Tesis

Perbandingan proporsi Malassezia spp. pada lesi inflamasi dan non inflamasi akne vulgaris pada wajah = Comparison of Mallassezia spp. proportion in inflammatory and non-inflammatory facial acne vulgaris lesion.

Latar belakang: Beberapa faktor berperan dalam patogenesis akne vulgaris (AV), di antaranya peningkatan produksi sebum, hiperproliferasi duktus folikel pilosebasea, inflamasi dan aktivitas mikrobiota. Salah satu mikrobiota yang terdapat di folikel pilosebasea yaitu Malassezia spp, namun perannya pada AV belum diketahui pasti. Hingga saat ini belum terdapat data distribusi spesies Malassezia pada lesi AV wajah di Indonesia, serta belum ada studi yang membandingkan keberadaannya pada lesi inflamasi dan non inflamasi AV. Tujuan: Mengetahui keberadaan Malassezia spp. serta distribusi spesiesnya pada lesi AV di wajah dan mengetahui perbandingan proporsi Malassezia spp. pada lesi inflamasi dan non inflamasi AV di wajah. Metode: Penelitian ini bersifat deskriptif-analitik dengan desain potong lintang. Pasien yang memenuhi kriteria penerimaan dan bersedia mengikuti penelitian dilakukan pengambilan isi folikel lesi inflamasi AV atau lesi non inflamasi AV sesuai randomisasi. Spesimen diambil dari empat lesi. Satu lesi dilakukan pemeriksaan mikroskopis dengan larutan KOH 20% dan tinta Parker, kemudian tiga lesi dilakukan biakan di media CHROMagar Malassezia dan dilakukan uji biokimia untuk identifikasi spesies. Hasil: Didapatkan total 120 subjek. Usia rerata seluruh subjek 22,7 tahun (SB ±6,192 tahun) dan mayoritas subjek berjenis kelamin perempuan (61,7%). Mayoritas subjek memiliki derajat AV yang ringan, yaitu sebanyak 71,7%. Pada pemeriksaan mikroskopis, tidak ditemukan perbedaan perbandingan jumlah spora jamur pada lesi inflamasi dan non inflamasi AV (p=0,142). Ditemukan isolat Malassezia spp. pada 64,2% subjek, yang terdiri dari M. dermatis (43%), M. sympodialis (18%), M. slooffiae (16%), M. japonica (5%), M. furfur (5%), M. pachydermatis (3%), dan M. restricta (1%). Proporsi isolat Malassezia spp. pada lesi non inflamasi lebih besar daripada lesi inflamasi (p=0,019). Malassezia spp. predominan pada lesi inflamasi adalah M. dermatis (45,8%), diikuti dengan M. sympodialis (17,1%), dan M. slooffiae (11,4%)
Kesimpulan: Terdapat spesies Malassezia pada lesi AV wajah dengan spesies predominan, yaitu M. dermatis, M. sympodialis, dan M. slooffiae. Didapatkan proporsi Malassezia spp.yang lebih banyak ditemukan pada lesi non inflamasi. Penelitian ini belum dapat membuktikan kemungkinan peran Malassezia spp. pada timbulnya AV.
Kata kunci: Akne vulgaris, Malassezia spp., lesi inflamasi, lesi non inflamasi


Background: There are multiple etiological factors that play roles in the pathogenesis of acne vulgaris (AV), among others the increased production of sebum, hyperproliferation of the ductal pilosebaceus follicle, inflammation, and microbiome activity. Malassezia spp. can be found in the pilosebaceus follicle but its role on the pathogenesis of AV has not yet been described. There were no studies reporting Malassezia spp. distribution on facial AV lesion in Indonesia, and there were no studies comparing inflammatory to non inflammatory lesions in the distribution on Malassezia spp. Objective: To identify the presence and the species distribution of Malassezia spp on facial AV lesion and to compare the distribution of Malassezia spp. in inflammatory to non inflammatory AV lesions Methods: A cross sectional study of AV patients who fulfilled inclusion criteria and willing to participate in this study, allocated to two groups based on type of lesion that were taken, the non inflammation group, and inflammation group. Four lesion were taken as specimen from each group. Microscopic examination of one follicular content was conducted using 20% of potassium hydroxide and Parker ink, while the other three specimen were grown in CHROMagar Malassezia and underwent various biochemistry test to identify the species. Results: A total of 120 subjects were enrolled. The mean age of all subjects was 22,7 years (DS±6,192) and the majority of the subjects was female (61,7%). Most of the subjects had mild AV (71,7%). On microscopic examination, there was no difference in spore load between non inflammation and inflammation group (p=0,142). Malassezia spp. were isolated from 64.2% subjects, and consist of M. dermatis (43%), M. sympodialis (18%), M. slooffiae (16%), M. japonica (5%), M. furfur (5%), M. pachydermatis (3%), and M. restricta (1%). There was a significant difference in Malassezia spp. proportion in inflammatory and non inflammatory AV lesions, with the tendency of higher proportion on the non inflammatory lesions (p=0,019). The predominant species in inflammatory AV lesions was M. dermatis (45,8%), followed by M. sympodialis (17,1%), dan M. slooffiae (11,4%)
Conclusion: Malassezia spp. can be found in facial acne lesion. M. dermatis was the common isolate, followed by M. sympodialis, and M. slooffiae. There was a significant difference in Malassezia spp. proportion in AV lesion, with the tendency of higher proportion in the non inflammatory lesions. The outcome of this study still hasn’t conclude the relationship between Malassezia spp. and acne.
Keyword: Acne vulgaris, Malassezia spp., inflammatory lesion, non-inflammatory lesion