnosis impetigo bulosa 27 pasien (50.9%) dan lokasi lesi pada kepala yaitu 32 pasien (60.4%). Hasil positif pemeriksaan kokus gram positif sebanyak 28 pasien (52.8%) diikuti dengan sebagian besar pasien mendapatkan kombinasi topikal dan antibiotik sistemik adalah 42 pasien (79.2%).Kesimpulan: Berdasarakan hasil analisis data dan pembahasan, maka dapat disimpulkan bahwa insidens pioderma pada anak masih cukup banyak terjadi di Rumah Sakit Umum Pusat Sanglah periode Juni 2015-2016.

Background: The development of the garment industry in Bali is increasing as a tourism supporting industry. As a consequence the number of garment and textile companies is growing in quantity and quality. According to data in the Denpasar City, there were around 125 large garment companies employing at least 100 workers. A small garment company as a home industry is almost five hundred. The impact of the development of the garment industry requires a lot of human resources by recruiting, opening jobs both for trained and untrained workers, most of whom are casual workers, without getting attention in terms of health. This research was conducted to collect data about the pattern of skin lesions (work-related contact dermatitis) in garment workers in Denpasar City because they do not have complete and accurate data.Methods: The method used in this study was a survey on three large garment companies in Denpasar with interviews and examinations of their skin disease patterns.Results: Total 288 workers included in this study consisted of 105 (36.5%) men and 183 (63.5%) women. From 288 respondents, 74 workers (25.7%) suffer from skin disorders related to their work. The occupational category that suffered the most was colouring workers of 30 people.Conclusion: The pattern of skin disease in garment workers by 25.7% suffering from DKAK. Disease categories are often workers who come into contact with colour materials. Latar Belakang: Perkembangan industri garment di Bali semakin meningkat sebagai salah satu industri penunjang pariwisata. Sebagai konsekuensi jumlah perusahan garmen dan tekstil semakin banyak secara kuantitas dan kualitas. Menurut data di kodya Denpasar, tercatat sekitar 125 perusahan garmen yang besar dengan memperkerjakan sedikitnya 100 orang pekerja. Perusahan garmen yang kecil sebagai industri rumah tangga hampir sebanyak lima rastusan. Dampak dari perkembangan industri garment membutuhkan banyak tenaga kerja dengan merekrut, membuka lapangan pekerjaan baik itu untuk pekerja yang terlatih maupun yang tidak terlatih, kebanyakan merupakan pekerja lepas, tanpa mendapat perhatian dari segi kesehatan. Penelitian ini dilakukan untuk mengumpulkan data tentang pola kelainaan kulit pada(DKAK) pekerja garment  di Kodya Denpasar, karena belum memiliki data yang lengkap dan akurat.Metode: Metode yang digunakan pda penelitian ini adalah survelanse, pada 3 perusahan garment yang besar di Denpasar dengan wawancara dan pemeriksaan terhadap pola penyakit kulitnya.Hasil: Dari 288 pekerja yang di ikut sertakan dalam penelitian ini terdiri dari 105 (36,5%) laki-laki dan 183 (63,5%) perempuan. Dari 288 responden, sebanyak 74 pekerja (25,7%) yang menderita kelainan kulit yang berhubungan dengan pekerjaannya. Katagori pekerjaan yang paling banyak menderita adalah pada pekerja pencelupan (coloring) sebesar 30 orang.Simpulan: Pola penyakit kulit pada pekerja garment sebesar 25,7% menderita DKAK. Katagori penyakit sering adalah pekerja yang berhubungan kontak dengan bahan warna.

Introduction: Melasma is an acquired pigmentation disorder characterized by symmetrical hyperpigmented patches, most commonly seen on the face. Melasma and iron deficiency are most common in women of reproductive age. Iron deficiency causes a decrease in ferritin levels, which are iron stores in the body. The mechanism of iron deficiency causing melasma is thought to be due to cell hypoxia in the tissue involving mediators that increase melanogenesis. This study aims to prove that the mean ferritin level is lower in melasma than without melasma and that low ferritin levels are a risk factor for melasma in women. Methods: A case-control research included 28 participants with melasma and 28 without melasma who visited the dermatovenereology department of Prof. Dr. I.G.N.G Ngoerah Hospital, medical cosmetic division, in May-July 2022. The two groups will compare ferritin mean and ferritin risk factor analysis on the incidence of melasma. Data were tabulated and analyzed using SPSS 26. Results: The mean age in the melasma group was 40.64±3.39 years old, and the group without melasma was 37.64±3.50 years old (p=0.75). Of the 28 melasma subjects, there were more subjects with low ferritin levels (60.7%) than the group without melasma (32.1%). From the results of the Mann-Whitney test, the mean ferritin level in the melasma group (36.32±31.05) was significantly lower than in the non-melasma group (58.26±5.39); p=0.006. From the results of the Chi-Square test, it was found that low ferritin levels had a risk of 3.2 times the occurrence of melasma [OR (95% CI) = 3.2 (1.098-9.776), p=0.032]. Conclusion: The mean ferritin level in women with melasma is lower than in women without melasma, and low ferritin levels are a risk factor for melasma.   Latar Belakang: Melasma merupakan kelainan pigmentasi didapat yang ditandai dengan adanya bercak hiperpigmentasi simetris, paling sering terlihat pada wajah. Melasma dan defisiensi besi paling sering dijumpai pada wanita usia reproduktif. Defisiensi besi menyebabkan turunnya kadar feritin yang merupakan cadangan besi dalam tubuh. Mekanisme defisiensi zat besi menyebabkan melasma diduga akibat hipoksia sel di dalam jaringan melibatkan mediator yang meningkatkan melanogenesis. Studi ini bertujuan untuk membuktikan rerata kadar feritin lebih rendah pada melasma dibandingkan tanpa melasma serta membuktikan kadar feritin yang rendah merupakan faktor risiko melasma pada wanita. Metode: Studi case-control yang melibatkan 28 subjek dengan melasma dan 28 subjek tanpa melasma yang berobat ke poliklinik kulit dan kelamin RSUP Prof. Dr. I.G.N.G Ngoerah divisi kosmetik medik periode Mei-Juli 2022. Kedua kelompok akan dibandingkan rerata feritin dan analisis faktor risiko feritin terhadap kejadian melasma. Data ditabulasi dan dianalisis dengan menggunakan SPSS 26. Hasil: Rerata usia pada kelompok melasma 40.64±3,39 tahun dan kelompok tanpa melasma 37,64±3,50 tahun (p=0,75). Dari 28 subjek melasma, didapatkan lebih banyak subjek dengan kadar feritin rendah (60,7%) dibandingkan kelompok tanpa melasma (32,1%). Dari hasil uji Mann-Whitney didapatkan rerata kadar feritin pada kelompok melasma (36,32±31,05) lebih rendah secara signifikan dibandingkan pada kelompok bukan melasma (58,26±5,39); p=0,006. Dari hasil uji Chi-Square didapatkan kadar feritin yang rendah memiliki risiko sebesar 3,2 kali terjadinya melasma [OR (IK 95%) =3,2 (1,098-9,776), p=0,032]. Simpulan: rerata kadar feritin pada wanita dengan melasma lebih rendah dibandingkan wanita tanpa melasma dan kadar feritin yang rendah merupakan faktor risiko melasma.