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Abstrak :
Latar Belakang: Psoriatic arthritis (PsA) merupakan inflamasi muskuloskeletal yang progresif. Psoriasis kuku merupakan faktor prediktor kuat PsA dengan prevalensi mencapai 87%. Skor modified nail psoriasis severity index (mNAPSI) merupakan salah satu penilaian derajat keparahan psoriasis kuku dengan reliabilitas interrater yang baik. Beberapa penelitian menunjukkan hubungan antara skor mNAPSI dengan PsA serta kerusakan sendi interfalang distal, sehingga dipikirkan bahwa derajat keparahan kuku dapat dijadikan sebagai penapisan kejadian PsA serta kaitannya dengan aktivitas penyakit PsA. Tujuan: Menilai hubungan derajat keparahan kuku menggunakan skor mNAPSI dengan kejadian PsA dan korelasi skor mNAPSI dengan derajat keparahan PsA menggunakan skor clinical disease activity for psoriatic arthritis (cDAPSA). Sebagai hasil tambahan, dilakukan penilaian korelasi skor psoriasis area severity index (PASI) dan cDAPSA. Secara deskriptif menilai proporsi kelainan psoriasis kuku secara klinis maupun dermoskopi pada pasien PsA dan tanpa PsA. Metode: Penelitian observasional analitik. Setiap subyek penelitian (SP) dengan psoriasis kuku yang telah memenuhi kriteria inklusi dan eksklusi dilakukan perhitungan mNAPSI, diagnosis PsA menggunakan classification criteria for psoriatic arthritis (CASPAR), dan menentukan derajat keparahan PsA dengan cDAPSA. Analisis statistik yang sesuai untuk membuktikan hipotesis penelitian. Nilai p <0,05 dianggap signifikan secara statistik. Hasil: Di antara 34 SP terdapat 15 SP yang mengalami PsA. Hubungan antara skor mNAPSI dengan kejadian PsA dianalisis menggunakan ROC dengan hasil nilai area under ROC curve (AUC) 0,58. Korelasi antara skor mNAPSI dengan cDAPSA adalah 0,217 (p=0,437). Terdapat korelasi positif antara PASI dan cDAPSA (r=0,621; p=0,013). Kelainan kuku terbanyak pada penelitian ini adalah onikolisis (72,6%), leukonikia (19,6%), diikuti dengan oil drop dan crumbling masing-masing 12,8%. Seluruh kelainan kuku lebih mudah dilihat dengan dermoskopi, kecuali pitting dan Beau’s line. Kesimpulan: Skor mNAPSI memiliki hubungan lemah dengan kejadian PsA, sehingga tidak dapat digunakan sebagai penapisan kejadian PsA. Selain itu, mNAPSI memiliki korelasi lemah dengan cDAPSA, sehingga derajat kerusakan kuku tidak mencerminkan derajat keparahan PsA. ......Background: Psoriatic arthritis (PsA) is a progressive musculoskeletal inflammation. Nail psoriasis is a strong predictor of PsA with a prevalence of 87%. The modified nail psoriasis severity index (mNAPSI) score is an objective score for evaluating the severity of nail psoriasis and has excellent interrater reliability. Several studies have shown a correlation between mNAPSI scores and PsA and distal interphalangeal joint damage, so it is thought that the severity of the nail can be used as a screening for the incidence of PsA. Objective: This study aims to assess the relationship between nail severity using the mNAPSI score with the incidence of PsA and to assess the correlation between the mNAPSI score with PsA severity using the clinical disease activity for psoriatic arthritis (cDAPSA) score. In addition, the correlation between psoriasis area severity index (PASI) and cDAPSA scores was also carried out as additional results. This study also descriptively assessed the proportion of psoriasis nail abnormalities both clinically and dermoscopy in patients with PsA and without PsA. Methods: This research is an analytic observational. All research data are recorded in the research status. Each subject met the inclusion and exclusion criteria, calculated the mNAPSI score, diagnosed PsA using the classification criteria for psoriatic arthritis (CASPAR) score, and determined the severity of PsA with the cDAPSA score. Appropriate statistical analysis was performed to prove the research hypothesis. P value < 0.05 was considered statistically significant. Results: Among 34 subject, 15 (44%) experienced PsA. The relationship between the mNAPSI score and the incidence of PsA was analyzed using ROC. Based on this analysis, the area under ROC curve (AUC) value was 0.58. The correlation between mNAPSI and cDAPSA scores was 0.217 (p=0.437). There was a positive correlation between the PASI value and cDAPSA and it was statistically significant (r=0.621; p=0.013). The most common nail abnormalities in this study were onycholysis (72.6%), leukonychia (19.6%), followed by oil drop and crumbling (12.8%). All nail abnormalities are easier to see with dermoscopy, except for pitting and Beau's line. Conclusion: The mNAPSI score has a weak relationship with the incidence of PsA, so it cannot be used as a screening for the incidence of PsA. In addition, this score also has a weak correlation with the cDAPSA score, so the degree of nail damage does not reflect the severity of PsA.

Abstrak :
Latar Belakang Kortikosteroid merupakan obat dengan fungsi imunosupresif dan antiinflamasi. Kortikosteroid dalam sediaan topikal umum digunakan untuk mengobati berbagai dermatosis. Efek kortikosteroid topikal (KST) yang cepat dalam meredakan gejala dermatosis menyebabkan maraknya pemakaian KST di kalangan dokter. Penggunaan KST yang salah dikhawatirkan memicu efek samping seperti penipisan kulit atau supresi tumbuh kembang. Oleh karena itu, penggunaan KST sebagai tatalaksana memerlukan pengetahuan, sikap, dan perilaku dokter umum yang baik. Namun, belum terdapat penelitian terkait pengetahuan, sikap, dan perilaku dokter umum terhadap penggunaan KST di Indonesia. Pada studi ini, akan dieksplorasi tingkat pengetahuan, sikap, dan perilaku dokter umum terhadap penggunaan KST. Metode Instrumen penelitian yang digunakan berupa kuesioner yang dinilai validitasnya menggunakan uji korelasi Pearson dengan nilai signifikansi <0,05. Reliabilitas kuesioner dinilai dari koefisien Cronbach’s Alpha. Data penelitian dianalisis secara deskriptif untuk menilai tingkat pengetahuan, sikap, dan perilaku dokter umum terhadap penggunaan KST. Hasil Responden telah memiliki pengetahuan yang baik terhadap KST (72,1%). Sebagian besar responden memiliki sikap yang positif terhadap kenyamanan penggunaan KST (76%) dan kepuasan terhadap hasil tatalaksana KST (74,1%). Sebanyak 98,1% responden telah memberikan/meresepkan KST. Terdapat 1,9% responden yang meresepkan KST tidak sesuai indikasi. Kesimpulan Tingkat pengetahuan dokter umum terhadap KST baik. Sebagian besar dokter umum memiliki sikap positif terhadap penggunaan KST. Mayoritas dokter umum telah meresepkan KST dengan indikasi yang sesuai. ......Introduction Corticosteroids are medications with immunosuppressive and anti-inflammatory functions. Topical corticosteroids (TCS) are commonly used to treat various dermatoses. The rapid effects of TCS in relieving dermatosis symptoms have led to its widespread use. Improper use of TCS may trigger side effects such as skin thinning or growth suppression. Therefore, the use of TCS requires good knowledge, attitude, and behavior from doctors. However, there is currently no research on the knowledge, attitude, and behavior of general practitioners regarding the use of TCS in Indonesia. This study explore the level of knowledge, attitude, and behavior of general practitioners regarding the use of TCS. Method The research instrument used is questionnaire, and its validity is assessed using Pearson correlation with significance level of <0.05. The reliability of the questionnaire is evaluated through the Cronbach's Alpha coefficient. Research data is analyzed descriptively to assess the level of knowledge, attitude, and behavior of general practitioners regarding the use of TCS. Results The respondents exhibited good knowledge of TCS (72.1%). Majority of respondents demonstrated positive attitude toward the comfort of using TCS (76%) and satisfaction with the results of TCS management (74.1%). A total of 98.1% of the respondents have prescribed TCS. There were 1.9% of respondents who prescribed TCS outside the recommended indications. Conclusion The level of knowledge among general practitioners regarding TCS is good. Majority of general practitioners have positive attitude towards the use of TCS. Most general practitioners have prescribed TCS with correct indications.

Abstrak :
ABSTRAK Latar Belakang. Dermatitis pada tangan akibat kerja DTAK bersifat kronis, memiliki prognosis buruk, dan berdampak signifikan terhadap aspek psikososial dan pekerjaan. Prevalensi dermatitis kontak pada tenaga kerja bongkar muat TKBM Pelabuhan Sunda Kelapa Jakarta adalah sebesar 24,3 , dengan lesi di tangan 47,1 . Penggunaan alat pelindungdiri APD masih belum cukup untuk mengatasi masalah ini, sehingga dibutuhkan intervensi lain. Penggunaan pelembap untuk memperbaiki sawar kulit dipertimbangkan efektif untuk mencegah keparahan DTAK.Metode. Penelitian ini adalah kuasi eksperimental satu kelompok. Intervensi dilakukan dengan menggunakan gliserin 10 dalam vaselin album sekali sehari setelah bekerja selama 14 hari.Hasil. Rerata nilai transepidermal water loss TEWL setelah intervensi 11,4 3,8 g/m2/jam lebih rendah dibandingkan rerata nilai TEWL awal 14,2 4 g/m2/jam , dengan perbedaan rerata nilai TEWL sebesar 2,8 2,9 g/m2/jam p= 0,000 95 CI 1,5-4,1 . Median nilai hand eczema severity index HECSI setelah intervensi 9,5 3-34 lebih rendah dibandingkan median skor HECSI awal 29,5 6-80 , dengan perbedaaan rerata skor HECSI sebesar 19,5 -2-46 p= 0,000 . Korelasi antara perubahan nilai TEWL dan perubahan skor HECSI tidak bemakna p= 0,476 dengan kekuatan korelasi sangat lemah r= 0,160 . Variabel exposure rating tahunan debu semen berhubungan dengan perubahan skor HECSI p= 0,002 . Setelah intervensi seluruh lesi di jari-jari, telapak tangan, punggung tangan dan pergelangan tangan mengalami perbaikan yang bermakna.

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ABSTRACT Background. Occupational hand dermatitis OHD is chronic, has a poor prognosis, and significantly affects psychosocial and occupational aspects. The prevalence of contact dermatitis of loading dockworkers at Port Sunda Kelapa Jakarta was 24,3 and 47,1 lesion was on the hands. The use of personal protective equipment PPE is deemed inadequate to solve this problem, thus requiring other intervention. Using moisturizer for improvement of skin barrier is considered to be effective for preventing severity of occupational hand dermatitis.Method. The study design was quasi experimental one group pre and post test design. The 14 days intervention was performed on the loading dockworkers by instructing them to apply 10 glycerin in vaseline album on their hands once daily after working.Result. The mean value of transepidermal water loss TEWL after intervention 11.4 3.8 g m2 hour was lower than the mean value of TEWL before the intervention 14.2 4 g m2 hour . The TEWL mean difference was 2.8 2.9 g m2 hour p 0.000 95 CI 1.53 4.1 . The median value of hand eczema severity index HECSI after intervention 9.5 3 34 was lower than the median value of HECSI before the intervention 29,50 6 80 . The HECSI mean difference was 19.5 2 46 p 0,000 . The correlation between TEWL changes and HECSI changes was not significant p 0.476 and the correlation strength was very weak r 0.160 . Annual exposure rating of cement dust associated with the HECSI changes p 0,002 . After intervention, all lesions on the fingers, palms, back of hand and wrist were significantly improved p 0,05 , except for the finger tips. Additional analysis showed that the commonly found morphology of the lesion was infiltrate papule, scaling and erythema. After intervention, the severity score of the morphology lesions was also significantly decreased p 0,05 .Conclusion. Once daily application of 10 glycerin in vaseline album for 14 days could improved skin barrier function and the severity of OHD, thus can be advised for loading dockworkers with high annual exposure rating of cement dust.

Abstrak :
Pendahuluan: Pekerjaan basah merupakan faktor risiko utama terjadinya dermatitis kontak akibat kerja (DKAK) pada tangan. Terdapat dua jenis faktor risiko DKAK yaitu faktor eksogen, seperti jenis pekerjaan dan jumlah jam kerja mingguan; dan faktor endogen, seperti jenis kelamin, usia, dan riwayat penyakit atopik. Tujuan penelitian ini untuk menganalisis faktor-faktor yang berhubungan dengan kejadian DKAK pada pekerja basah. Metode: Desain penelitian ini adalah cross-sectional. Teknik pengambilan sampel menggunakan total sampling. Jumlah sampel penelitian sebanyak 134 orang. Kriteria inklusi yaitu pekerja basah yang telah bekerja minimal 6 bulan dan tidak berganti pekerjaan minimal 6 bulan. Kriteria eksklusi yaitu pekerja basah yang mengalami dermatitis kontak bukan akibat kerja. Variabel independen yaitu jenis pekerjaan, jumlah jam kerja mingguan, usia, jenis kelamin, dan riwayat penyakit atopik. Variabel dependen yaitu DKAK. Hasil: Tidak ada hubungan antara jenis pekerjaan (p value = 0,283), jumlah jam kerja mingguan (p value = 0,313), jenis kelamin (p value = 0,652), dan usia (p value = 0,556) terhadap kejadian DKAK pada pekerja basah. Terdapat hubungan yang signifikan antara riwayat atopi dengan kejadian DKAK pada pekerja basah. Riwayat atopi memiliki pengaruh terhadap hubungan antara jenis pekerjaan dengan DKAK (p value < 0,001). Pekerjaan sebagai tenaga kesehatan dapat mencegah kejadian DKAK sebesar 90,3% dibandingkan dengan pekerjaan sebagai non tenaga kesehatan setelah dikontrol dengan faktor risiko riwayat atopi. Kesimpulan: Tidak terdapat hubungan antara jenis pekerjaan, jumlah jam kerja mingguan DKAK lebih tinggi pada tenaga non kesehatan dibandingkan tenaga kesehatan karena tenaga non kesehatan memiliki lebih banyak pajanan terhadap pekerjaan basah dan pajanan bahan iritan dibandingkan dengan tenaga kesehatan serta tindakan pencegahan terhadap kejadian DKAK yang dilakukan tenaga non kesehatan lebih sedikit dibandingkan oleh tenaga kesehatan. Terdapat hubungan yang signifikan antara riwayat atopi dengan kejadian DKAK. Tenaga non kesehatan dengan riwayat atopi merupakan faktor yang paling berpengaruh terhadap kejadian DKAK pada pekerja basah. ......Introduction: Wet work is the main risk factor for Occupational contact dermatitis (OCD) on the hands. Risk factors for OCD consist of two types: exogenous factors, such as type of occupation and number of weekly working hours; and endogenous factors, such as gender, age, and history of atopic disease. This study aims to analyze the factors related to the incidence of OCD in wet workers. Method: The study design is cross-sectional. The sampling technique used total sampling. There were 134 research samples. Inclusion criteria are wet workers who have worked for at least 6 months and have not changed occupations for at least 6 months. Exclusion criteria include wet workers who experience non-occupational contact dermatitis. The independent variables are type of occupation, number of weekly working hours, age, gender, and history of atopic disease. The dependent variable is OCD. Result: This study did not find any relationship between type of occupation (p value = 0,283), number of weekly working hours (p value = 0,313), gender (p value = 0,652), and age (p value = 0,556) on the incidence of OCD in wet workers. Meanwhile, this study found a significant relationship between history of atopic disease and incidence of OCD in wet workers. History of atopic disease has an influence on the relationship between type of occupation and OCD (p value < 0,001). An occupation as a health worker can prevent the incidence of OCD by 90,3% compared to an occupation as a non-health worker after being controlled by the risk factor of a history of atopic disease. Conclusion: There is no relationship between type of occupation, number of weekly working hours, gender and age to the incidence of OCD in wet workers. The proportion of OCD incidence is higher in non-health workers than health workers due to non-health workers having more exposure to wet work and irritant exposure than health workers. Besides that, the number of non-health workers who take preventive measures to prevent OCD incidence is less than health workers. There is a significant relationship between history of atopic disease and the incidence of OCD. Non-health workers with a history of atopic disease is the most influential factor in the incidence of OCD in wet workers.

Abstrak :
Latar belakang: Alopesia androgenetik (AAG) adalah kebotakan rambut yang paling umum, ditandai dengan miniaturisasi progresif tanpa jaringan parut pada pria, akibat kerentanan terhadap hormon androgen. Penyakit ini terjadi secara multifaktorial, dari faktor genetik, lingkungan dan hormon androgen. Penyakit ini menyebabkan gangguan kosmetik yang mempengaruhi kualitas hidup dan rasa percaya diri. Hingga saat ini belum ada data mengenai kadar ferritin serum dan rambut pada pria dengan AAG yang dibandingkan dengan kelompok non-alopesia dan dikaitkan dengan densitas dan diameter rambut. Penelitian ini bertujuan menganalisis perbedaan kadar feritin serum dan besi total rambut pada populasi AAG dan non-alopesia.

Metode: Penelitian ini merupakan suatu studi analitik observasional potong lintang antara dua kelompok. 33 pria dengan diagnosis alopesia androgenetik dan 33 pria tanpa alopesia androgenetik diikutsertakan dalam penelitian ini. Diagnosis alopesia androgenetik ditegakkan secara klinis. Kadar feritin serum dan total besi rambut pasien dibandingkan antara dua kelompok dan dikorelasikan dengan dengan diameter dan densitas rambut.

Hasil: Sebanyak 66 SP mengikuti penelitian dengan median usia 37-38 tahun. Feritin serum dan besi total rambut pada kelompok alopesia androgenetik lebih tinggi dibandingkan kelompok non-alopesia. Median 232 ng/mL, dan 222 ng/mL,  Tidak terdapat perbedaan bermakna antara kedua kelompok (p = 0,758). Kadar besi total pada kelompok AAG lebih rendah dibandingkan non-alopesia. (22,65 ng/mL dan 39,67 ng/mL, p= 0,102). Terdapat korelasi positif lemah pada kelompok alopesia androgenetik derajat < 4 terhadap diameter rambut.

Kesimpulan: Kadar serum feritin dan besi total rambut pada pria non-alopesia lebih tinggi dibandingkan pria dengan alopesia androgenetik, namun tidak bermakna secara statistik. ......Background: Androgenetic alopecia (AGA) is the most common nonscarring hair loss disorder in men due to susceptibility to testosterone. AGA is amultifactorial disease, due to genetic, hormonal and environmental influence. AGA causes cosmetic disturbances that affects confidence and quality of life. In women, it has been proven correlation between low ferritin serum and AGA occurrences, however not many studies have proven likewise in men. Till now, not many data provides sufficient correlation between ferritin levels and hair iron concentration in men with control group, associated with hair diameter and density. This study aims to compare the differences of serum ferritin and hair iron content between two populations.

Method: This is a cross-sectional analysis of two groups, 33 AGA men and 33 men without AGA were included in this study. Serum ferritin and hair level of iron were measured. Diagnosis of AGA was made clinically. Difference of serum ferritin and hair level of iron was analyzed and correlated with hair diameter and density.

Result: 66 men were included in this study. Median age was 37-38 year-old. Ferritin serum (232 ng/mL) and hair iron (39,67 ng/mL) was slightly higher in control group as compared to alopecia androgenetic group (ferritin 222 ng/mL and hair iron 22,65 ng/mL), but there was no statistically significant result (p = 0,758 and p = 0,102). Hair iron level correlates weakly positive with hair diameter in subgroup analysis.

Conclusion: Serum ferritin and hair iron level in non-alopecia population is higher compared to alopecia androgenetic men, but statistically insignificant

Abstrak :
Latar Belakang TOPICOP adalah suatu skala yang dikembangkan untuk mengevaluasi topical steroidphobia pada pasien dermatitis atopik atau orang tuanya yang telah menjalani validasi statistik awal. TOPICOP dibuat dan diuji di Perancis, namun dimensi yang dieksplorasi pada kuesioner ini tidak terbatas pada pasien di Perancis dan validasi skala lebih lanjut di negara dan budaya lain diperlukan untuk memfasilitasi studi perbandingan internasional. Saat ini, belum tersedia instrumen penilaian prevalensi fobia steroid topikal di Indonesia. Oleh karena itu, dibutuhkan terjemahan serta uji validasi dan reliabilitas untuk membuat kuesioner TOPICOP berbahasa Indonesia agar dapat digunakan untuk penelitian dan pelayanan. Setelah divalidasi, akan dilakukan survey terhadap responden terkait topical steroid-phobia. Metode Kuesioner TOPICOP asli berbahasa Inggris diterjemahkan ke Bahasa Indonesia. Pengisian kuesioner TOPICOP ini dilakukan pada 30 subjek penelitian (SP) di Poliklinik Kulit dan Kelamin dr. Cipto Mangunkusumo (RSCM). Uji validitas dilakukan dengan menghitung nilai Pearson Correlation dan nilai signifikansi. Uji reliabilitas dilakukan dengan menghitung nilai Cronbach’s alpha. Hasil Terjemahan kuesioner TOPICOP asli berbahasa Inggris menghasikan kuesioner TOPICOP versi Bahasa Indonesia. Rentang nilai Pearson Correlation. pada seluruh pernyataan pada kuesioner ini sebesar 0,162-0,768 dan nilai signifikansi berada di rentang 0,000001-0,394. Terdapat tiga butir kuesioner yang tidak valid, yaitu BEL1, WOR2, dan BEH3. Nilai uji reliabilitas konsistensi internal pada pertanyaan yang valid pada kuesioner ini sebesar 0,826. Kesimpulan Perlu dilakukan beberapa modifikasi pada beberapa butir instrumen kuesioner TOPICOP agar dapat memenuhi uji validitasi. ......Introduction TOPICOP is a scale developed to evaluate topical steroid-phobia in atopic dermatitis patients or their parents that has undergone initial statistical validation. TOPICOP was created and tested in France, however the questionnaire are not limited to patients in France and further validation of the scale in other countries and cultures is needed to facilitate international comparative studies. Currently, there is no instrument available to assess the prevalence of topical steroid phobia in Indonesia. Translation as well as validation and reliability tests are needed to create a TOPICOP questionnaire in Indonesian so that it can be used for research and services. After validation, a survey will be conducted on respondents regarding topical steroid-phobia Method The original TOPICOP questionnaire in English was translated into Indonesian. Filling out the TOPICOP questionnaire was answered by 30 research subjects at the Dermatology and Venereology clinic of dr. Cipto Mangunkusumo. The validity test is carried out by calculating the Pearson Correlation value and significance value. The reliability test was carried out by calculating the Cronbach's alpha value. Results The translation of the original TOPICOP questionnaire into English produces the Indonesian version of the TOPICOP questionnaire. Pearson Correlation value range. for all statements in this questionnaire it is 0.162-0.768 and the significance value is in the range 0.000001-0.394. There are three invalid questionnaire items, namely BEL1, WOR2, and BEH3. The internal consistency reliability test value for valid questions on this questionnaire is 0.826. Conclusion Several modifications need to be made to several items of the TOPICOP questionnaire instrument so that they can meet the validity test.

Abstrak :

ABSTRAK

 

Nama                   : Yenny Rachmawati

Program studi      : Dermatologi dan Venereologi

Judul                    : Perbandingan Efektivitas serta Keamanan antara Krim Pelembap Niasinamid 4% dan Virgin Coconut Oil 30% untuk Pencegahan Sekunder Dermatitis Tangan Akibat Kerja pada Perawat Intensive Care Unit : Uji Klinis Acak Tersamar Ganda

 

Latar belakang:  Dermatitis tangan akibat kerja (DTAK) sering terjadi pada perawat Intensive Care Unit (ICU) terutama pada individu yang rentan akibat pajanan iritan berupa hand rub alcohol dan aktivitas cuci tangan berulang. Penggunaan pelembap adalah salah satu rekomendasi untuk perawatan kulit pada DTAK. Niasinamid memiliki efek antiinflamasi dan dapat memperbaiki fungsi sawar kulit. Vigin coconut oil (VCO) kaya akan kandungan lipid dan asam laurat, serta memiliki efek oklusif. Sampai saat ini belum ada panduan dan referensi jenis pelembap untuk pencegahan sekunder pada DTAK.

 

Tujuan: Mengetahui perbandingan efektivitas serta keamanan antara krim pelembap niasinamid 4% dan VCO 30% untuk pencegahan sekunder dermatitis tangan akibat kerja pada perawat ICU.

 

Metode: Penelitian ini merupakan uji klinis acak tersamar ganda terhadap perawat ICU dengan DTAK pada bulan September hingga Oktober 2019. Pasien yang memenuhi kriteria penerimaan dan bersedia mengikuti penelitian, mendapat niasinamid 4% atau VCO 30% sesuai dengan randomisasi blok. Pengolesan pelembap dilakukan dua kali sehari selama 28 hari. Perbaikan klinis dinilai dengan parameter skor Hand Eczema Scoring Index (HECSI) dan penilaian sawar kulit dinilai dengan transepidermal water loss (TEWL) serta hidrasi kulit dengan skin capasitance (SCap) pada hari ke-14 dan hari ke-28. Keamanan dinilai berdasarkan efek samping selama penelitian.

 

Hasil: Didapatkan 46 SP pada masing-masing kelompok niasinamid 4% dan VCO 30%. Terdapat penurunan skor HECSI pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28. Median skor HECSI  di kelompok niasinamid 4% dan VCO 30%  pada hari ke-14 yaitu 6,5 dan 6 (p 0,160), serta pada hari ke-28 yaitu 4 dan 3 (p 0,046). Pada hari ke-28, perbedaan skor HECSI kedua kelompok secara statistik bermakna, namun secara klinis tidak bermakna. Terdapat penurunan nilai TEWL pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28 dibandingkan baseline, namun pada area palmar di kelompok niasinamid 4% terdapat sedikit peningkatan nilai TEWL pada hari ke-28. Terdapat peningkatan nilai SCap pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28 dibandingkan baseline. Kedua pelembap dapat ditoleransi dengan baik dengan efek samping minimal.

 

Kesimpulan: Niasinamid dan VCO efektif memperbaiki klinis DTAK pada perawat ICU, walaupun tidak terdapat perbedaan bermakna antara krim pelembap niasinamid 4% dengan VCO 30% untuk pencegahan sekunder dermatitis tangan akibat kerja pada perawat ICU

 

Kata kunci: dermatitis tangan akibat kerja, efektivitas, keamanan, pelembap, niasinamid 4%, VCO 30%

 

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ABSTRACT

 

Name                 : Yenny Rachmawati

Study Program : Dermatologi dan Venereologi

Title                   : Comparison of the Effectiveness and Safety between Moisturizing Cream Containing Niacinamide 4% and Virgin Coconut Oil 30% for Secondary Prevention of Occupational Hand Dermatitis in Intensive Care Unit Nurses: a Double Blind Randomized Clinical Trial

 

Background:  Occupational hand dermatitis (OHD) often occurs in intensive care unit (ICU) nurses, especially in individuals who are vulnerable due to irritant exposure e.g. hand rub alcohol and repeated hand washing activities. The use of moisturizer is one of the recommendations for skin care in OHD. Niacinamide which has anti-inflammatory effects and can improve the skin sawar function. Virgin coconut oil (VCO) is rich in lipids and lauric acid, and has an occlusive effect. Until now there are no guidelines and reference types of moisturizers for secondary prevention in OHD.

 

Objective: To assess the difference of effectiveness and safety between moisturizing cream containing niacinamide 4% and VCO 30%  for secondary prevention of occupational hand dermatitis in ICU nurses

 

Methods: A double blind randomized controled trial was performed in ICU nurses with OHD during September–October 2019. Patients who fulfilled inclusion criteria and willing to be involved in the study were allocated to niacinamide 4% or VCO 30% based on block randomization.  Moisturizer were applied twice daily for 28 days. Measurement of Hand Eczema Scoring Index (HECSI) scores were conducted to evaluate the clinical improvement . Measurement of transepidermal water loss (TEWL) were conducted to evaluate the barrier skin and skin capacitance (SCap) values were conducted to evaluate skin hydration on 14^th and 28^th day. Safety were assessed based on side effects during research.

 

Results: There were 46 subjects in each arms of intention, the niacinamide 4% arm and in the VCO 30% arm. There were a decrease in HECSI scores in both treatment groups on 14^th and 28th  day. The median score of HECSI in niacinamide 4% and VCO 30% on 14^th day were 6.5 and 6 (p 0.160), and on 28^th day were 4 and 3 (p 0.046). On 28^th day, the difference in HECSI scores of the two groups were statistically significant, but clinically not significant. There were a decrease in TEWL values in both treatment groups on 14^th and  28^th day compared to baseline, but there were a slight increase in TEWL values in the palmar area in the niacinamide group on 28^th day. There were an increase in SCap values in both treatment groups on 14^th and 28^th day compared to baseline. Both moisturizers were well tolerated with minimal side effects.

 

Conclusion: Niacinamide 4% and VCO 30% were effective in improving clinical OHD in ICU nurses, although there were no significant difference between moisturizing cream containing niacinamide 4% and virgin coconut oil 30% for secondary prevention of occupational hand dermatitis in ICU nurses.

 

Keywords: occupational hand dermatitis, effectiveness, safety, moisturizer, niacinamide 4%, VCO 30%

Abstrak :
Latar belakang: Saat ini, peran vitamin D dalam berbagai penyakit kronis banyak diteliti. Vitamin D dianggap memiliki efek imunomodulator sehingga diduga berkaitan dengan beberapa penyakit alergi dan autoimun, termasuk urtikaria kronik. Terdapat laporan kadar vitamin D yang rendah pada pasien urtikaria kronik dan suplementasi vitamin D terbukti memperbaiki gejala urtikaria kronik yang dinilai dengan kuesioner yang sudah tervalidasi Urticaria activity score 7 (UAS7). Namun, penelitian mengenai korelasi kadar vitamin D serum dengan aktivitas penyakit urtikaria masih terbatas, terutama di Indonesia. Tujuan: Menganalisis korelasi kadar vitamin D (25[OH]D) serum dengan aktivitas penyakit pada pasien urtikaria kronik. Metode: Penelitian deskriptif-analitik dengan desain potong lintang. Tiga puluh pasien urtikaria kronik usia 18–59 tahun yang memenuhi kriteria penerimaan dan penolakan direkrut dalam penelitian ini. Penilaian aktivitas penyakit menggunakan UAS7 dan dilakukan pengukuran kadar 25(OH)D serum. Korelasi kadar 25(OH)D serum dan aktivitas penyakit dilakukan dengan menggunakan analisis Spearman. Penelitian ini juga menilai kecukupan pajanan matahari menggunakan kuesioner pajanan matahari mingguan. Hasil: Rerata skor UAS7 adalah 14,63±7,8, median durasi penyakit adalah 12 (2–120) bulan, median skor pajanan matahari mingguan adalah 8 (2–34), dan median kadar 25(OH)D serum adalah 12,10 ng/mL (6,85–29.87). Mayoritas subjek mengalami defisiensi vitamin D (80%). Tidak terdapat korelasi antara kadar 25(OH)D serum dengan aktivitas penyakit (r=0,151; p=0,425), tetapi didapatkan korelasi negatif kuat yang bermakna pada kelompok defisiensi vitamin D berat (r=-0,916; p=0,001). Terdapat korelasi positif sedang bermakna antara aktivitas penyakit dan durasi penyakit (r=0,391; p=0,033). Pada kuesioner pajanan sinar matahari mingguan, didapatkan perbedaan bermakna skor bagian tubuh yang terpajan matahari antar kelompok insufisiensi dan defisiensi vitamin D (p=0,031). Kesimpulan: Tidak terdapat korelasi kadar 25(OH)D serum dengan aktivitas penyakit pasien urtikaria kronik, namun terdapat kecenderungan peningkatan aktivitas penyakit pada kelompok defisiensi berat vitamin D. ......Background: Nowadays, the role of vitamin D in various chronic diseases is a matter of great interest. Vitamin D is thought to have an immunomodulatory effect so it is thought to be associated with several allergic and autoimmune diseases, including chronic urticaria. There have been reports of low vitamin D levels in patients with chronic urticaria and vitamin D supplementations has been shown to improve symptoms of chronic urticaria which was assessed by a validated questionnaire Urticaria activity score 7 (UAS7). However, data on the correlation between serum vitamin D levels and disease activity in chronic urticaria are still limited, especially in Indonesia. Objective: To analyze the correlation between vitamin D (25[OH]D) serum and disease activity in chronic urticaria patients. Methods: This is an analytic-descriptive cross-sectional study. Thirty chronic urticaria patients age 18 – 59 years old who meet all inclusion and exclusion criterias were recruited in this study. Assessment of disease activity using UAS7 and measurement of 25(OH)D serum levels were performed. Correlation of 25(OH)D serum levels and disease activity was done using Spearman analysis. In this study, an assessment of sun exposure adequacy was carried out using a weekly sunlight exposure questionnaire. Results: The mean of UAS7 was 14.63±7.8, median duration of illness was 12 (2 – 120) month, median weekly sunlight exposure score was 8 (2 – 34), and the median serum 25(OH)D was 12.10 ng/mL (6.85 – 29.87). The majority of subjects had vitamin D deficiency (80%). There was no correlations between serum 25(OH)D levels and disease activity (r=0.151; p=0.425). However, a significant negative correlation was found in severe deficiency vitamin D group (r=-0.916; p=0.001). There was also significant moderate correlation between disease activity and duration of illness (r=0.391; p=0.033). In weekly sunlight exposure questionnaire, we found that body surface area score was significantly different between insufficiency and deficiency vitamin D groups (p=0,031). Conclusion: There was no correlation between serum 25(OH)D levels and disease activity in chronic urticaria patients, however there was a tendency of increasing disease activity in severe deficiency vitamin D group

Abstrak :
Latar belakang: Diabetes melitus (DM) dapat menimbulkan komplikasi kulit kering yang berkorelasi dengan pembentukan ulkus pada pasien DM. Pemakaian pelembap sebagai bagian dari perawatan kaki dapat mencegah pembentukan ulkus. Tujuan: Mengetahui efektivitas dan keamanan pelembap yang mengandung krim urea 10% dan vaselin album untuk mengatasi kulit kering pada pasien DM tipe 2. Metode: Uji klinis acak tersamar ganda dilakukan pada 68 pasien DM tipe 2 dengan kulit kering pada bulan Juli-Oktober 2018. Setiap subjek penelitian mendapat terapi krim urea 10% atau vaselin album untuk masing-masing tungkai. Perbaikan kulit kering dilihat dari skor klinis specified symptom sum score (SRRC), hidrasi kulit (korneometer) dan fungsi sawar kulit (tewameter) pada minggu kedua dan keempat. Hasil: Tidak terdapat perbedaan efektivitas yang bermakna antara kelompok krim urea 10% dan vaselin album. Kedua pelembap ini tidak menimbulkan efek samping. Kesimpulan: Kedua jenis pelembap ini sama efektif dan dapat dipertimbangkan untuk terapi kulit kering pada pasien DM tipe 2. ......Background: Diabetes mellitus (DM) could cause xerotic skin which correlates with ulcer formation in DM patients. Daily use of moisturizer as part of foot care were expected to prevent it. Objective: To asses the effectiveness and safety of moisturizers containing 10% urea cream and white petrolatum in overcoming dry skin in type 2 DM patients. Methods: A double blind randomized clinical trial was conducted on 68 diabetes patients with xerotic skin in July-October 2018. Each study subject received 10% urea cream or white petrolatum for each leg. Repair of xerotic skin assessed from the specified symptom sum score (SRRC), skin hydration (corneometer) and skin barrier function (tewameter) in the second and fourth weeks. Results: There was no significant difference in effectiveness between the two groups. Both moisturizers were well tolerated.

Abstrak :
Latar Belakang: Rambut memiliki berbagai fungsi, salah satunya sebagai perkiraan usia individu. Kanitis, atau uban, merupakan tanda penuaan yang muncul pada rambut yang umumnya terjadi pada dekade ke-4 kehidupan. Kanitis prematur (KP) merupakan istilah munculnya kanitis sebanyak 5 helai rambut sebelum usia 25 tahun pada ras Asia. Etiologi penyakit KP belum sepenuhnya dipahami dan dianggap sebagai kelainan multifaktorial. Defisiensi mikronutrien tertentu, meliputi besi dan seng, diperkirakan berperan dalam munculnya KP. Oleh karena itu, diperkirakan kadar besi dan seng dalam serum dan rambut dapat mencerminkan risiko terjadinya KP pada seseorang. Tujuan: Menganalisis perbedaan rerata kadar besi dan seng rambut dan serum KP dibandingkan populasi sehat dan menganalisis korelasi antara kadar besi dan seng rambut dan serum pasien KP dengan derajat keparahan KP. Metode: Penelitian ini merupakan studi observasional analitik dengan desain kasus kontrol dan dilakukan matching jenis kelamin dan usia. Populasi target penelitian adalah pasien KP dan individu sehat yang diambil dengan metode consecutive sampling berdasarkan kriteria penerimaan dan penolakan. Analisis statistik yang sesuai dilakukan untuk membuktikan hipotesis penelitian. Nilai p<0,05 dianggap signifikan secara statistik. Hasil: Diantara 32 sampel kelompok KP, 7 orang mengalami KP ringan, 14 orang mengalami KP sedang, dan 11 orang mengalami KP berat. Diperoleh perbedaan kadar seng rambut yang bermakna secara statistik antara kelompok KP dengan kelompok sehat (184,03 vs. 231,83; p=0,01). Perbedaan parameter lainnya ditemukan tidak bermakna secara statistik. Tidak ditemukan adanya korelasi yang bermakna secara statistik antara kadar besi dan seng serum maupun rambut terhadap kejadian atau derajat keparahan KP. Data tambahan, ditemukan korelasi positif lemah antara indeks massa tubuh (IMT) dengan derajat keparahan KP (rρ= 0,392; p=0,026). Riwayat KP keluarga merupakan faktor risiko KP (aOR 14,829; 95% IK 3,073–71,566, p=0,001). Setiap penurunan 1 unit (µg/g) kadar seng rambut, kemungkinan mengalami KP meningkat (aOR 1,007; 95% IK 1,001–1,013, p=0,022). Kesimpulan: Kadar seng rambut pada kelompok KP lebih rendah dan berbeda bermakna secara statistik dibandingkan dengan kelompok kontrol sehat, namun tidak ditemukan perbedaan rerata yang bermakna pada parameter lainnya. Tidak ditemukan korelasi antara kadar besi dan seng rambut dengan serum, maupun dengan derajat keparahan KP. ......Background: Hair has various functions, one of which is an estimate of an individual's age. Canities, or gray hair, is a sign of aging that appears on the hair and generally begins to occur in the 4th decade of life. Premature canities (PC) is a term for the appearance of gray hair as much as 5 strands of hair before the age of 25 years in Asian ethnicity. The etiology of PC is not fully understood and is considered a multifactorial disorder. Certain micronutrient deficiencies, including iron and zinc, are thought to play a role in the development of PC. Therefore, it is predicted that iron and zinc levels in serum and hair can reflect a person's risk of developing PC. Aim: To analyze the difference in mean serum and hair levels of iron and zinc between subjects with PC and healthy controls and to assess their correlation with the severity of PC. Method: This study is an analytic observational study with a case-control design and matched according to age and gender. The target population of the study was patients with PC and healthy individuals who were recruited by consecutive sampling based on inclusion and exclusion criteria. Appropriate statistical analysis was performed to prove the research hypothesis. A p-value of <0.05 is considered statistically significant. Results: Among the 32 subjects of the PC group, 7 subjects had mild PC, 14 subjects had moderate PC, and 11 subjects had severe PC. There was a statistically significant difference in hair zinc levels between the PC group and the healthy controls (184.03 vs. 231.83; p=0.01). Differences in other parameters were found to be not statistically significant. There was no statistically significant correlation between serum and hair iron and zinc levels on either the incidence or the severity of PC. A weak positive correlation between body mass index (BMI) and the severity of PC (rρ= 0.392; p= 0.026) was obtained. Family history of PC is a risk factor for PC with an aOR 14,829; 95% CI 3.073–71,566, p=0.001. In addition, for every 1 µg/g decrease in hair zinc levels, the probability of experiencing PC increased (aOR 1.007; 95% CI 1.001–1.013, p=0.022). Conclusion: Hair zinc levels in the PC group were lower and statistically significant compared to the healthy controls but no significant difference was found in other parameters. There was no correlation between hair iron and zinc levels with serum, nor with the severity of PC.