KORELASI KLINIS, LABORATORIS, HISTOPATOLOGIS KASUS ERITRODERMA DI RSUP DR SARDJITO YOGYAKARTA PERIODE 2009 - 2013

Ika Fatimah D, Prof. Dr. dr. Hardyanto Soebono, Sp.KK(K)

2015 | Tesis | SP ILMU PENYAKIT KULIT DAN KELAMIN

Latar Belakang: Eritroderma merupakan kelainan kulit inflamasi yang ditandai kulit eritem generalisata dan skuama yang melibatkan 90% luas permukaan kulit dan dapat berakibat fatal. Gambaran klinis dan laboratorium serta etiologi bervariasi pada kasus eritroderma. Belum pernah dilakukan penelitian mengenai gambaran klinis, laboratoris, dan histopatologis pada kasus eritroderma di RSUP Dr. Sardjito Yogyakarta periode 2009-2013. Tujuan: Untuk mengidentifikasi gambaran klinis, laboratorium, dan etiologi eritroderma serta korelasi dengan temuan histopatologi. Subyek dan Metoda: Penelitian ini merupakan studi retrospektif. Subyek penelitian merupakan kasus rawat inap dan rawat jalan eritroderma di RSUP Dr Sardjito periode 2009 – 2013, yang memenuhi kriteria diagnosis klinis eritroderma/dermatitis eksfoliatif. Data diambil dari catatan medis pasien meliputi umur, jenis kelamin, gejala klinis, hasil pemeriksaan laboratorium, dan temuan histopatologi. Hasil: Didapatkan 134 kasus eritroderma, rerata usia 49,27+20,824 tahun dengan rasio laki-laki dan perempuan 1,4:1. Gambaran klinis subyek yang sering dijumpai: skuama (100%), pruritus (71,64%), kulit eritem (63,43%), sedangkan pustulasi (11,19%) merupakan gambaran klinis paling jarang. Abnormalitas hasil pemeriksaan laboratorium yang sering dijumpai: hipoalbuminemia (56,72%), leukositosis (52,24%), anemia (32,09%), eosinofilia (31,34%), neutrofilia (27,61%), sedangkan yang paling jarang dijumpai hipokalsemia (3,73%). Etiologi eritroderma yang sering adalah psoriasis (35,82%), dermatitis kontak alergika (14,93%), dan erupsi obat (11,94%). Biopsi kulit dilakukan pada 117 kasus (87,31%). Kesepakatan klinis dan histopatologis dinilai kuat dengan nilai κ (Kappa) 76,07%. Korelasi kuat didapatkan antara psoriasis dengan perubahan kuku dan hiperkeratosis palmoplantar; dermatitis kontak alergika dengan eosinofilia; sedangkan korelasi sedang antara psoriasis dengan gatal, dermatitis kontak alergika dengan gatal dan hiperkeratosis palmoplantar, erupsi obat dengan gatal dan eosinofilia. Kesimpulan: Gambaran klinis dan laboratoris bervariasi pada tiap kasus. Kulit berskuama, pruritus, kulit eritem merupakan manifestasi klinis eritroderma yang sering dijumpai. Hipoalbuminemia, leukositosis, anemia, eosinofilia, dan neutrofilia merupakan hasil laboratorium yang sering ditemui. Etiologi eritroderma tersering yaitu psoriasis. Terdapat kesepakatan klinis dan histopatologis yang kuat dengan κ=76,07%. Terdapat korelasi beberapa gambaran klinis dan laboratoris dengan diagnosis etiologi secara kliniko-patologi pada kasus eritroderma di RSUP Dr. Sardjito periode 2009 – 2013.

Background: Erythroderma is an inflammatory disorder in which erythema and scaling occur in generalized distribution involving more than 90% of the body surface, which can be potentially fatal. There were various clinical and laboratory features and etiology in erythroderma patients. The correlation of clinical, laboratory, and histopathological in Sardjito hospital period 2009-2013 has not been investigated in any study yet. Objective: To identify the etiology, clinical and laboratory features and to correlate with histopathological findings. Subjects and Methods: The subjects were erythroderma/exfoliative dermatitis inpatients and outpatients Sardjito hospital within 2009 – 2013. It was a retrospective study by collecting data from medical record, including age, sex, etiology, clinical and laboratoty features and histopathological findings. Results: There were 134 cases, mean age of onset was 49,27+20,824 years with a male:female ratio of 1.4:1. Scaling (100%), pruritus (71.64%) and erythema (63.43%) were the common clinical manifestations while pustule (11.19%) was the rarest one. Laboratory results: hypoalbuminemia (56.72%), leukocytosis (52.24%), anemia (32.09%), eosinophilia (31.34%), and neutrophilia (27.61%). The common etiologies of erythroderma were psoriasis (35.82%), allergic contact dermatitis (14.93%), and drug eruption (11.94%). Skin biopsy was performed in 117 cases (87.31%) with clinical agreement 76.07% (κ). There were strong significant correlation between psoriasis with nail changes and palmoplantar hyperkeratosis; allergic contact dermatitis with eosinophilia, while moderate correlation between psoriasis with pruritus, allergic contact dermatitis with pruritus and palmoplantar hyperkeratosis; drug eruption with pruritus and eosinophilia. Conclusion: Clinical and laboratory findings varied in each patients. Scaling, pruritus, erythema were the common clinical manifestations. While hypoalbuminemia, leukocytosis, anemia, eosinophilia, and neutrophilia were the common laboratory features. The most frequent etiology of erythroderma was psoriasis. Strong clinical–histological agreement was found in 76.07% of cases. The correlation obtained in some clinical and laboratory features with etiology of erythroderma cases.

Kata Kunci : eritroderma, gambaran klinis, laboratoris, histopatologis, etiologi