Pulse metilprednizolon tedavisi uygulanan alopesi hastalarında klinik yanıt ve rantes, MIG, IL-17, IL-8 ve eotaksin kemokinlerinin serum düzeylerinin incelenmesi
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Date
2009
Authors
Öztürk, H. Zerrin Yazıcı
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Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Bu çalışmada alopesi hastalarında pulse steroid tedavisinin klinik ve immunolojik etkilerinin değerlendirilmesi, tedaviye yanıttaki farklılıkların bazı kemokin düzeyleriyle ilişkili olup olmadığının araştırılmasını amaçladık.Çalışmaya Ocak 2008-Ocak 2009 arasında polikliniğimize başvuran yamasal alopesi areatalı (AA) 10 hasta, alopesi totalisli (AT) 5 hasta ve alopesi universalisli (AU) 5 hasta olmak üzere toplam 20 hasta alındı. Erişkin yaş grubuna 8 mg/kg/gün, çocuk hastalara 5 mg/kg/gün dozunda metilprednizolon, 3 gün üst üste İV yolla ayda bir kez, toplam 6 ay boyunca verildi. Olgular takiben 6 ay süresince ilaçsız izleme alındı. Klinik yanıt SALT (alopesi şiddet ölçeği) ile değerlendirildi. Yanıt veren olgularda saç çekme testi uygulandı. Tedavinin başlangıcında, 3. ve 6. aylarında; izlemde 3 ayda bir, ayrıca aktivasyon ve nüks dönemlerinde ELISA yöntemiyle serumda RANTES, MIG, IL-17, IL-8 ve Eotaksin konsantrasyonları ölçüldü.Olguların 13'ü erkek, 7'si kadın olup, yaşları 6-43 (19.2±12) yıl, hastalık süresi 6-432 (131.1±119.3) ay arasında değişiyordu. Daha önce topikal, sistemik tedavi ve/veya fototerapi uygulanmıştı. Yamasal kaybı olan olguların birisinde tam, ikisinde orta derecede yanıt, AT olgularının ikisinde orta derecede yanıt ve AU'li bir olguda tam yanıt sağlandı. Olguların üçünde aktivasyon, üçünde nüks gözlendi. "Flushing" ve reaktif lenfadenopati dışında bir yan etki görülmedi. Çekme testi pozitif olan olgularda saçların %60'ı distrofik anagen kıl özelliğindeydi. Sadece eotaksinle tedavi öncesi hastalık şiddeti arasında ters ilişki bulundu (p<0.05). Aktivasyon ve nüks görülen 6 olgudan beşinde bu dönemde alınan serum örneklerinde MIG, IL-17 ve IL-8, düzeylerinde, birinde sadece IL-8 düzeyinde artış saptandı.Diğer immunsupresif tedavilere yanıtsız ve hastalığı uzun süredir devam eden olgularda pulse metilprednizolon tedavisinin dar yan etki profiliyle güvenilir olmasına rağmen etkinliğinin de sınırlı olduğunu gördük. Tedavi öncesi eotaksin düzeyiyle hastalık şiddeti arasında istatistiksel olarak saptanan ters ilişki ve aktivasyon ve nüks gelişen olgular bazında MIG, IL-17, ve IL-8'le saptanan pozitif ilişki nedeniyle bu konunun daha geniş olgu serili çalışmalarla araştırılması gerektiği kanısındayız.
In this study we aimed to evaluate the clinical and immunological effects of pulse steroid therapy in alopecia patients and the relation between the different responses to therapy and some chemokine levels.Ten patients with patchy type of alopecia areata, 5 patients with alopecia totalis and 5 patients with alopecia universalis applied to our clinic between January 2008 and January 2009 were included in the study. Adult patients recieved 8 mg/kg/day and pediatric patients received 5 mg/kg/day methylprednisolone IV for 3 consecutive days once a month a total of 6 months. The patients were followed up for 6 months unmedicated. Clinical response was evaluated according to SALT (Severity of Alopecia Tool) score. Pull test was applied to responded patients. Serum RANTES, MIG, IL-17, IL-8 and Eotaxin concentrations were measured at the beginning of the therapy, at 3rd and 6th months of therapy; at every 3 months in the follow up period and if activation or relaps occurs.Our cases consisted of 13 men and 7 women; ages varying between 6-13 (19.2±12) years and duration of their illnesses varying between 6-432 (131.1±119.3) months. Topical and systemic therapies and/or phototherapy were previously applied. Complete response was achieved in one, moderate response in two of patchy type of alopecia areata patients. Moderate response was achieved provided in two patients with alopecia totalis and complete response in one patient with alopecia universalis. Three cases had activation and 3 cases relapsed during the study. No side effects were observed except flushing and reactive lymphadenopathy. We observed that 60% of hairs were at dystrophic anagen stage in the cases with pull test positivity. There was an inverse relationship between pretreatment levels of eotaxin and severity of illness (p<0.05). 5 of 6 patients with activation or relapse showed increased levels of serum MIG, IL-17 and IL-8 levels and one of them showed increased levels of serum IL-8 only.In this study, we observed that the efficacy of methylprednisolone therapy in patients who are unresponsive to other immunosuppressive agents is limited, though it was safe with minimal side effects. Since we detected an inverse relationship between the severity of illness and pretreatment levels of eotaxin and an increase in levels of MIG, IL-17 and IL-8 in patients with activation and/or relapse, we consider that this issue should be evaluated with further studies.
In this study we aimed to evaluate the clinical and immunological effects of pulse steroid therapy in alopecia patients and the relation between the different responses to therapy and some chemokine levels.Ten patients with patchy type of alopecia areata, 5 patients with alopecia totalis and 5 patients with alopecia universalis applied to our clinic between January 2008 and January 2009 were included in the study. Adult patients recieved 8 mg/kg/day and pediatric patients received 5 mg/kg/day methylprednisolone IV for 3 consecutive days once a month a total of 6 months. The patients were followed up for 6 months unmedicated. Clinical response was evaluated according to SALT (Severity of Alopecia Tool) score. Pull test was applied to responded patients. Serum RANTES, MIG, IL-17, IL-8 and Eotaxin concentrations were measured at the beginning of the therapy, at 3rd and 6th months of therapy; at every 3 months in the follow up period and if activation or relaps occurs.Our cases consisted of 13 men and 7 women; ages varying between 6-13 (19.2±12) years and duration of their illnesses varying between 6-432 (131.1±119.3) months. Topical and systemic therapies and/or phototherapy were previously applied. Complete response was achieved in one, moderate response in two of patchy type of alopecia areata patients. Moderate response was achieved provided in two patients with alopecia totalis and complete response in one patient with alopecia universalis. Three cases had activation and 3 cases relapsed during the study. No side effects were observed except flushing and reactive lymphadenopathy. We observed that 60% of hairs were at dystrophic anagen stage in the cases with pull test positivity. There was an inverse relationship between pretreatment levels of eotaxin and severity of illness (p<0.05). 5 of 6 patients with activation or relapse showed increased levels of serum MIG, IL-17 and IL-8 levels and one of them showed increased levels of serum IL-8 only.In this study, we observed that the efficacy of methylprednisolone therapy in patients who are unresponsive to other immunosuppressive agents is limited, though it was safe with minimal side effects. Since we detected an inverse relationship between the severity of illness and pretreatment levels of eotaxin and an increase in levels of MIG, IL-17 and IL-8 in patients with activation and/or relapse, we consider that this issue should be evaluated with further studies.
Description
Keywords
Alopesi, Metilprednizolon, RANTES, Eotaksin, Alopecia, Methylprednisolone, Eotaxin
Citation
Öztürk, H. Z. Y. (2009). Pulse metilprednizolon tedavisi uygulanan alopesi hastalarında klinik yanıt ve rantes, MIG, IL-17, IL-8 ve eotaksin kemokinlerinin serum düzeylerinin incelenmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.