FUNGSI SAWAR KULIT PENDERITA HUMAN IMMUNODEFICIENCY VIRUS/ ACQUIRED IMMUNODEFICIENCY SYNDROME (HIV/AIDS) DENGAN PRURITIC PAPULAR ERUPTION

QAMARIAH, dr. Fajar Waskito, Sp.KK(K), M.Kes;Dr.dr. Satiti Retno Pudjiati, Sp.KK(K)

2020 | Tesis-Spesialis | DERMATOLOGI DAN VENEREOLOGI

Latar Belakang: Pruritic papular eruption (PPE) merupakan kelainan kulit non-infeksi yang bersifat kronis pada penderita HIV/AIDS dengan etiopatogenesis tidak diketahui pasti. Peran Th-2 dominan pada tahap lanjut perjalanan infeksi HIV/AIDS dianggap ikut berperan dalam etiopatogenesis PPE dan di sisi lain telah dikaitkan pula dengan terjadinya gangguan fungsi sawar kulit penderita HIV/AIDS non-atopi. Tujuan: Mengetahui apakah penderita HIV/AIDS dengan PPE mengalami gangguan fungsi sawar kulit lebih berat dibandingkan penderita non-PPE. Metode: Penelitian menggunakan rancangan kasus kontrol. Fungsi sawar kulit diukur menggunakan parameter TEWL dan hidrasi kulit dengan alat Tewameter dan Corneometer. Analisis bivariat perbedaan rerata nilai TEWL dan hidrasi kulit menggunakan independent-t test. Analisis perbedaan karakteristik subyek, serta hubungan nilai TEWL dan nilai hidrasi kulit dengan kejadian PPE menggunakan Chi-Square test dengan kemaknaan p kurang dari 0,05. Hasil analisis bivariat dengan p kurang dari 0,25 dianalisis lanjut menggunakan uji regresi logistik. Hasil: Jumlah total subyek penelitian 58 subyek, terdiri 29 subyek PPE sebagai kelompok kasus dan 29 subyek non-PPE sebagai kelompok kontrol. Terdapat perbedaan bermakna rerata nilai TEWL (p = 0,011) dan hidrasi kulit (p = 0,000) kelompok kasus (8,6 plus minus 2,2 g/h/m2; 25,3 plus minus 6,2 a.u.) dan kelompok kontrol (6,9 plus minus 2,6 g/h/m2; 32,3 plus minus 6,8 a.u.), serta terdapat hubungan bermakna nilai TEWL lebih dari atau sama dengan 7,8 g/h/m2 (OR = 4,938; 95% CI 1,623-15,023; p = 0,004) dan nilai hidrasi kulit kurang dari 28,8 a.u. (OR = 5,143; 95% CI 1,655-15,985; p = 0,004) dengan kejadian PPE. Analisis multivariat bersama variabel bermakna lain menunjukkan hanya variabel jumlah limfosit CD4 kurang dari 200 sel/mm3 (OR = 16,577; 95% CI 3,637-75,558; p = 0,000) dan nilai TEWL lebih dari atau sama dengan 7,8 g/h/m2 (OR = 4,986; 95% CI 1,286-19,325; p = 0,020) yang menunjukkan hubungan bermakna dengan kejadian PPE. Kesimpulan: Gangguan fungsi sawar kulit penderita HIV/AIDS dengan PPE lebih berat dibandingkan penderita non-PPE serta terdapat hubungan bermakna nilai TEWL lebih dari atau sama dengan 7,8 g/h/m2 dan nilai hidarsi kulit kurang dari 28,8 a.u. dengan kejadian PPE.

Background: Pruritic papular eruption (PPE) is a chronic non-infectious skin disease in HIV/AIDS patients with unknown etiopathogenesis. The role of T helper 2 (Th-2) which was dominant in the advanced stages of HIV/AIDS infection is considered to play a role in the etiopathogenesis of PPE and on the other hand, the dominant role of Th-2 cytokines has been associated with the occurrence of impaired skin barrier function in non-atopic HIV/AIDS patients. Objective: To know, whether HIV/AIDS patients with PPE have more severe skin barrier dysfunction compared to non-PPE patients. Method: This study using case-control design. The skin barrier function was measured are TEWL and skin hydration parameters using Tewameter and Corneometer tools. Bivariate analysis of mean differences in TEWL and skin hydration using independent-t test. Analysis of differences in subject characteristics, as well as the relationship between TEWL and skin hydration with PPE using the Chi-Square test with significance p less than 0.05. Bivariate analysis results with p less than 0.25 were analyzed using logistic regression tests. Results: This study included 58 subjects, consisted of 29 PPE subjects as a case group and 29 non PPE subjects as a control group. There were significant differences in mean TEWL (p = 0.011) and skin hydration (p = 0.000) between case groups (8.6 plus minus 2.2 g/h/m2; 25.3 plus minus 6.2 a.u.) and control groups (6.9 plus minus 2.6 g/h/m2; 32.3 plus minus 6.8 a.u.), and there was a significant relationship between the TEWL more than or equals to 7.8 g/h/m2 (OR = 4.938; 95% CI 1.623-15.023; p = 0.004) and the skin hydration less than 28.8 a.u. (OR = 5.143; 95% CI 1.655-15.985; p = 0.004) with PPE. Multivariate analysis with other significant variables showed that only variable CD4 lymphocyte count less than 200 cells/mm3 (OR = 16.577; 95% CI 3.637-75.558; p = 0.000) and TEWL more than or equals to 7.8 g/h/m2 (OR = 4.986; 95% CI 1.286-19.325; p = 0.020) which has a significant relationship with PPE. Conclusion: Skin barrier dysfunction in HIV/AIDS patients with PPE more severe than non-PPE patients and also there was a significant relationship between TEWL more than or equals to 7.8 g/h/m2 and skin hydration less than 28.8 a.u with PPE.

Kata Kunci : HIV/AIDS, PPE, sawar kulit, TEWL, hidrasi kulit/HIV/AIDS, PPE, skin barrier, TEWL, skin hydration