Correlation of Skin Pigmentation Changes as a Side Effect of Clofazimine Treatment with Anxiety Level in MDR-TB Patients at Dr. Soebandi Hospital

Raisa Sudjarwo; Jauhar Firdaus; Angga Raharjo

doi:10.47134/ijhis.v3i2.57

Authors

Raisa Rahmadina Sudjarwo Universitas Jember
Jauhar Firdaus Universitas Jember
Angga Mardro Raharjo Universitas Jember

DOI:

https://doi.org/10.47134/ijhis.v3i2.57

Keywords:

Skin Pigmentation, Level of Anxiety, Clofazimine, MDR-TB

Abstract

Clofazimine, used to treat Multidrug-resistant tuberculosis (MDR-TB), often causes skin pigmentation changes, potentially impacting patients' self-esteem and anxiety. Anxiety represents a common but often underrecognized comorbidity in MDR-TB patients, who are challenged by lengthy treatment regimens, social stigma, and distressing adverse effects. This study aimed to examine this correlation at Dr. Soebandi Hospital. The study utilized an observational analytic method with a cross-sectional design. The population was all MDR-TB patients in Dr. Soebandi hospital, presented from April to May 2024. We recruited 67 patients using a total sampling technique. We analyzed the primary data from the respondents: 1) Respondents' self-rating of skin pigmentation change; 2) Hamilton Anxiety Rating Scale (HARS) score. We also checked the medical records to analyze the respondents' treatment history. The data were analyzed using the chi-square test. Most respondents were male and in a productive age. The chi-square test results show a p-value of 0.822, indicating no significant correlation between skin pigmentation changes and anxiety levels in MDR-TB patients. Clofazimine-induced skin pigmentation changes had no significant correlation with the anxiety levels among MDR-TB Patients at Dr. Soebandi Hospital. Further studies should consider methodological improvements, including prospective design, larger sample size, mixed method, and involvement of dermatology experts in assessing the skin changes induced by clofazimine. Recognizing individual differences in psychological response highlights the need to offer reassurance, counseling, and psychosocial support for MDR-TB patients.

References

1. Y. Xi, W. Zhang, R. J. Qiao, and J. Tang, “Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis,” PLoS One, vol. 17, no. 6 June, pp. 1–15, 2022, doi: 10.1371/journal.pone.0270003.

2. Kementerian Kesehatan RI and Tim Kerja TBC, “Laporan Program Penanggulangan Tuberkulosis Tahun 2022,” Jakarta, 2023.

3. J. Xu, A. Koval, and V. L. Katanaev, “Clofazimine: A journey of a drug,” Biomedicine & Pharmacotherapy, vol. 167, p. 115539, Nov. 2023, doi: 10.1016/j.biopha.2023.115539.

4. S. D. Chavhan and S. Jawade, “Clofazimine induced pigmentation in leprosy patches,” Pan African Medical Journal, vol. 42, 2022, doi: 10.11604/pamj.2022.42.14.34956.

5. A. F. Nahhas, T. L. Braunberger, and I. H. Hamzavi, “An Update on Drug-Induced Pigmentation,” Am J Clin Dermatol, vol. 20, no. 1, pp. 75–96, Feb. 2019, doi: 10.1007/s40257-018-0393-2.

6. M. Nasr, “Skin Pigment Disorders and Mental Health : The Psychological Impact,” Journal of Cosmetology & Trichology, vol. 9, no. 4, pp. 4–5, 2023, doi: 10.37421/2471-9323.2023.9.220.

7. J. G. Jang and J. H. Chung, “Diagnosis and treatment of multidrug-resistant tuberculosis,” Yeungnam Univ J Med, vol. 37, no. 4, pp. 277–285, Oct. 2020, doi: 10.12701/yujm.2020.00626.

8. G. Dabas, K. Vinay, D. Parsad, A. Kumar, and M. S. Kumaran, “Psychological disturbances in patients with pigmentary disorders: a cross‐sectional study,” Journal of the European Academy of Dermatology and Venereology, vol. 34, no. 2, pp. 392–399, Feb. 2020, doi: 10.1111/jdv.15987.

9. A. C. Sweetland et al., “Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic,” The International Journal of Tuberculosis and Lung Disease, vol. 21, no. 8, pp. 852–861, Aug. 2017, doi: 10.5588/ijtld.16.0584.

10. T. D. Susanto et al., “Anxiety and depression level of patients with multidrug-resistant tuberculosis (MDR-TB) in two hospitals in Banten province, Indonesia,” Dialogues in Health, vol. 2, Dec. 2023, doi: 10.1016/j.dialog.2023.100115.

11. S. E. Hayward et al., “The relationship between mental health and risk of active tuberculosis: A systematic review,” Jan. 06, 2022, BMJ Publishing Group. doi: 10.1136/bmjopen-2021-048945.

12. A. C. Sweetland et al., “Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic,” International Journal of Tuberculosis and Lung Disease, vol. 21, no. 8, pp. 852–861, Aug. 2017, doi: 10.5588/ijtld.16.0584.

13. R. Sutar, A. Majumdar, V. Yadav, D. S. Basera, and H. Gupta, “Anxiety, stress, and quality of life in patients with tuberculosis: A systematic review and meta-analysis,” Ind Psychiatry J, vol. 33, no. 1, pp. 13–29, Jan. 2024, doi: 10.4103/ipj.ipj_58_23.

14. B. Ayu et al., “Kecemasan pada Penderita Tuberculosis (Anxiety in Tuberculosis Patients),” 2022.

15. J. L. Arbiser and S. L. Moschella, “Clofazimine: A review of its medical uses and mechanisms of action,” 1995. doi: 10.1016/0190-9622(95)90134-5.

16. H. Zhu et al., “Activity of Clofazimine and TBI-166 against Mycobacterium tuberculosis in Different Administration Intervals in Mouse Tuberculosis Models,” 2021. [Online]. Available: https://journals.asm.org/journal/aac

17. I. M. Ramdan, “Reliability and Validity Test of the Indonesian Version of the Hamilton Anxiety Rating Scale (HAM-A) to Measure Work-related Stress in Nursing,” Jurnal Ners, vol. 14, no. 1, pp. 33–40, Apr. 2019, doi: 10.20473/jn.v14i1.10673.

18. G. Chrisnawati and T. Aldino, “Aplikasi Pengukuran Tingkat Kecemasan Berdasarkan Skala Hars Berbasis Android,” Jurnal Teknik Komputer, vol. 5, no. 2, pp. 277–282, Aug. 2019, doi: 10.31294/jtk.v5i2.6312.

19. H. Lv et al., “Global prevalence and burden of multidrug-resistant tuberculosis from 1990 to 2019,” BMC Infect Dis, vol. 24, no. 1, p. 243, Feb. 2024, doi: 10.1186/s12879-024-09079-5.

20. F. Mirzayev et al., “World Health Organization recommendations on the treatment of drug-resistant tuberculosis, 2020 update,” European Respiratory Journal, vol. 57, no. 6, p. 2003300, Jun. 2021, doi: 10.1183/13993003.03300-2020.

21. K. Mehari et al., “Prevalence and Factors Associated with Multidrug-Resistant Tuberculosis (MDR-TB) among Presumptive MDR-TB Patients in Tigray Region, Northern Ethiopia,” Canadian Journal of Infectious Diseases and Medical Microbiology, vol. 2019, pp. 1–8, Sep. 2019, doi: 10.1155/2019/2923549.

22. M. D. Murashov et al., “The Physicochemical Basis of Clofazimine-Induced Skin Pigmentation,” Journal of Investigative Dermatology, vol. 138, no. 3, pp. 697–703, Mar. 2018, doi: 10.1016/j.jid.2017.09.031.

23. A. A. Marques, M. C. do N. Bevilaqua, A. M. P. da Fonseca, A. E. Nardi, S. Thuret, and G. P. Dias, “Gender Differences in the Neurobiology of Anxiety: Focus on Adult Hippocampal Neurogenesis,” Neural Plast, vol. 2016, pp. 1–14, 2016, doi: 10.1155/2016/5026713.

24. X. Sun et al., “Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study,” Front Public Health, vol. 10, 2022, doi: https://doi.org/10.3389/fpubh.222.944103.

25. Y. Fu, J. Xie, D. Xu, Y. Xia, Z. Wang, and Y. Fan, “Health literacy status and associated factors among residents in Anhui Province, China: a cross-sectional study,” Front Public Health, vol. 12, 2024, doi: 10.3389/fpubh.2024.1493682.

26. C. P. McLean, A. Asnaani, B. T. Litz, and S. G. Hofmann, “Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness,” J Psychiatr Res, vol. 45, no. 8, pp. 1027–1035, Aug. 2014, doi: 10.1016/j.jpsychires.2011.03.006.

27. S. G. Hofmann and D. E. Hinton, “Cross-Cultural Aspects of Anxiety Disorders,” Curr Psychiatry Rep, vol. 16, no. 6, p. 450, Jun. 2014, doi: 10.1007/s11920-014-0450-3.

28. L. Handayani and A. A. Suryana, “Peran Social Support dalam Strategi Coping Penderita TBC Paru: Literature Review,” Media Publikasi Promosi Kesehatan Indonesia (MPPKI), vol. 7, no. 5, pp. 1101–1107, May 2024, doi: 10.56338/mppki.v7i5.5018.

29. L. Muna and U. Soleha, “Motivasi Dan Dukungan Sosial Keluarga Mempengaruhi Kepatuhan Berobat Pada Pasien Tb Paru Di Poli Paru Bp4 Pamekasan,” Journal of Health Sciences, vol. 7, no. 2, Apr. 2018, doi: 10.33086/jhs.v7i2.506.

30. C. T. Mahoney, D. L. Segal, and F. L. Coolidge, “Anxiety Sensitivity, Experiential Avoidance, and Mindfulness Among Younger and Older Adults,” The International Journal of Aging and Human Development, vol. 81, no. 4, pp. 217–240, Oct. 2015, doi: 10.1177/0091415015621309.

31. S. Hausknecht, L.-F. Low, K. O’Loughlin, J. McNab, and L. Clemson, “Older Adults’ Self-Perceptions of Aging and Being Older: A Scoping Review,” Gerontologist, vol. 60, no. 7, pp. e524–e534, Sep. 2020, doi: 10.1093/geront/gnz153.

32. I. F. Walker et al., “Depression and anxiety in patients with multidrug-resistant tuberculosis in Nepal: an observational study,” Public Health Action, vol. 9, no. 1, pp. 42–48, Mar. 2019, doi: 10.5588/pha.18.0047.

33. C. Maynard, S. Tariq, G. Sotgiu, G. B. Migliori, M. van den Boom, and N. Field, “Psychosocial support interventions to improve treatment outcomes for people living with tuberculosis: a mixed methods systematic review and meta-analysis,” EClinicalMedicine, vol. 61, Jul. 2023, doi: 10.1016/j.eclinm.2023.102057.