PERBANDINGAN DAYA GUNA TERAPIINTENSE PULSE LIGHT AND HEAT ENERGYDENGANJEL BENZOIL PEROKSIDA 2,5% UNTUK AKNE VULGARIS DERAJATRINGAN DAN SEDANG

TRIASARI OKTAVRIANA, dr. Kristiana Etnawati, MPH, Sp.KK,

2013 | Tesis | S2 Ked.Klinik/MS-PPDS

Latar Belakang: Akne vulgaris adalah penyakit peradangan kronis pada unit pilosebasea, dengan lesi non inflamasi berupa komedo dan lesi inflamasi berupa papul, pustul dan nodul. Etiopatogenesis akne multifaktorial sehingga menyebabkan munculnya berbagai modalitas terapi akne. Pemanfaatan teknologi terapi berbasis sinar seperti intense pulsed light and heat energy (IPL) memberikan alternatif terapi selain jel benzoil peroksida (BP) sebagai terapi standar. Kedua macam terapi ini memiliki target pada P. acnes dan kerusakan unit pilosebasea. Berbagai penelitian terkait keduanya telah banyak dilakukan dengan hasil yang bervariasi. Tujuan:Membandingkan efektivitas terapi antara IPLdan jel BP 2,5%. Metode: Penelitian ini menggunakan uji klinis randomisasi. Subyek adalah penderita akne vulgaris derajat ringan dan sedang, ditentukan dengan metoda combined acne severity classification (CASC). Pengambilan sampel secara consecutive sampling.Analisis stastistik menggunakan analisis varians repeated measurement untuk menilai penurunan lesi dan P. acnes pada masing-masing kelompok. Perbandingan selisih rerata penurunan lesi dan P. acnes antara kedua kelompok terapi dianalisis secara statistik dengan independent t-test, nilai kemaknaan p<0,05. Hasil: Sebanyak 62 subyek penderita akne vulgaris derajat ringan dan sedang, tipe kulit IV dan V. Terapi IPL diberikan pada 32 pasien, 8 kali sesi terapi sinar; 30 pasien mendapat terapi jel BP 2,5% dioles 2 kali sehari, diberikan selama 4 minggu. Dua pasien kelompok IPL dinyatakan drop out karena tidak dapat memenuhi persyaratan untuk rutin menjalani terapi. Semua subyek menunjukkan perbaikan lesi akne. Pengurangan jumlah lesi non inflamasi kelompok terapi IPL tidak berbeda bermakna dibanding BP 2,5% pada minggu 2 (p=0,705) dan minggu 4 (p=0,186); pengurangan jumlah lesi inflamasi kelompok terapi IPL tidak berbeda bermakna dibanding BP 2,5% pada minggu 2 (p=0,604) dan lebih tinggi secara bermakna pada minggu 4 (p=0,003). Penurunan kolonisasi P. acnes pada kelompok IPL lebih banyak secara bermakna dibanding BP 2,5% baik pada minggu ke 2 (p=0,000) maupun minggu 4 (p=0,000). Didapatkan eritema ringan pada 2 (6,67%) pasien kelompok IPL dan kulit kering pada 4 (13,3%) pasien kelompok BP 2,5%. Kesimpulan: Pengurangan jumlah lesi non inflamasi pada kelompok terapi IPL tidak berbeda bermakna dibanding BP 2,5% pada pengamatan minggu 2 dan minggu 4. Pengurangan jumlah lesi inflamasi pada kelompok terapi IPL tidak berbeda bermakna dibanding BP 2,5% pada pengamatan minggu 2; pengurangan jumlah lesi inflamasi kelompok terapiIPL lebih tinggi secara bermakna dibanding BP 2,5% pada minggu 4. Penurunan jumlah P. acnes pada kelompok terapi IPL lebih banyak dibanding kelompok BP 2,5% baik pada minggu 2 maupun minggu 4.

Background: Acne vulgaris is a chronic inflammatory disease of pilosebaceous units of the skin characterized by the development of non-inflammatory lesions in the form of blackheads and/or inflammatory lesions such as papules, pustules and nodules. Aetiopathogenesis of acne is multifactorial and the involvement of these factors led to the emergence of variety in acne treatments modality. The use of technology-based light therapies such as intense pulsed light and heat energy (IPL) provides an alternative therapy for patients with acne besides many standard therapies thatalready available, including benzoyl peroxide (BP) gel, which has a similar therapeutic targets, that isP. acnes and the damage of pilosebaceous unit. More research required based on clinical evidence to explain the efficacy and safety of light therapy as well as support on clinical use of light therapy. Objective: To evaluate the efficay of the therapy by comparing the reduction in the number of non-inflammatory lesions, inflammatory lesions and the number of P.acnes in patients with mild and moderate acne vulgaris treated with intense pulsed light and heat energy and benzoyl peroxide gel 2.5%. Methods: The study was conducted with randomized controlled trial parallel design. Subjects were patients with mild and moderate acne vulgaris by using consecutive sampling. Acne severity was determined by the method of Combined Acne Severity Classification (CASC). Statistical analysis using repeated measurement analysis of variance to assess the reduction in lesions and number of P. acnes in each group. Comparison of the difference in the mean reduction in lesion and number of P. acnes between the two treatment groups were statistically analyzed by independent t-test with a significance value of p<0.05. Results: Of the 62 patients, with mild and moderate acne vulgaris, skin types of IV and V were enrolled in this study. Thirty-two patientstreated with IPL; 30 patients treated with BP gel 2.5%. Two patients from the IPL otherwise drop out because they could not meet the requirements to come into the study routinely.All subjects showed improvement in acne lesions. Reduction the number of non-inflammatory lesions at IPL therapy group was not significantly different than the BP gel 2.5% at week 2 (p=0.705) and week 4 (p=0.186), while reduction in the number of inflammatory lesions in the IPL treatment group was not significantly different than BP gel 2.5%at week 2 (p=0.604) and significantly higher at week 4 (p=0.003). The reduction ofP. acnescolonization in the IPL group significantly higher than BP gel 2.5% group at week 2 (p=0.000) and also at week 4 after treatment (p=0.000). Conclusion: Reduction of the number of non-inflammatory lesions at IPL therapy group was not significantly different than BP 2.5% gel in the observation of week 2 and week 4. While the reduction of the number of inflammatory lesions in the IPL therapy group was not significantly different compare to BP 2.5% gel in the observation week 2; reduction in the number of inflammatory lesions on the IPL therapy is higher than BP gel 2.5% at week 4. Decrease of P. acnes colonization on the IPL therapy is significantly higher than BP gel 2.5% at week 2 and week 4 after treatment.

Kata Kunci : Akne vulgaris, intense pulsed light and heat energy, benzoil peroksida 2,5%