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ARTIKEL ASLI
TERAPI JARINGAN PARUT ATROFIK VARISELA DENGAN LASER CO2 RESURFACING
Susie Rendra, Aryani Sudharmono, IGAK Rata
Departemen IK Kulit dan Kelamin FK Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo - Jl. Diponegoro 71, Jakarta Pusat.
ABSTRAK

Latar belakang: Jaringan parut atrofik (JPA) varisela merupakan salah satu JPA yang sering ditemukan. Terdapat beberapa pilihan terapi untuk revisi JPA, yaitu subsisi, penggunaan bahan pengisi (filler), peeling kimiawi, eksisi, dan resurfacing (ablatif dan nonablatif), dengan hasil bervariasi.     
Kasus: Seorang perempuan usia 16 tahun datang dengan JPA sewarna kulit, multipel, atrofik sangat dalam, bergaung, sebagian besar berbentuk segi empat pada leher depan. Lesi timbul sejak pasien berusia 2 tahun, pasca varisela. Sebelum laser CO2 resurfacing, pasien telah mendapatkan terapi topikal menggunakan campuran krim tretinoin dan hidrokinon, serta tabir surya SPF 30 selama 1 tahun untuk skin restoration. Kemudian dilakukan laser CO2 resurfacing sebanyak 2 pass pada seluruh leher sisi depan, dilanjutkan secara setempat pada JPA. Pada follow-up yang dilakukan selama 7 bulan, didapatkan pendangkalan kedalaman dan pengecilan diameter JPA.        
Diskusi: Penggunaan laser resurfacing merupakan suatu metode terapi untuk JPA yang banyak digunakan, terutama bila meliputi area yang luas seperti pasien ini. Laser CO2 merupakan resurfacing ablatif yang paling banyak digunakan. Ablasi epidermis dan efek termal akan menyebabkan kontraksi kolagen dan remodeling kolagen sampai dengan 1-1,5 tahun setelah tindakan laser CO2 resurfacing. Penilaian perbaikan JPA sebaiknya dilakukan jangka panjang sesuai dengan remodeling kolagen.  Tindakan laser CO2 resurfacing terbukti dapat memperbaiki JPA pada pasien ini, ditandai dengan pendangkalan kedalaman dan pengecilan diameter JPA. 

Kata kunci: jaringan parut atrofik, varisela, laser CO2 resurfacing

ABSTRACT

Background: Varicella scar is one of the common atrophic scars. There are some alternative therapy for scar revision, such as subsicion, filler, chemical peeling, excision, and resurfacing (ablative and nonablative), with varied results.      
Case: A 16-year old girl suffered from multiple, very deep, undermined flesh colored atrophic scars, some were rectangular shaped on the front neck. The condition occurred when the patient was 2 years old, after the patient suffered from varicella. Before CO2 laser resurfacing, the patient has been treated with topical treatment, using the combination of tretinoin and hydroquinone cream, and SPF 30 sunblock for about a year as skin restoration method. CO2 laser resurfacing was then given 2 passes on the full anterior neck, followed by the focal treatment on the atrophic scars. In the 6-month follow up, the scars depth became shallower and the diameter was smaller.         
Discussion:  Laser resurfacing is a frequently used method for atrophic scars revision, especially if there were huge amount of scars, covering a broad area, like this patient. CO2 laser is the mostly used ablative resurfacing method until now. Epidermal ablation and thermal effect will cause collagen shrinkage and collagen remodeling that will occur up to 1-1.5 years after the resurfacing. The evaluation should be conducted in the long-term period in accordance with the length of remodeling process. CO2 laser resurfacing was proven quite effective in scar revision in the patient, by lessening the scar depth and diameter. 

Key words: atrophic scar, varicella, CO2 laser resurfacing


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