Pengaruh Krim Kombinasi Asam Traneksamat 4%, Nikotinamida 3%, Asam Hialuronat 1%, dan Laktobasilus 1% pada Skor MASI Pasien Melasma
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Melasma merupakan kelainan hiperpigmentasi kronis rekuren yang ditandai bercak kecokelatan hingga keabu-abuan pada wajah dan dapat menurunkan kualitas hidup pasien. Patogenesis melasma yang multifaktorial melibatkan paparan sinar ultraviolet, faktor hormonal, predisposisi genetik, inflamasi, dan stres oksidatif sehingga diperlukan terapi yang mampu menargetkan berbagai jalur biologis. Penelitian ini bertujuan menilai pengaruh krim kombinasi asam traneksamat 4%, nikotinamida 3%, asam hialuronat 1%, dan laktobasilus 1% terhadap skor Melasma Area and Severity Index (MASI) pada pasien melasma. Penelitian menggunakan desain uji klinik eksperimental double-blind randomized controlled trial terhadap 28 subjek yang dibagi ke dalam dua kelompok (krim kombinasi, n=14; modifikasi formula Kligman, n=14) menggunakan computer-generated randomization. Luaran utama penelitian adalah skor MASI, sedangkan keamanan terapi yang dinilai dari reaksi kulit lokal merupakan luaran sekunder. Evaluasi dilakukan pada minggu ke-2, minggu ke-4, minggu ke-6, dan minggu ke-8 menggunakan skor MASI. Analisis data pre-post menggunakan Repeated Measure ANOVA dan Friedman test, sedangkan analisis komparatif menggunakan independent t-test. Kelompok krim kombinasi menunjukkan tren penurunan skor MASI dari 12,90±5,47 menjadi 6,62±3,00 pada minggu ke-8 (ΔMASI = −6,28) , meskipun belum mencapai kemaknaan statistik (p=0,054). Kelompok modifikasi formula Kligman menunjukkan penurunan skor MASI yang bermakna dari 13,94 menjadi 7,93 pada minggu ke-8 (ΔMASI = −6,01) (p<0,001). Analisis komparatif menunjukkan tidak terdapat perbedaan bermakna antara kedua kelompok terhadap perubahan skor MASI selama periode observasi (p>0,05). Skor reaksi kulit lokal secara konsisten lebih rendah pada kelompok krim kombinasi sejak minggu ke-4 hingga minggu ke-8 (seluruh p≤0,004). Krim kombinasi asam traneksamat 4%, nikotinamida 3%, asam hialuronat 1%, dan laktobasilus 1% menunjukkan kecenderungan perbaikan skor MASI yang tidak berbeda bermakna dibandingkan modifikasi formula Kligman, dengan profil tolerabilitas yang lebih baik.
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