KORELASI ANTARA RESPON PIGMENTASI PAJANAN MATAHARI DENGAN DERAJAT PARUT AKNE VULGARIS

Istiana Fiatiningsih, Prof. Dr. dr. Hardyanto Soebono, Sp.KK(K)

2014 | Tesis | S2 Ilmu Kesehatan Kulit dan Kelamin

Latar Belakang: Parut akne terjadi karena kerusakan struktur mikroskopis kulit ditandai perubahan warna dan/ tekstur yang berbeda kontras dengan sekitarnya akibat inflamasi berlebihan lesi akne. Parut akne terjadi pada 95% kasus akne, sering dijumpai pada tipe kulit gelap dibandingkan tipe kulit terang. Pajanan matahari menyebabkan peningkatan inflamasi lesi akne dengan terbentuknya mediator proinflamasi dan peningkatan produksi matriks metalloproteinase yang mendegradasi kolagen menyebabkan terjadinya parut atrofi. Pajanan matahari menyebabkan proses melanogenesis menghasilkan pigmentasi kulit yang dapat diukur. Penelitian tentang pengaruh pajanan matahari terhadap penyembuhan luka akne yang menyebabkan parut akne belum pernah dilaporkan. Tujuan: Mengetahui hubungan antara jumlah pajanan matahari yang diukur dengan respon pigmentasi dengan derajat parut akne. Metode: Penelitian potong lintang dilakukan di Yogyakarta, Juni-Oktober 2013. Subyek adalah penderita akne derajat ringan hingga sangat berat, tipe kulit Fitzpatrick IV-V, tanpa riwayat penggunaan produk kosmetik dengan pemutih, tabir surya dan terapi akne dalam sebulan terakhir. Pajanan matahari diukur dengan kolorimeter (area terpapar dan non-paparan) sebagai delta L* dan delta L*a*b. Derajat parut diukur dengan Global Acne Scarring Classification (GASC) dan hitung morfologi parut. Analisis statistik dengan uji korelasi Spearman, p<0,05. Hasil: Sebanyak 81 subyek dilibatkan, 5 dieksklusi. Median usia 20 tahun (17-27). Didapatkan parut akne dengan derajat ringan 22,37%, sedang 69,74%, dan berat 7,89% dari total 76 subyek. Morfologi parut makular dijumpai 96,05% dan parut atrofi 97,37% (ice-pick 92,11%, boxcar 85,53% dan rolling scars 36,84%. Didapatkan korelasi antara respon pigmentasi delta L* (p=0,001;r=0,362) dan delta L*a*b* (p=0,000;r=0.392) dengan derajat parut akne (skor GASC). Didapatkan korelasi respon pigmentasi dengan hitung morfologi parut atrofi (ice-ick, boxcar dan rolling scars) dan tidak berkorelasi dengan hitung morfologi parut makular. Kesimpulan: Didapatkan korelasi antara jumlah pajanan matahari yang diukur dengan respon pigmentasi dengan derajat parut akne dengan kekuatan hubungan lemah. Kata Kunci: Paparan sinar matahari, respon pigmentasi, parut akne, parut makular

Background: Acne scars were caused by destruction of perifollicular pilobaseus due to excessive acne inflammation marked by change in color, texture or both that contrast to the surrounding skin. It occurs in 95% of all degrees of acne and more common in dark skin than lighter skinned. Sunlight exposure may increase inflammatory process of acne caused by formation of proinflammatory mediators and increases production of matrix metalloproteinase that can degrade extracellular matrix collagen causing of atrophic scar formation. Sunlight exposure may cause melanogenesis which results in skin pigmentation that can be measured. Research on the effect of sunlight exposure toward wound healing in acne which causes acne scars has never been reported. Objective: To determine correlation between the amount of sunlight exposure measured by skin pigmentation with acne scars severity. Methods: A cross-sectional study in Yogyakarta on June-October,2013th was conducted. Subjects were patients with mild until very severe degree of acne, having IV-V Fitzpatrick skin phototype, without using cosmetic products containing whitening, sunscreen and acne medication in the last month. Sunlight exposure were measured by colorimeter (exposed and non-exposed area) as delta of L*value and delta of L*a*b*value. Acne scars severity were measured by Global Acne Scar Classification (GASC) and scars morphology count. Spearman correlation analysis were used with p<0.05. Results: A total of 81 patients were included and 5 were excluded. Median age of study was 20 years (17-27). A total of 76 subjects had mild grade (22,37%), moderate (69,74%), and severe acne scars (7,89%). Morphological scars were found 96,05% of macular scars and 97,37% of atrophic scars (ice-pick 92,11%, boxcar 85,53% dan rolling scars 36,84%. There were correlation between skin pigmentation measured using delta of L*value (p=0,001, r=0,362) and delta of L*a*b* value (p=0,000, r=0,392) with acne scars severity based on GASC. There were correlation between skin pigmentation and morphology count of atrophic scars (ice-pick, boxcar and rolling scars), without correlation with morphology count of macular scars. Conclusion: There were correlation between the amount of sunlight exposure measured by skin pigmentation with acne scars severity with mild coefficient correlation. Keywords: Sunlight exposure, skin pigmentation, acne scars, macular scars

Kata Kunci : Paparan sinar matahari, respon pigmentasi, parut akne, parut makular