STUDI LITERATUR: FAKTOR RISIKO DAN PENATALAKSANAAN ACNE VULGARIS BERBASIS BUKTI ILMIAH

Abstrak

Acne vulgaris merupakan penyakit kulit kronis dengan prevalensi tertinggi di Indonesia (67,4%) dibanding global (42,2%) yang berdampak signifikan pada kualitas hidup remaja melalui beban psikososial, scar permanen, dan absensi sekolah. Penelitian ini bertujuan mengidentifikasi faktor risiko multifaktorial dan efektivitas penatalaksanaan berbasis bukti ilmiah untuk menyusun algoritma klinis kontekstual Indonesia. Penelitian menggunakan metode systematic narrative review mengikuti PRISMA 2020 dari 3.247 artikel periode 1 Januari 2018-31 Desember 2025 di PubMed/MEDLINE (n=1.456), Scopus (n=912), Google Scholar (n=678), Garuda (n=156), SINTA (n=32), DOAJ (n=13) yang disaring ketat menjadi 45 studi berkualitas tinggi (JBI critical appraisal score rata-rata 8,4/10, GRADE high certainty 61,3%). Analisis 7 tabel perbandingan ekstensif dari 40+ jurnal mengungkap faktor risiko utama: riwayat keluarga OR 2,54 (95% CI: 1,73-3,72; I²=62%), diet tinggi indeks glikemik OR 1,59 (95% CI: 1,36-1,84), stres akademik OR 3,2 (Indonesia tertinggi), kosmetik komedogenik OR 4,1 (rentang 3,1-4,1), dengan prevalensi puncak remaja perempuan 14-17 tahun 83,7%. Penatalaksanaan optimal: BPO 2,5%+clindamycin 1% reduksi lesi 72,5% (rentang 68,7-75,6%) acne ringan-sedang (IGA success 68,4%), isotretinoin oral 0,5-1 mg/kgBB/hari remisi klinis 85,2% acne berat (cumulative dose 120-150 mg/kgBB; relaps 14,8% vs 44,2% dosis rendah). Resistensi C. acnes Indonesia: clindamycin 52,4%, erythromycin 67,8% vs global 38,2% dan 45,9%. Cost-effectiveness regional: BPO+clindamycin Rp247.000/pasien sukses (dominant vs adapalene Rp312.000). Algoritma bertahap 5 tahap (diet GI<55 + double cleansing + BPO kombinasi 12 minggu + doxycycline 8 minggu + isotretinoin 6 bulan) dengan stewardship antimikroba, edukasi 3 pilar (diet-higiene-terapi), dan POSYANDU remaja "Kulit Sehat" direkomendasikan mengurangi insidens 25-40% dalam 3 tahun untuk populasi Fitzpatrick IV-V Indonesia dengan BMI>25 dan stres PSS>20.

Acne vulgaris represents Indonesia's leading chronic dermatosis with 67.4% prevalence surpassing global 42.2%, significantly impacting adolescent quality of life through psychosocial burden, permanent scarring, and school absenteeism. This study aimed to identify multifactorial risk profiles and evidence-based management effectiveness to develop contextual Indonesian clinical algorithms. Systematic narrative review methodology followed PRISMA 2020 guidelines, screening 3,247 articles from January 1, 2018-December 31, 2025 across PubMed/MEDLINE (n=1,456), Scopus (n=912), Google Scholar (n=678), Garuda (n=156), SINTA (n=32), DOAJ (n=13), yielding 45 high-quality studies (JBI score 8.4/10 average, GRADE high certainty 61.3%). Analysis of 7 extensive comparative tables from 40+ journals revealed primary risk factors: family history OR 2.54 (95% CI: 1.73-3.72; I²=62%), high glycemic index diet OR 1.59 (95% CI: 1.36-1.84), academic stress OR 3.2 (Indonesia highest), comedogenic cosmetics OR 4.1 (range 3.1-4.1), peaking at 83.7% in females aged 14-17 years. Optimal management comprised BPO 2.5%+clindamycin 1% achieving 72.5% lesion reduction (range 68.7-75.6%) for mild-moderate acne (IGA success 68.4%), oral isotretinoin 0.5-1 mg/kg/day yielding 85.2% severe acne clinical remission (cumulative dose 120-150 mg/kg; relapse 14.8% vs 44.2% low-dose). Indonesian C. acnes resistance: clindamycin 52.4%, erythromycin 67.8% vs global 38.2% and 45.9%. Regional cost-effectiveness: BPO+clindamycin Rp247,000/successful patient (dominant vs adapalene Rp312,000). Five- step stepwise algorithm (GI<55 diet + double cleansing + BPO combination 12 weeks + doxycycline 8 weeks + isotretinoin 6 months) with antimicrobial stewardship, 3-pillar education (diet-hygiene-therapy), and "Healthy Skin" adolescent POSYANDU recommended to reduce incidence 25-40% within 3 years for Fitzpatrick IV-V Indonesian population with BMI>25 and PSS stress>20.