Tesis

Perbandingan Efektivitas Beberapa Bahan Topikal dalam Mengurangi Medical Adhesive-Related Skin Injury dan Parameter Terkait dalam Prosedur Pelepasan Perekat Medis Berbahan Dasar Akrilat pada Kulit Dewasa Normal = Comparison of Effectiveness of Several Substances in Reducing Medical Adhesive-Related Skin Injury and Corresponding Parameters in Acrylic-Based Tape Removal on The Skin of Normal Adults.

Latar belakang: Perekat medis berbahan dasar akrilat banyak digunakan di fasilitas pelayanan kesehatan. Medical adhesive-related skin injury atau MARSI kerap terjadi pada pengangkatan perekat medis, dalam bentuk eritema, fisura, erosi, bula, maserasi, folikulitis, dermatitis kontak atau lainnya, yang bertahan minimal 30 menit. Lansia, neonatus, serta kondisi kulit dan sistemik tertentu rentan terhadap cedera ini. Upaya pencegahan dilakukan dengan menggunakan larutan NaCl 0,9%, vaselin album, atau alkohol saat proses pengangkatan perekat, namun belum terdapat penelitian yang menunjukkan efektivitas mereka dalam pengurangan MARSI. Tujuan: Mengetahui apakah penambahan bahan topikal dalam prosedur pelepasan perekat medis berbahan dasar akrilat efektif mengurangi angka kejadian MARSI dan parameter objektif terkait. Metode: Penelitian ini merupakan uji klinis acak terkontrol tersamar tunggal yang berlangsung pada bulan September hingga November 2018 di Poliklinik Ilmu Kesehatan Kulit dan Kelamin RS Cipto Mangunkusumo. Pada 61 orang dewasa normal dilakukan penempelan perekat medis berbahan dasar akrilat pada empat lokasi di kedua lengan atas. Pengangkatan perekat dilakukan pada hari ketiga dan keenam dengan/tanpa bantuan NaCl 0,9%, vaselin album, atau alkohol pada keempat lokasi secara acak. Angka kejadian MARSI, skor eritema klinis, nilai eritema berdasarkan mexameter, nilai TEWL serta skor VAS nyeri adalah parameter yang diukur. Hasil: Sebanyak 56 orang subjek penelitian dapat menyelesaikan penelitian sehingga didapatkan 224 lokasi uji. Angka kejadian MARSI adalah 49,5% pasca pengangkatan pertama, meningkat menjadi 59,3% pasca pengangkatan kedua. Angka kejadian pada kelompok perlakuan, khususnya alkohol, lebih rendah dibandingkan kontrol (p=0,421). Penambahan alkohol menunjukkan peningkatan rerata skor eritema klinis terendah (p=0,102) dan penurunan nilai berdasarkan mexameter (p=0,024). Baik penambahan alkohol maupun vaselin album menghasilkan peningkatan nilai TEWL terendah (p=0,709). Pada kelompok alkohol dan NaCl 0,9% peningkatan skor VAS nyeri terhadap baseline tidak bermakna (p=0,173 dan p=0,699). Kesimpulan: Penambahan bahan topikal NaCl 0,9%, vaselin album, atau alkohol dalam prosedur pelepasan perekat medis berbahan dasar akrilat setiap 3 hari dalam 6 hari pengamatan pada dewasa normal mengurangi angka kejadian MARSI, namun tidak bermakna secara statistik. Alkohol (isopropil alkohol 70%) secara konsisten menunjukkan perubahan parameter terkait MARSI yang lebih baik, khususnya nilai objektif eritema berdasarkan mexameter dan derajat nyeri.
Kata kunci: akrilat, MARSI, topikal, eritema, TEWL


Background: Acrylic-based tapes are widely used in various clinical settings. Medical adhesive-related skin injury is often encountered in their removal, manifesting as erythema, fissure, erosion, blister, maceration, folliculitis, contact dermatitis or others, lasting for at least 30 minutes. The elderly, neonates, and people with certain cutaneous/systemic conditions are prone to MARSI. Prevention consists of removal aided with normal saline, vaseline or alcohol; however, studies that prove their effectiveness are lacking. Aim: To learn if topical use of certain substances was effective in reducing MARSI and other related parameters, in the removal of acrylic-based adhesives. Methods: This was a single blind, randomized controlled study conducted from September through November 2018 in the Dermatology and Venereology clinic Cipto Mangunkusumo Hospital. Acrylic-based tapes were placed on four sites on the upper forearms of 61 healthy adults. Removal was done on the third and sixth days with/without applying normal saline, vaseline, or alcohol randomly on each study sites. Incidence of MARSI, clinical scores and mexameter values of erythema, TEWL values, and pain visual scale were measured. Results: Fifty-six subjects completed the schedule so that 224 test locations were obtained. The incidence of MARSI was 49.5% on the third day, increased to 59.3% on the sixth. The incidence among experiment groups, especially alcohol, were lower than control (p=0.421). Application of alcohol resulted in lower mean of clinical erythema score (p=0.102) as well as a decrease measured by mexameter (p=0.024). Both alcohol and vaselin gave the lowest increase of TEWL (p= 0.709). In alcohol dan normal saline groups, increase of pain score against baseline was insignificant (p=0.173 and p=0.699, respectively). Conclusion: Application of normal saline, vaseline, or alcohol in aiding removal of acrylic-based adhesives every third day in a 6-day observation among normal adults reduced the incidence of MARSI, but not significantly. Alcohol (isopropyl alcohol 70%) consistently demonstrated more favorable outcome in MARSI-related parameters, especially erythema by mexameter dan pain severity.
Key words: acrylic, MARSI, topical, erythema, TEWL