Hubungan Makula Fitzpatrick dengan Karakteristik Klinis Melasma

Saraswati Anindhita Kusumaningrum, dr. Flandiana Yogianti Ph.D., Sp.D.V.E., Subsp.D.K.E ; dr. Agnes Sri Siswati, Sp.D.V.E., Subsp.D.T.

2026 | Tesis | S2 Kedokteran Klinik

Pendahuluan:  Melasma merupakan kelainan hiperpigmentasi kronik pada wajah yang terutama dijumpai pada perempuan dan individu dengan fototipe kulit lebih gelap. Patogenesisnya bersifat multifaktorial dan melibatkan paparan radiasi ultraviolet, faktor hormonal, serta perubahan mikrolingkungan kulit yang dapat menimbulkan distribusi pigmentasi tidak homogen dalam lesi melasma. Salah satu manifestasi klinisnya adalah makula Fitzpatrick atau confetti-like sparing, yaitu pulau kecil kulit yang relatif mempertahankan pigmentasi normal di antara area hiperpigmentasi. Makula Fitzpatrick selama ini terutama diteliti sebagai tanda diagnostik melasma, sedangkan variasi jumlahnya berdasarkan karakteristik klinis melasma belum banyak diketahui.

Tujuan: Menilai perbedaan jumlah makula Fitzpatrick berdasarkan pola distribusi dan tipe kedalaman pigmentasi serta mengetahui hubungannya dengan derajat keparahan melasma.

Metode: Penelitian potong lintang dilakukan terhadap 39 perempuan dengan melasma di Yogyakarta. Jumlah makula Fitzpatrick dihitung pada foto klinis terstandar menggunakan ImageJ. Pola distribusi ditentukan berdasarkan pemeriksaan klinis, tipe kedalaman dinilai menggunakan lampu Wood, dan derajat keparahan dinilai menggunakan MASI. Perbedaan jumlah makula Fitzpatrick berdasarkan pola distribusi dan tipe kedalaman dianalisis menggunakan uji Mann–Whitney U, sedangkan hubungannya dengan derajat keparahan dianalisis menggunakan uji korelasi Spearman. Variabel perancu potensial dengan nilai p<0>

Hasil: Reliabilitas penghitungan makula sangat baik (ICC=0,999). Median jumlah makula pada pola centrofacial lebih tinggi dibandingkan malar, yaitu 15 (IQR 25) dan 5 (IQR 9,5), dengan perbedaan bermakna (p=0,039). Median jumlah makula pada pigmentasi dengan komponen dermal dan pigmentasi terbatas epidermal masing-masing 7,0 (IQR 22) dan 5,5 (IQR 11), tanpa perbedaan bermakna (p=0,145). Jumlah makula berkorelasi positif kuat dengan derajat keparahan melasma (rs=0,778; p<0>

Kesimpulan: Terdapat perbedaan jumlah makula Fitzpatrick pada melasma pola centrofacial dan malar. Tidak terdapat perbedaan jumlah makula Fitzpatrick yang bermakna pada melasma tipe pigmentasi terbatas epidermal dan tipe pigmentasi dengan komponen dermal. Jumlah makula Fitzpatrick berkorelasi positif kuat dengan derajat keparahan melasma sehingga semakin banyak jumlah makula Fitzpatrick maka semakin berat derajat keparahan melasma.

Introduction: Melasma is a chronic hyperpigmentation disorder of the face that predominantly affects women and individuals with darker skin phototypes. Its pathogenesis is multifactorial and involves ultraviolet radiation exposure, hormonal factors, and alterations in the skin microenvironment, which may result in heterogeneous pigment distribution within melasma lesions. One of its clinical manifestations is the Fitzpatrick macule, or confetti-like sparing, characterized by small islands of relatively normally pigmented skin within areas of hyperpigmentation. Fitzpatrick macules have primarily been studied as a diagnostic sign of melasma, whereas variations in their number according to the clinical characteristics of melasma remain poorly understood.

Objective: To assess differences in the number of Fitzpatrick macules according to distribution pattern and pigment depth type and to determine their association with melasma severity.

Methods: A cross-sectional study was conducted among 39 women with melasma in Yogyakarta. The number of Fitzpatrick macules was quantified from standardized clinical photographs using ImageJ. The distribution pattern was determined by clinical examination, pigment depth type was assessed using a Wood's lamp, and disease severity was evaluated using the Melasma Area and Severity Index (MASI). Differences in the number of Fitzpatrick macules according to distribution pattern and pigment depth type were analyzed using the Mann–Whitney U test, while their association with disease severity was assessed using Spearman's correlation test. Potential confounding variables with p<0>

Results: The reliability of Fitzpatrick macule counting was excellent (ICC=0.999). The median number of macules was higher in the centrofacial pattern than in the malar pattern, at 15 (IQR 25) and 5 (IQR 9.5), respectively, with a statistically significant difference (p=0.039). The median number of macules in pigmentation with a dermal component and predominantly epidermal pigmentation was 7.0 (IQR 22) and 5.5 (IQR 11), respectively, with no statistically significant difference (p=0.145). The number of macules showed a strong positive correlation with melasma severity (rs=0.778; p<0>

Conclusion: The number of Fitzpatrick macules differs between centrofacial and malar melasma patterns. No significant difference in the number of Fitzpatrick macules was observed between melasma with predominantly epidermal pigmentation and melasma with a dermal component. The number of Fitzpatrick macules showed a strong positive correlation with melasma severity, indicating that a greater number of Fitzpatrick macules is associated with greater melasma severity.

Kata Kunci : melasma, makula fitzpatrick, confetti like sparing, karakteristik klinis melasma