Faktor Risiko Skabies Krustosa Di RSUP Dr. Sardjito Periode 2018 - 2022

AIDHA JUNIAR P H, Prof. Dr. dr. Hardyanto Soebono, Sp.KK(K).; dr. Agnes Sri Siswati, SpKK(K)

2023 | Tesis-Spesialis | DERMATOLOGI DAN VENEREOLOGI

Latar Belakang: Skabies krustosa merupakan varian skabies yang lebih jarang dengan manifestasi klinis yang lebih berat dibandingkan skabies klasik. Etiologi kedua varian klinis tersebut merupakan tungau yang sama. Faktor risiko perkembangan infestasi S.scabiei menjadi fenotipe skabies krustosa masih belum diketahui secara pasti, namun disinyalir kondisi imunosupresi merupakan faktor risiko terjadinya skabies krustosa. Tujuan: Menginvestigasi faktor risiko skabies krustosa yang meliputi komorbiditas dan status imunosupresi di RSUP Dr. Sardjito Yogyakarta, Indonesia pada tahun 2018 sampai 2022. Metode: Studi ini dilaksanakan di RSUP Dr. Sardjito Yogyakarta menggunakan rancangan kasus kontrol berdasarkan data rekam medis elektronik. Sejumlah 25 pasien skabies krustosa sebagai kasus dan 50 pasien skabies klasik sebagai kontrol direkrut secara acak dengan matching usia dan jenis kelamin. Analisis bivariat dengan uji chi square (X2) atau dengan uji Fishers exact, dilanjutkan dengan analisis multivariat menggunakan regresi logistik yang menghitung odds ratio (OR) dan interval kepercayaan (IK) 95%. Hasil: Dua puluh tiga dari 25 kasus (92%) dan 17 dari 50 kontrol (34%) memiliki riwayat komorbiditas diantaranya keganasan, penyakit autoimun, diabetes mellitus, penyakit saraf, dan terapi imunosupresif. Analisis bivariat mendapatkan hubungan yang bermakna secara statistik antara skabies krustosa dengan keganasan (OR 5,41; 95%CI 1,44 - 20,32), penyakit autoimun (OR 4,95; 95%CI 1,12 - 21,84) serta riwayat terapi imunosupresif (OR 8,5; 95%CI 2,86 - 25,26). Pada analisis multivariat dengan regresi logistik backward stepwise hanya didapatkan satu variabel yang konsisten bermakna secara statistik, yaitu terapi imunosupresif (OR 8.5; 95%CI 2,86 -25,26). Kesimpulan: Penyakit keganasan, penyakit autoimun, serta terapi imunosupresif merupakan faktor risiko kejadian skabies krustosa di RSUP Dr. Sardjito periode 2018 - 2022. Terapi imunosupresif merupakan faktor risiko yang paling signifikan berkaitan dengan kejadian skabies krustosa.

Background: Crusted scabies is a rare variant of scabies with more severe clinical manifestations than classic scabies. Many factors associated with crusted scabies have been reported, mostly related with immune status of the patients. Objective: To investigate the possible risk factors for crusted scabies including co- morbidities and immunosuppression status in Dr. Sardjito Hospital Yogyakarta Indonesia from 2018 until 2022. Methods: This study was conducted in Dr. Sardjito Hospital Yogyakarta using case control design based on electronic medical records. Twenty-five crusted scabies was found as the case and 50 classic scabies were randomly recruited as control by matched of age and sex. Bivariate analysis was done using the chi square test (X2) or Fishers exact test, continued with multivariate analysis using logistic regression which OR and 95% confidence interval were calculated. Results: Various conditions were found to be associated with scabies. Twenty three of 25 cases (92%) and 17 of 50 controls (34%) had these conditions which consisted of malignancy, autoimmune diseases, diabetes mellitus, neurological diseases, and immunosuppressive therapy. Bivariate analysis showed that some co-morbidities were associated with crusted scabies, particularly malignancy (OR 5.41, 95%CI 1,44 - 20,32) and autoimmune disease (OR 4.95, 95%CI 1,12 - 21,84), and other risk factor significantly that also associated with crusted scabies was immunosuppressive therapy (OR 8.5, 95%CI 2,86 - 25,26). The results of multivariate using backward stepwise method demonstrated only immunosuppressive therapy was consistently significant risk factor for crusted scabies (OR 8.5, 95%CI 2,86 - 25,26). Conclusion: Malignancy, autoimmune disease, and immunosuppressive therapy were found to be the risk factors for crusted scabies in Dr. Sardjito Hospital from 2018 to 2022. Immunosuppressive therapy is the most significantly associated risk factor of crusted scabies.

Kata Kunci : skabies, skabies klasik, skabies krustosa, komorbiditas, faktor risik, Scabies, crusted scabies, comorbidities, immunosuppression, risk factors