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"Bedah kimia trichloroacetic acid (TCA) memiliki efek samping yang lebih banyak dibandingkan larutan bedah kimia lainnya. Penelitian ini bertujuan untuk menilai efektivitas pelembap dalam mengurangi efek samping pasca-bedah kimia TCA. Penelitian ini merupakan uji klinis acak terkontrol tersamar ganda dengan metode split face yang dilakukan di Poliklinik Dermatologi dan Venereologi Rumah Sakit dr. Cipto Mangunkusumo. Penilaian global peneliti (PGP), penilaian subjektif pasien (PSP), pemeriksaan indeks eritema (IE), transepidermal water loss (TEWL), dan skin capacitance (SCap) dilakukan pada hari ke-0, 3, dan 7. Subjek penelitian (SP) merupakan wanita dengan diagnosis penuaan kulit (rata-rata usia 46,7 tahun). Sebanyak 27 SP dirandomisasi untuk mendapatkan krim intervensi (krim campuran ekstrak spent grain wax, argan oil, dan shea butter) atau krim vehikulum pada salah satu sisi wajah pasca-tindakan bedah kimia TCA 15%. Terdapat penurunan nilai PGP, PSP, kadar TEWL, dan IE pada kelompok intervensi pada hari ke-3 dan 7 dibandingkan dengan kelompok vehikulum, namun tidak signifikan secara statistik. Kadar SCap meningkat signifikan pada hari ke-7 pada pasien yang mendapat krim intervensi dibandingkan dengan krim vehikulum. Tidak ada efek samping obat yang dilaporkan pada penelitian ini. Krim campuran ekstrak spent grain wax, argan oil, dan sheabutter  aman digunakan dan dapat mengurangi efek samping pasca-bedah kimia TCA.

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TCA chemical peel has more side effects than other chemical peel solutions. This study aims to assess the effectiveness safety of a post-peel cream containing spent grain wax, argan oil, and shea butter in reducing TCA peel side effects. A randomized, placebo-controlled, double-blinded, split face trial on women undergoing TCA 15% chemical peels. Assessment for global investigator assessment (GIA), subject self-assessment (SSA), erythema index, transepidermal water loss (TEWL), and skin capacitance (SCap) was conducted on days 0, 3, and 7. Twenty-seven patients (mean age 46.7 years) were recruited. There were significant improvements in GIA and SSA scores on both groups, but it is not different between the treatment groups. There were erythema index and TEWL improvement on days 3 and 7 compared to baseline, however, there were no differences between groups. The SCap measurement showed significant improvement in skin capacitance on both groups on day 7, but it was better improvement within intervention group. No adverse effects were reported. Cream containing spent grain wax, argan oil, and shea butter showed higher skin capacitance levels but did not significantly affect erythema index, TEWL, clinical and subjective assessments after TCA chemical peeling. "

"ABSTRAKBatik workers are a group at highest risk of acquiring occupational contactdermatitis, especially hand dermatitis. Prevention of using personal protectiveequipment (PPE) does not provide optimal protection therefore other interventionsare needed for secondary prevention. The development of topical agents thatimprove skin barrier function is a promising approach for the management ofhand dermatitis. Topically applied lipids and humectants may interfere with skinbarrier function, and facilitate skin barrier repair. The aim of this study is toevaluate the effectiveness of Cocos nucifera and glycerine for secondaryprevention of hand dermatitis among batik workers.In a double-blind, cross-over randomized study, the effect of glycerine coconutoil-containing cream vs. glycerine alone on skin barrier functions was determinedby assessment after repeated application of moisturizers over a 2-week period inbatik workers with occupational hand dermatitis. As much as 32 batik dyeingand/or rinsing process workers were enrolled in this study for a minimum of 6months with mild to moderate occupational hand dermatitis. Assessment oftransepidermal water loss (TEWL), skin capacitance and the Hand EczemaSeverity Index (HECSI) were made at baseline and day 14.The research showed that the type of hand dermatitis among subjects that occurswere 56 palmar hyperkeratosis, 15.6 interdigital eczema, 12.5 nummularhand eczema, 9.4 pulpitis and 6.3 recurrent vesicular hand eczema. As muchas 96.97 of the subjcts have nail discoloration. 40.6 of the subjects always usePPE were at risk of developing hand dermatitis.After applying 14 days, both moisturizers showed clinical improvement by 20decreased of HECSI and TEWL and 20 increased of skin capacitance. Therewas no statistically significant treatment effect between both moisturizers. Skinstripping result was analyzed using chromatography method showed penetrationat 3rd hour (uptake) and still detected at 12th hour (clearance).The findings of the study support the skin health program for batik workers androutine usage of moisturizers are recommended for a minimal of 12 hours per dayto prevent hand dermatitis."

"ABSTRAKLatar Belakang. Dermatitis pada tangan akibat kerja DTAK bersifat kronis, memiliki prognosis buruk, dan berdampak signifikan terhadap aspek psikososial dan pekerjaan. Prevalensi dermatitis kontak pada tenaga kerja bongkar muat TKBM Pelabuhan Sunda Kelapa Jakarta adalah sebesar 24,3 , dengan lesi di tangan 47,1 . Penggunaan alat pelindungdiri APD masih belum cukup untuk mengatasi masalah ini, sehingga dibutuhkan intervensi lain. Penggunaan pelembap untuk memperbaiki sawar kulit dipertimbangkan efektif untuk mencegah keparahan DTAK.Metode. Penelitian ini adalah kuasi eksperimental satu kelompok. Intervensi dilakukan dengan menggunakan gliserin 10 dalam vaselin album sekali sehari setelah bekerja selama 14 hari.Hasil. Rerata nilai transepidermal water loss TEWL setelah intervensi 11,4 3,8 g/m2/jam lebih rendah dibandingkan rerata nilai TEWL awal 14,2 4 g/m2/jam , dengan perbedaan rerata nilai TEWL sebesar 2,8 2,9 g/m2/jam p= 0,000 95 CI 1,5-4,1 . Median nilai hand eczema severity index HECSI setelah intervensi 9,5 3-34 lebih rendah dibandingkan median skor HECSI awal 29,5 6-80 , dengan perbedaaan rerata skor HECSI sebesar 19,5 -2-46 p= 0,000 . Korelasi antara perubahan nilai TEWL dan perubahan skor HECSI tidak bemakna p= 0,476 dengan kekuatan korelasi sangat lemah r= 0,160 . Variabel exposure rating tahunan debu semen berhubungan dengan perubahan skor HECSI p= 0,002 . Setelah intervensi seluruh lesi di jari-jari, telapak tangan, punggung tangan dan pergelangan tangan mengalami perbaikan yang bermakna.

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ABSTRACT

Background. Occupational hand dermatitis OHD is chronic, has a poor prognosis, and significantly affects psychosocial and occupational aspects. The prevalence of contact dermatitis of loading dockworkers at Port Sunda Kelapa Jakarta was 24,3 and 47,1 lesion was on the hands. The use of personal protective equipment PPE is deemed inadequate to solve this problem, thus requiring other intervention. Using moisturizer for improvement of skin barrier is considered to be effective for preventing severity of occupational hand dermatitis.Method. The study design was quasi experimental one group pre and post test design. The 14 days intervention was performed on the loading dockworkers by instructing them to apply 10 glycerin in vaseline album on their hands once daily after working.Result. The mean value of transepidermal water loss TEWL after intervention 11.4 3.8 g m2 hour was lower than the mean value of TEWL before the intervention 14.2 4 g m2 hour . The TEWL mean difference was 2.8 2.9 g m2 hour p 0.000 95 CI 1.53 4.1 . The median value of hand eczema severity index HECSI after intervention 9.5 3 34 was lower than the median value of HECSI before the intervention 29,50 6 80 . The HECSI mean difference was 19.5 2 46 p 0,000 . The correlation between TEWL changes and HECSI changes was not significant p 0.476 and the correlation strength was very weak r 0.160 . Annual exposure rating of cement dust associated with the HECSI changes p 0,002 . After intervention, all lesions on the fingers, palms, back of hand and wrist were significantly improved p 0,05 , except for the finger tips. Additional analysis showed that the commonly found morphology of the lesion was infiltrate papule, scaling and erythema. After intervention, the severity score of the morphology lesions was also significantly decreased p 0,05 .Conclusion. Once daily application of 10 glycerin in vaseline album for 14 days could improved skin barrier function and the severity of OHD, thus can be advised for loading dockworkers with high annual exposure rating of cement dust. "

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ABSTRAK

 

Nama                   : Yenny Rachmawati

Program studi      : Dermatologi dan Venereologi

Judul                    : Perbandingan Efektivitas serta Keamanan antara Krim Pelembap Niasinamid 4% dan Virgin Coconut Oil 30% untuk Pencegahan Sekunder Dermatitis Tangan Akibat Kerja pada Perawat Intensive Care Unit : Uji Klinis Acak Tersamar Ganda

 

Latar belakang:  Dermatitis tangan akibat kerja (DTAK) sering terjadi pada perawat Intensive Care Unit (ICU) terutama pada individu yang rentan akibat pajanan iritan berupa hand rub alcohol dan aktivitas cuci tangan berulang. Penggunaan pelembap adalah salah satu rekomendasi untuk perawatan kulit pada DTAK. Niasinamid memiliki efek antiinflamasi dan dapat memperbaiki fungsi sawar kulit. Vigin coconut oil (VCO) kaya akan kandungan lipid dan asam laurat, serta memiliki efek oklusif. Sampai saat ini belum ada panduan dan referensi jenis pelembap untuk pencegahan sekunder pada DTAK.

 

Tujuan: Mengetahui perbandingan efektivitas serta keamanan antara krim pelembap niasinamid 4% dan VCO 30% untuk pencegahan sekunder dermatitis tangan akibat kerja pada perawat ICU.

 

Metode: Penelitian ini merupakan uji klinis acak tersamar ganda terhadap perawat ICU dengan DTAK pada bulan September hingga Oktober 2019. Pasien yang memenuhi kriteria penerimaan dan bersedia mengikuti penelitian, mendapat niasinamid 4% atau VCO 30% sesuai dengan randomisasi blok. Pengolesan pelembap dilakukan dua kali sehari selama 28 hari. Perbaikan klinis dinilai dengan parameter skor Hand Eczema Scoring Index (HECSI) dan penilaian sawar kulit dinilai dengan transepidermal water loss (TEWL) serta hidrasi kulit dengan skin capasitance (SCap) pada hari ke-14 dan hari ke-28. Keamanan dinilai berdasarkan efek samping selama penelitian.

 

Hasil: Didapatkan 46 SP pada masing-masing kelompok niasinamid 4% dan VCO 30%. Terdapat penurunan skor HECSI pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28. Median skor HECSI  di kelompok niasinamid 4% dan VCO 30%  pada hari ke-14 yaitu 6,5 dan 6 (p 0,160), serta pada hari ke-28 yaitu 4 dan 3 (p 0,046). Pada hari ke-28, perbedaan skor HECSI kedua kelompok secara statistik bermakna, namun secara klinis tidak bermakna. Terdapat penurunan nilai TEWL pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28 dibandingkan baseline, namun pada area palmar di kelompok niasinamid 4% terdapat sedikit peningkatan nilai TEWL pada hari ke-28. Terdapat peningkatan nilai SCap pada kedua kelompok perlakuan di hari ke-14 dan hari ke-28 dibandingkan baseline. Kedua pelembap dapat ditoleransi dengan baik dengan efek samping minimal.

 

Kesimpulan: Niasinamid dan VCO efektif memperbaiki klinis DTAK pada perawat ICU, walaupun tidak terdapat perbedaan bermakna antara krim pelembap niasinamid 4% dengan VCO 30% untuk pencegahan sekunder dermatitis tangan akibat kerja pada perawat ICU

 

Kata kunci: dermatitis tangan akibat kerja, efektivitas, keamanan, pelembap, niasinamid 4%, VCO 30%

 

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ABSTRACT

 

Name                 : Yenny Rachmawati

Study Program : Dermatologi dan Venereologi

Title                   : Comparison of the Effectiveness and Safety between Moisturizing Cream Containing Niacinamide 4% and Virgin Coconut Oil 30% for Secondary Prevention of Occupational Hand Dermatitis in Intensive Care Unit Nurses: a Double Blind Randomized Clinical Trial

 

Background:  Occupational hand dermatitis (OHD) often occurs in intensive care unit (ICU) nurses, especially in individuals who are vulnerable due to irritant exposure e.g. hand rub alcohol and repeated hand washing activities. The use of moisturizer is one of the recommendations for skin care in OHD. Niacinamide which has anti-inflammatory effects and can improve the skin sawar function. Virgin coconut oil (VCO) is rich in lipids and lauric acid, and has an occlusive effect. Until now there are no guidelines and reference types of moisturizers for secondary prevention in OHD.

 

Objective: To assess the difference of effectiveness and safety between moisturizing cream containing niacinamide 4% and VCO 30%  for secondary prevention of occupational hand dermatitis in ICU nurses

 

Methods: A double blind randomized controled trial was performed in ICU nurses with OHD during September–October 2019. Patients who fulfilled inclusion criteria and willing to be involved in the study were allocated to niacinamide 4% or VCO 30% based on block randomization.  Moisturizer were applied twice daily for 28 days. Measurement of Hand Eczema Scoring Index (HECSI) scores were conducted to evaluate the clinical improvement . Measurement of transepidermal water loss (TEWL) were conducted to evaluate the barrier skin and skin capacitance (SCap) values were conducted to evaluate skin hydration on 14^th and 28^th day. Safety were assessed based on side effects during research.

 

Results: There were 46 subjects in each arms of intention, the niacinamide 4% arm and in the VCO 30% arm. There were a decrease in HECSI scores in both treatment groups on 14^th and 28th  day. The median score of HECSI in niacinamide 4% and VCO 30% on 14^th day were 6.5 and 6 (p 0.160), and on 28^th day were 4 and 3 (p 0.046). On 28^th day, the difference in HECSI scores of the two groups were statistically significant, but clinically not significant. There were a decrease in TEWL values in both treatment groups on 14^th and  28^th day compared to baseline, but there were a slight increase in TEWL values in the palmar area in the niacinamide group on 28^th day. There were an increase in SCap values in both treatment groups on 14^th and 28^th day compared to baseline. Both moisturizers were well tolerated with minimal side effects.

 

Conclusion: Niacinamide 4% and VCO 30% were effective in improving clinical OHD in ICU nurses, although there were no significant difference between moisturizing cream containing niacinamide 4% and virgin coconut oil 30% for secondary prevention of occupational hand dermatitis in ICU nurses.

 

Keywords: occupational hand dermatitis, effectiveness, safety, moisturizer, niacinamide 4%, VCO 30%

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