Tesis

Korelasi Antara Jumlah Jari Tangan dengan Kelainan Kuku dan Disfungsi Vasomotor Berdasarkan Skor Stimulated Skin Wrinkling pada Pasien Kusta Multibasiler = Correlation Between the Number of Fingers with Nail Changes and Vasomotor Dysfunction Based on the Stimulated Skin Wrinkling Score in Multibacillary Leprosy Patients.

Latar belakang: Kelainan kuku pada kusta sering ditemukan dan dapat berkaitan dengan neuropati, termasuk neuropati otonom. Disfungsi vasomotor merupakan salah satu manifestasi neuropati otonom dan dapat dinilai melalui pemeriksaan stimulated skin wrinkling dengan eutectic mixture of local anaesthetics (SSWEMLA). Namun, belum ada studi yang menilai hubungan kuantitatif keduanya pada kusta. Tujuan: Mengevaluasi korelasi antara jumlah jari tangan yang mengalami kelainan kuku dan skor kerutan kulit berdasarkan pemeriksaan SSW-EMLA pada pasien kusta tipe multibasiler. Metode: Studi observasional analitik potong lintang ini melibatkan 35 pasien kusta multibasiler (BB, BL, LL), berusia 18–55 tahun, serta menjalani multidrug therapy selama 1–12 bulan. Pasien direkrut dari poliklinik dermatologi dan venereologi 2 rumah sakit rujukan tersier di Jakarta, Indonesia. Data sosiodemografis dan klinis dikumpulkan melalui anamnesis, pemeriksaan fisik, dan rekam medis. Kelainan kuku dinilai melalui foto klinis terstandar dan dermoskopi DermLite DL5® 10×. Penilaian kerutan jari tangan dengan SSW-EMLA dilakukan pada jari tangan 2–5 dengan oklusi krim EMLA® (lidokain 2,5% dan prilokain 2,5%) selama 30 menit, dan kerutan jari dinilai berdasarkan skala Clark (0–4) per jari. Analisis korelasi menggunakan uji Spearman. Hasil: Kelainan kuku jari tangan ditemukan pada seluruh subjek, dengan median jumlah kuku tangan yang mengalami kelainan 9 (2–10). Median skor SSW-EMLA adalah 30 (9–32). Tidak ditemukan korelasi bermakna antara jumlah jari tangan yang mengalami kelainan kuku dan skor SSW-EMLA (r = −0,171; p = 0,327). Kesimpulan: Pada pasien kusta tipe multibasiler, jumlah kuku jari tangan yang mengalami kelainan tidak berkorelasi bermakna dengan skor SSW-EMLA.
Kata kunci: disfungsi vasomotor, kelainan kuku, kusta multibasiler, neuropati otonom, stimulated skin wrinkling.


Background: Nail changes in leprosy are common and may be associated with neuropathy, including autonomic neuropathy. Vasomotor dysfunction is one manifestation of autonomic neuropathy and can be assessed using the stimulated skin wrinkling test with eutectic mixture of local anaesthetics (SSW-EMLA). However, no studies have evaluated the quantitative relationship between these two measures in leprosy. Objective: To evaluate the correlation between the number of fingers with nail changes and the skin-wrinkling score assessed by SSW-EMLA in patients with multibacillary leprosy. Methods: This analytical cross-sectional observational study included 35 patients with multibacillary leprosy (BB, BL, LL), aged 18–55 years, receiving multidrug therapy for 1–12 months. Patients were recruited from the dermatology and venereology outpatient clinics of two tertiary referral hospitals in Jakarta, Indonesia. Sociodemographic and clinical data were collected through history taking, physical examination, and medical records. Nail changes were assessed using standardized clinical photographs and DermLite DL5® 10× dermoscopy. SSW-EMLA was performed on digits 2–5 of the hands using occlusion with EMLA® cream (lidocaine 2.5% and prilocaine 2.5%) for 30 minutes. Finger wrinkling was graded using the Clark scale (0–4) for each digit. Correlation analysis was performed using Spearman’s test. Results: Fingernail changes were found in all participants, with a median number of affected fingernails of 9 (2–10). The median SSW-EMLA score was 30 (9–32). No significant correlation was found between the number of fingers with nail changes and the SSW-EMLA score (r = −0.171; p = 0.327). Conclusion: In patients with multibacillary leprosy, the number of fingers with nail changes was not significantly correlated with the SSW-EMLA score.
Keywords: autonomic neuropathy, multibacillary leprosy, nail changes, stimulated skin wrinkling, vasomotor dysfunction.