Terapi Kombinasi Poli Peptida Topikal Dan Gel Astaxantin Pada Ulkus Fenomena Lucio

Putri Oktriana Rachman; Indah Julianto Kampono; Nurrachmat Mulianto

doi:10.30595/hmj.v5i2.12348

Terapi Kombinasi Poli Peptida Topikal Dan Gel Astaxantin Pada Ulkus Fenomena Lucio

Putri Oktriana Rachman, Indah Julianto Kampono, Nurrachmat Mulianto

Abstract

Lucio’s leprosy, also known as diffuse lepromatous leprosy, is a non-nodular and diffuse form of LL type leprosy caused by chronic infection with Mycobacterium lepromatous. Lucio’s phenomenon (LP) or type III leprosy reaction is a vasculitis-like leprosy reaction that can occur in untreated leprosy (Lucio’s leprosy). Multidrug therapy (MTD) for multibacillary leprosy (MB) was used in conjunction with corticosteroids to treat LP. Antibiotics and wound care are critical in preventing sepsis complications. Topical polypeptide and astaxanthin gel are both effective in the treatment of ulcers. We report the case of a 53-year-old man who presented to the Emergency Department of Dr. Moewardi Hospital Surakarta with red spots on his fingers and toes that developed into blisters and sores. Histopathological examination revealed a picture consistent with LP. Aeromonas hydrophyla bacteria were identified in pus cultures that are susceptible to gentamycin antibiotics. As recommended, the patient received systemic corticosteroids, specifically methylprednisolone IV 62.5 mg/24 hours as LP therapy and MDT treatment for MB leprosy. Additionally, the patient received systemic antibiotic gentamycin 80 mg/24 hours intravenously, and ulcer treatment with a topical polypeptide and astaxanthin gel applied to the skin. After three months of MDT therapy and treatment, patients’ ulcers improved. LP management and wound care help to reduce LP patients’ mortality and morbidity. Adjuvant therapy with topical polypeptide and astaxanthin may be used to repair ulcers in LP.

Kusta Lucio atau kusta lepromatosa difus, merupakan variasi kusta tipe LL yang bersifat non nodular dan difus yang dihubungkan dengan infeksi kronis bakteri M.Lepromatosa. Fenomena Lucio (FL) atau reaksi kusta tipe III adalah suatu reaksi kusta dengan gambaran vaskulitis dapat terjadi pada (kusta Lucio) tidak diobati. Terapi multi drug terapy (MDT) kusta tipe multibasiler (MB) dan kortikosteroid diberikan untuk mengatasi FL. Perawatan luka dan antibiotik penting diberikan untuk mencegah komplikasi sepsis. Polipeptida dan astaxantin gel topikal memiliki efektivitas yang baik dalam penyembuhan ulkus. Kami melaporkan kasus seorang laki-laki berusia 53 tahun yang datang ke Instalasi Gawat Darurat Rumah Sakit Dr.Moewardi Surakarta dengan keluhan muncul bercak kemerahan yang kemudian menjadi lepuh dan luka pada jari-jari tangan dan kedua kaki. Pemeriksaan histopatologi didapatkan gambaran yang sesuai dengan FL. Pada pemeriksaan kultur pus didapatkan bakteri Aeromonas hydrophyla yang sensitif terhadap antibiotik gentamisin. Pasien diberikan kortikosteroid sistemik yaitu metilprednisolon IV 62.5mg/24 jam sebagai terapi FL dan pengobatan MDT kusta tipe MB sesuai yang direkomendasikan, pasien diberi antibiotik sistemik gentamisin 80 mg/24 jam intravena serta perawatan ulkus dengan polipeptida topikal dan astaxantin gel yang diaplikasikan pada ulkus pasien. Ulkus pada pasien mengalami perbaikan setelah 3 bulan menjalani terapi dan pengobatan MDT. Penatalaksanaan FL dan perawatan luka akan mengurangi mortalitas dan morbiditas pasien FL. Polipeptida topikal dan astaxantin dapat dijadikan terapi ajuvan untuk perbaikan ulkus pada FL.

Keywords

astaxantin; fenomena Lucio; kusta; lepromatosa difus; polipeptida

References

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yes'>ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY

style='mso-element:field-separator'>1. Salgado C, de Brito A, Salgado U, JS S. Leprosy. In: Kang S, Amaragai M, Brucjner A, Enk A, Margolis D, McMichael A, editors. Fitzpatrick’s Dermatology. 9th Editio. McGraw Hill; 2019. p. 2892–924.

2. Rodriguez O, de Lucio L. Historia y concepto. Dermatol Rev Mex. 1978;22:117–40.

3. Jurado F, Rodriguez O, Novales J, Navarrete G, Rodriguez M. Lucio’s leprosy: A clinical and therapeutic challenge. Clin Dermatol [Internet]. 2015;33(1):66–78. Available from: http://dx.doi.org/10.1016/j.clindermatol.2014.07.004

4. Rocha RH, Emerich PS, Diniz LM, De Oliveira MBB, Cabral ANF, Do Amaral ACV. Lucio’s phenomenon: Exuberant case report and review of Brazilian cases. An Bras Dermatol. 2016;91(5):60–3.

5. Han XY, Seo YH, Sizer KC, Schoberle T, May GS, Spencer JS, et al. A new Mycobacterium species causing diffuse lepromatous leprosy. Am J Clin Pathol. 2008;130(6):856–64.

6. Choon SE, Tey KE. Lucio’s phenomenon: A report of three cases seen in Johor, Malaysia. Int J Dermatol. 2009;48(9):984–8.

7. Che Ya SN, Muhamad R, Zakaria R, Ishak A, Abdullah WNHW. Lucio Phenomenon: Sequelae of Neglected Leprosy. Korean J Fam Med. 2021;42(3):245–9.

8. Latapi F, Chevez Z. The“ Spotted” Leprosy of Lucio (La lepra“ Manchada” de Lucio). Int J Lepr. 1948;16(4):421–30.

9. Kavya M, Sacchidanand S. Lucio’s Phenomenon: A Rare Case Report. Int J Basic Appl Med Sci. 2013;3(2):325–30.

10. Ang P, Tay YK, Ng SK, Seow CS. Fatal Lucio’s phenomenon in 2 patients with previously undiagnosed leprosy. J Am Acad Dermatol. 2003;48(6):958–61.

11. Rea T, Jerskey R. Clinical and Histologic Variations Among Thirty Patients with Lucio’s Phenomenon and Pure and Primitive Diffuse Lepromatosis (Latapi’s Lepromatosis). Int J Lepr. 2005;73(3):169–88.

12. Sehgal VN. Lucio’s phenomenon/erythema necroticans. Int J Dermatol. 2005;44(7):602–5.

13. Herath S, Navinan MR, Liyanage I, Rathnayaka N, Yudhishdran J, Fernando J, et al. Lucio’s phenomenon, an uncommon occurrence among leprosy patients in Sri Lanka. BMC Res Notes. 2015;8(1):4–9.

14. Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, et al. Wound bed preparation: a systematic approach to wound management. Wound repair Regen Off Publ Wound Heal Soc [and] Eur Tissue Repair Soc. 2003 Mar;11 Suppl 1:S1-28.

15. Cassino R, Ricci E. Effectiveness of topical application of amino acids to chronic wounds: A prospective observational study. J Wound Care. 2010;19(1):29–34.

16. Debats IBJG, Wolfs TGAM, Gotoh T, Cleutjens JPM, Peutz-Kootstra CJ, van der Hulst RRWJ. Role of arginine in superficial wound healing in man. Nitric Oxide - Biol Chem [Internet]. 2009;21(3–4):175–83. Available from: http://dx.doi.org/10.1016/j.niox.2009.07.006

17. Wu G, Bazer FW, Davis TA, Kim SW, Li P, Marc Rhoads J, et al. Arginine metabolism and nutrition in growth, health and disease. Amino Acids. 2009 May;37(1):153–68.

18. Ellinger S. Micronutrients, Arginine, and Glutamine: Does Supplementation Provide an Efficient Tool for Prevention and Treatment of Different Kinds of Wounds? Adv Wound Care. 2014;3(11):691–707.

19. Newsholme P. Glutamine Metabolism: Nutritional and Clinical Significance Why Is L-Glutamine Metabolism Important to Cells of the Immune System in Health, Postinjury, Surgery or Infection? J Nutr. 2001;131(January):2515–22.

20. Meephansan J, Rungjang A, Yingmema W, Deenonpoe R, Ponnikorn S. Effect of astaxanthin on cutaneous wound healing. Clin Cosmet Investig Dermatol. 2017;10:259–65.

style='font-size:10.0pt'>

Salgado C, de Brito A, Salgado U, JS S. Leprosy. In: Kang S, Amaragai M, Brucjner A, Enk A, Margolis D, McMichael A, editors. Fitzpatrick’s Dermatology. 9th Editio. McGraw Hill; 2019. p. 2892–924.