Tesis

Efektivitas Terapi Standar Akne Vulgaris Berdasarkan Panduan Praktik Klinis (PPK) di Indonesia = Effectiveness of Standard Therapy ofAcne Vulgaris Based on Clinical Practice Guidelines (CPG) in Indonesia.

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.
Kata kunci: akne vulgaris, efektivitas, panduan praktik klinis, terapi, Indonesia


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