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Abstrak :
Latar belakang: Akne vulgaris (AV) adalah penyakit unit pilosebasea kronis tersering yang dapat menimbulkan dampak psikologis berat dan mengganggu kualitas hidup penderitanya. Penggunaan terapi ajuvan yaitu ekstraksi lesi akne yang dikombinasikan dengan terapi standar dapat memperbaiki kondisi klinis dan kualitas hidup penderita akne. Pengukuran kualitas hidup penting dilakukan untuk menilai keberhasilan terapi. Saat ini telah tersedia kuesioner kualitas hidup spesifik akne berbahasa Indonesia (Acne-QoL- INA) yang tervalidasi, namun belum pernah ada data mengenai perbandingan kualitas hidup antara terapi kombinasi dan terapi standar. Metode: Studi uji klinis acak terkontrol tersamar tunggal ini dilakukan pada subjek akne vulgaris dewasa derajat sedang berdasarkan kriteria Lehmann yang dibagi ke dalam kelompok terapi kombinasi standar dan ekstraksi lesi akne (terapi kombinasi) serta terapi standar tanpa ekstraksi lesi akne (terapi standar). Skor kualitas hidup berdasarkan kuesioner Acne-QoL-INA dinilai pada baseline, minggu ke-4, dan minggu ke-8 setelah terapi. Selain itu, penilaian jumlah lesi dan derajat keparahan akne diukur pada setiap kunjungan oleh seorang evaluator secara tersamar melalui foto klinis. Hasil: Sebanyak 40 subjek dengan median usia 24 tahun (18–48), 17,5% laki-laki dan 82,5% perempuan berpartisipasi dalam penelitian ini. Skor Acne-QoL-INA baseline untuk kelompok kombinasi dan kelompok terapi standar masing-masing adalah 41 (37,5– 57) dan 45,5 (37–63), meningkat menjadi 79 (67,5–94,5) dan 72,5 (59,25–98,5) pada minggu ke-8 namun tidak berbeda bermakna secara statistik antar kedua kelompok (p=0,602). Jumlah lesi baseline pada kedua kelompok masing-masing 35 dan 32, menurun menjadi 18 dan 13 pada minggu ke-8 (p<0,0001) dan perbaikan derajat keparahan menjadi akne ringan pada 100% subjek di minggu ke-8. Kesimpulan: Tidak ada perbedaan dalam skor Acne-QoL-INA dan perbaikan klinis antara kelompok terapi kombinasi dan terapi standar pada pasien AV sedang. Namun, terapi kombinasi cenderung meningkatkan kualitas hidup dan pengurangan lesi lebih baik daripada terapi standar. ......Background: Acne Vulagis (AV) is the most commom chronic disease of the pilosebaceous unit that can have a significant psychological impact and reduce the quality of life. The use of adjuvant therapy such as acne lesion extraction, in combination with standard therapy could better improve clinical outcomes and quality of life. Assessing quality of life is crucial to evaluate the success of therapy. Currently, there has been a validated acne-specific quality of life questionnaire in Indonesian (Acne-QoL-INA), but there is no existing data on the comparison of quality of life between combination therapy and standard therapy. Method: This single-blinded randomized controlled study was conducted on adult subjects with moderate acne vulgaris based on Lehmann criteria, who were divided into combinations of standard therapy with acne lesion extraction (combination therapy) group, and standard therapy without acne lesion extraction (standard therapy) group. Quality of life score based on the Acne-QoL-INA questionnaire was assessed at the baseline, 4th, and 8th week after therapy. Additionally, the assessment of lesion number and acne grading is also measured at each visit by a blinded evaluator through clinical photos. Results: A total of 40 subjects with a median age of 24 years old (18–48), comprising 17.5% males and 82.5% females, participated in this study. The baseline Acne-QoL-INA scores for the combination therapy and the standard therapy group were 41 (37.5–57) and 45.5 (37–63), respectively. These scores increased to 79 (67.5–94.5) and 72.5 (59.25– 98.5) at week 8 but did not show statistically significant differences between the two groups (p=0.602). The baseline lesion count in both groups was 35 and 32, respectively, and decreased to 18 and 13 at week 8 (p<0.0001), with an improvement in the severity to mild acne in 100% of subjects by week 8. Conclusion: There was no difference in Acne-QoL-INA scores and clinical improvement between the combination therapy and standard therapy groups in moderate AV patients. However, combination therapy tended to improve the quality of life and lesion reduction better than standard therapy.

Abstrak :
Latar Belakang: Akne vulgaris (AV) adalah peradangan kronik pilosebasea yang umum terjadi pada semua usia, terutama remaja dan dewasa muda serta dapat memengaruhi psikologis pasien. Tata laksana AV merupakan sebuah tantangan karena keberagaman dalam menentukan diagnosis dan pilihan terapi antar negara. Indonesia mempunyai beberapa pedoman tatalaksana AV yang mempunyai similaritas antara lain konsensus IAEM 2015, PPK Perdoski dan PPK RSCM di tahun 2017. Tujuan: Penelitian ini bertujuan untuk menganalisis efektivitas terapi standar AV berdasarkan panduan praktik klinis di Indonesia. Metode: Penelitian merupakan studi observasional analitik secara retrospektif di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo menggunakan rekam medis tahun 2017-2019. Sampel penelitian merupakan rekam medis pasien AV baru yang diikuti selama 3 bulan dan dengan metode total sampling. Data subjek yang diambil termasuk karakteristik sosiodemografi, karakteristik klinis, diagnosis, terapi berdasarkan PPK RSCM 2017, dan hasil terapi. Studi dan analisis dilakukan pada bulan April 2023 hingga Juli 2023. Hasil: Terdapat 131 SP yang memenuhi kriteria, 63,4% AV sedang, 20,6% AV ringan, dan 16% AV berat. Sebagian besar SP (92,4%) mempunyai AV dengan awitan sebelum usia 25 tahun. Median lama sakit AV yaitu 48 bulan. Riwayat terapi AV sebelumnya ditemukan pada 58% SP dan riwayat konsumsi obat akne pada 16% SP. Faktor risiko terbanyak berupa riwayat AV pada orang tua. Terapi utama paling banyak digunakan yaitu kombinasi retinoic acid, benzoyl peroxide, antibiotik topikal dan antibiotik oral pada 22,2% SP. Terapi standar AV secara bermakna menurunkan median jumlah lesi noninflamasi (25 vs. 8; p<0,001), median jumlah lesi inflamasi (10 vs. 2; p<001), median jumlah lesi total (41 vs. 10; p<0,001) setelah 3 bulan terapi, dengan median penurunan ketiga jumlah lesi lebih dari 50%. Proporsi derajat keparahan AV berbeda secara bermakna pada 3 bulan (p<0,001), dimana AV ringan meningkat (20,6% vs 93,1%) dan AV sedang atau berat menurun (sedang = 63,6% vs. 6,1%; berat = 16% vs. 0,8%). Kesimpulan: Terapi standar AV berdasarkan PPK di Indonesia efektif dalam mengurangi jumlah lesi noninflamasi, lesi inflamasi, dan lesi total, dan menurunkan derajat keparahan AV. ......Background: Acne vulgaris is a prevalent chronic inflammation of the pilosebaceous unit affecting all ages, especially teenagers and young adults, and often leads to psychological impairment. Management of acne vulgaris has been challenging due to various diagnostic parameters and treatment options across nations. Several treatment guidelines are available in Indonesia, of which have similarities among one another, such as consensus by Indonesian Acne Expert Meeting in 2015 and clinical practice guidelines by the Indonesian Society of Dermatology and Venereology and by Dr. Cipto Mangunkusumo National Central General Hospital in 2017. Objective: This study aims to investigate the effectiveness of standard therapy for acne based on the clinical practice guidelines in Indonesia Methods: This is an analytical retrospective observational study using medical records from Dr. Cipto Mangunkusumo National Central General Hospital between 2017 – 2019. Research samples were medical records of new acne patients followed for 3 months by a total sampling technique. Extracted data included sociodemographic and clinical characteristics, diagnosis, and therapy based on the clinical practice guideline by Dr.Cipto Mangunkusumo National Central General Hospital in 2017 and the results. This study was conducted from April 2023 to July 2023. Results: There were 131 subjects included, of which 63,4% were with moderate acne, 20,6% with mild acne, and 16% with severe acne. Most participants (92,4%) experienced acne for the first time before 25 years old. The median duration from the first occurrence of acne to the visit was 48 months. History of topical and oral acne therapy was found in 58% and 16% of participants, respectively. History of acne in parents was the most reported risk factor. Most subjects (22,2%) received a combination of retinoic acid, benzoyl peroxide, topical antibiotic, and oral antibiotic. Standard therapies significantly reduced the median of non-inflammatory lesions (25 vs. 8; p<0,001), inflammatory lesions (10 vs. 2; p<001), and total lesions (41 vs. 10; p<0,001) after a 3 month-therapy, with the median of reduction for all type of lesions over 50%. The proportion of acne severity differed significantly after three months (p<0,001), with an increasing proportion of mild acne (20,6% vs 93,1%) and decreasing percentage of moderate and severe acne (moderate = 63,6% vs. 6,1%; severe = 16% vs. 0,8%). Conclusion: Standard therapy for acne vulgaris in clinical practice guidelines in Indonesia is effective for noninflammatory lesions, inflammatory lesions, and total lesions, as well as acne severity after 12 weeks.