The Relationship Between Sunscreen Application and Severity Of Melasma

Melasma is commonly observed in community among women of reproductive age. Incidence of melasma at least nine times higher in women than men, especially in pregnant women. The relationship between sunscreen application and melasma in women of reproductive age has not been widely studied and the correlation is not clear. This study aims to determine the relationship between sunscreen use and severity of melasma in women of reproductive age. An analytical observational cross-sectional study was conducted among 31 women of productive age. The results showed that 14 respondents had good sunscreen usage habit (45.2%), whereas 17 respondents had sun protector irregularly (54.8%). A total 27 respondents (74.2%) had mild melasma, whereas 3 respondents had moderate melasma (22.6%) and 1 respondent had severe melasma (3.2%). The Chi-Square test shows that the significance value (p) = 0.000 (p <0.05) so that there is a significant relationship, meaning that there is a relationship between the use of sunscreen and severity of melasma in women of reproductive age.


Introduction
Melasma, formerly known as chloasma, is the most common hyperpigmented of the skin, particularly on the face (Ogbechie-Godec & Elbuluk, 2017). It appears as mild to dark brown hyperpigmentation with symmetrical shape and irregular borders. The prevalence varies from 1.5% to 33% depends on the population (Huang et al., 2010  Sunscreen is a substance that helps reduce the amount of UV radiation by reflecting or absorbing harmful UV rays. Use sunscreen regularly can reduce the risk of skin cancer, premature aging, sunburn and other skin diseases caused by UV radiation (Xu et al., 2016). Broad-spectrum sunscreen (SPF 30) application was shown to reduce nevi in children in a 2000 study (Young et al., 2017). The incidence of melasma often occurs in Indonesia, because the majority of population has Fitzpatrick IV skin type (Suryaningsih et al., 2019). Based on the description above, authors are interested in conducting research on "The Relationship between Sunscreen Application and Severity of Melasma".

Methods
The analytic observational design was used because there was no intervention or treatment for variables in data or collecting information. The research method used is quantitative research or observation was obtained through identification of the size of variation in value. The data was obtained through a questionnaire to assess the habit of using sunscreen and severity of melasma. Data was collected according to the inclusion criteria with a simple random sampling technique.

Results
were irregularly. So that some respondents have bad behavior in using sunscreen. Based on the lambda test, it is known that the significance value is 0.000 (p value <0.05). Therefore, Ho is rejected and H1 is accepted. It can be concluded there are significant relationship between use of sunscreen and severity of Melasma.  10 minutes before doing activities/exposed to UV rays. Moreover, it was found that 74.2% respondents had mild melasma, 22.6% had moderate melasma, and 3.2% had severe melasma. The severity of disease can be influenced by internal and external factors. Internal factors that affect the severity of melasma such as genetic and hormonal factors, whereas external factors such as UV rays. Several factors may affect the severity melasma to tends to be mild such as not pregnant woman (hormonal factors) and lack in outdoor activities during the pandemic, which is an average of < 3 hours.
Chi Square test showed p = 0.001 (p value<0.05) which means that there is a relationship between the use of sunscreen and the severity of melasma in women of reproductive age. These results are supported by another study which showed that there was a relationship between the use of sunscreen and the severity of melasma (Putri, 2017).
External factors or internal factors may have their own role in influencing the severity of the respondent's melasma. This study took place during pandemic so respondents were often in their homes and rarely had contact with external factors that could increase the severity of melasma. Various internal factors such as genetic and hormonal factors can also affect the severity of melasma in each individual. The results of this study are also in accordance with the theory which states that sunscreen can provide protection or prevention against melasma through protect the skin from UV rays by scattering and binding keratinocytes due to UV radiation (Seite and Park, 2013).
Compared with previous studies, smaller total number of respondents in this study might influence the results of the study to conclude the relationship between sunscreen use and the severity of melasma. Besides, in this study data collection was carried out online might reduce the level of specificity of the results due to diagnosis was made based on questionnaires and did not see the patient directly.
Thus, some of the above evidence can be used as a consideration about sunscreen application and severity of melasma is relevant and need for further studies on the variables related to the behavior of using sunscreen and severity level of melasma.

Conclusion:
Based on the results of research and data analysis, as well as the discussion that has been carried out, it can be concluded that all 31 respondents have melasma. Most of these respondents had mild melasma severity, as many as 27 respondents (74.2%) of 31 respondents. Some respondents were also stated to have bad behavior in using sunscreen, which was 54.8%. In addition, there was also a relationship between the use of sunscreen and the severity of melasma in women of reproductive age (p=0.001).

Acknowlegment
The financing is obtained independently

Conflicts of Interest
There are no conflicts of interest declared by the author