PERAN FOTOTERAPI PADA VITILIGO ANAK

  • Indira Dharmasamitha Departemen Dermatologi dan Venereologi FK Universitas Udayana/RSUP Sanglah, Denpasar
  • Made Swastika Adiguna Departemen Dermatologi dan Venereologi FK Universitas Udayana/RSUP Sanglah, Denpasar

Abstrak

Vitiligo adalah gangguan pigmentasi didapat yang ditandai dengan lesi putih yang tidak berpigmen pada kulit dan rambut karena kehilangan fungsi melanosit. Sekitar 50% pasien vitiligo menunjukkan awitan sebelum usia 18 tahun, sehingga seringkali menimbulkan masalah di bidang pediatrik, baik dalam diagnosis maupun tata laksana. Penegakan diagnosis vitiligo umumnya berdasarkan anamnesis dan pemeriksaan fisik, namun dapat dilakukan pemeriksaan penunjang untuk memastikan diagnosis ataupun mencari penyakit komorbiditas. Fototerapi diberikan hanya pada pasien anak dengan vitiligo yang tetap stabil dan tidak responsif terhadap terapi topikal. Terdapat beberapa perbedaan dalam hal indikasi dan dosis yang diberikan pada fototerapi anak dan dewasa. Perkembangan dan temperamen/perilaku anak harus dinilai termasuk mempertimbangkan kecemasan, ketakutan terhadap ruangan tertutup, dan kemampuan untuk tetap diam selama perawatan, sehingga penatalaksanaannya perlu perhatian khusus. Rata-rata pemberian fototerapi pada anak dapat sampai 12-24 bulan. Oleh sebab itu efek samping pemberian fototerapi jangka panjang penting disampaikan kepada orang tua.


Kata kunci: anak, fototerapi, vitiligo

References

1. Anuradha B, Davinder P. Clinical and molecular aspects of vitiligo treatments. Int J Mol Sci. 2018;19:1509-16.
2. Speeckaert R, Geel, NV. Vitiligo: An update on pathophy-siology and treatment options. Am J Clin Dermatol. 2017;18:733–44.
3. Halder RM, Taliaferro SJ. Vitiligo. Dalam: Wolff K, Gold-smith LA, Katz SI, Gilchrest BA, Paller AS, Lefferll DJ, pe-nyunting. Fitzpatrick’s Dermatology in General Medicine. Edisi ke-7. New York: Mc Graw-Hill Company; 2008. h.616-22.
4. Jha KA, Sonthalia S, Lallas A. Dermoscopy in vitiligo: diagnosis and beyond. Int J Dermatol. 2018;57:50–4.
5. Ezzedine K, Silverberg N. A practical approach to the diagnosis and treatment of vitiligo in children. Pediatrics. 2016;138(1):23-24.
6. Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Watts MJ, Anstey AV, dkk. Guideline for the diagnosis and mana-gement of vitiligo. British J Dermatol. 2008;159: 1051–76.
7. Crall CS, Rork JF, Delano S, Huang JT. Phototherapy in children: considerations and indications. Clin Dermatol. 2016;2:4-15.
8. Rubeta M. Vitiligo in adults and children: surgical interventions. BMJ Clin Evid. 2015;2015:1717-24.
9. Kanwar AJ, Kumaran MS. Childhood vitiligo: treatment paradigms. Indian J Dermatol. 2013;57:466-74.
10. Sameh K, Attia, Sherif SA, Siham Y. PUVA versus NB-UVB in management of vitiligo: clinico-immuno-pathological study. J Cosm, Dermatol Sci Applic.2013;3:16-25.
11. Shenoi SD, Prabhu S. Photochemotherapy (PUVA) in psoriasis and vitiligo. Indian J Dermatol Venereol Leprol. 2014;80:497-504.
12. Valkova S, Trashlieva M, Christova P. Treatment of vitiligo with local khellin and UVA: comparison with systemic PUVA. Clin Exp Dermatol. 2003;29:180–4.
13. Samia E, Wedad M, Rehab AH. Phototherapy: the vitiligo management pillar. Clin Dermatol. 2016;34:594–602.
14. Narumol SA, Henry WL. Narrowband ultraviolet B photo-therapy in vitiligo. Dalam: Somesh Gupta, penyunting. Vitiligo: Medical and Surgical Management. Edisi ke-1. United Kingdom: John Wiley & Sons Ltd; 2018.h.96-105.
15. Bellet JS, Prose NS .Vitiligo in children: a review of classification, hypotheses of pathogenesis and treatment. An Bras Dermatol. 2013;80:633-7.
16. Dakoutrou M, Alexopoulos A, Kakourou T. Vitiligo in children and adults: a narrative review. J Dermatol Clin Res. 2016;4:1078-90.
17. Sameh G, Zarrab Z, Lotti T. Phototherapy and vitiligo re-pigmentation: from Psoralen Ultraviolet A (PUVA) to micro-focused phototherapy. Pigmen Dis. 2014;1:102-9.
18. Bae JM, Jung HM, Hong BY, Lee JH, Choi WJ, Kim GM, dkk. Phototherapy for vitiligo: a systematic review and meta-analysis. JAMA Dermatol. 2017;153:666-74.
19. Rao G, Kumar YK. Narrow-band ultraviolet B in childhood vitiligo: An open prospective uncontrolled study in 28 children of South India. Indian J Paedtr Dermatol. 2015;16(1):17-24.
20. Koh MJ, Mok ZR, Chong WS. Phototherapy for the treatment of vitiligo in Asian children. Pediatric Dermatol. 2015;28:1–6.
21. Phiske MM. Vitiligo in children: a birds eye view. Curr Pediatr Rev. 2016;12: 55-66.
22. Silverberg NB. Pediatric vitiligo. Pediatr Clin North Am. 2014; 61: 347-66.
Bagian
Artikel Asli