Kronik plak tipi psoriasiste topikal % 0.1 takrolimus merhemin etkinliği
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Date
2006
Authors
Kaçar, Seval Doğruk
Journal Title
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Publisher
Uludağ Üniversitesi
Abstract
Takrolimus (FK 506) ilk olarak organ transplantlarında doku rejeksiyonunu önlemede kullanılan bir immünsupresif ajandır. Son yıllarda yapılan çalışmalarda topikal ve sistemik uygulanan takrolimus çeşitli inflamatuar deri hastalıklarının tedavisinde etkili bulunmuştur. Randomize, çift-kör olarak yapılan bu çalışmada topikal takrolimusun kronik plak tipi psoriasisteki etkinliği mevcut diğer topikal tedaviler ve plasebo ile karşılaştırılmıştır. Kronik plak tipi psoriasisi olan 24 hasta çalışmaya alındı. Çalışmayı tamamlayan 22 hastada (16’sı kadın, 6’sı erkek) seçilen 27 plakta 19 gün boyunca günaşırı olarak % 0.1 takrolimus merhemi, % 0.1 mometasone furate merhemi, % 0.005 kalsipotriol merhemi ve plasebo lökotestlerle oklüzyon şeklinde uygulandı. Tedavinin etkinliği başlangıçta, tedavi ortası ve sonunda, eritem, kalınlık ve deskuamasyonun toplandığı toplam klinik skor hesaplanarak; tedavi başlangıcı ve sonunda yüzeyel Doppler Ultrasonografi ile epidermis kalınlığı ölçülerek değerlendirildi. Ayrıca tedavi sonunda 9 hastadan mikroplaklardan biyopsi alınarak toplam histolojik skor ve epidermal kalınlık hesaplandı. Tedavi sonunda takrolimus uygulanan plağa ait klinik skorlardaki ve ultrasonografik ölçülen epidermal kalınlıktaki değişim, plasebo ile karşılaştırıldığında takrolimus uygulanan plakta istatistiksel olarak daha belirgin düzelme olduğu saptandı (p<0,001). Mometasone furate ve kalsipotriol de plasebo karşısında benzer şekilde etkili bulundu (p<0,001). Toplam klinik skorda takrolimus ile % 62, plasebo ile % 31, kalsipotriol ile % 59, mometasone furate ile ise % 73 azalma sağlanmıştır. Dokuz hastanın tedavi sonrasında mikroplaklarında hesaplanan toplam histolojik skor ve epidermal kalınlıktaki plaseboya göre değişim karşılaştırıldığında ise en etkili olanın mometasone furate olduğu, bunu takrolimus ve kalsipotriolün izlediği görüldü. Buna göre takrolimus merheminin özellikle oklüzyonla uygulandığında topikal steroidlere alternatif oluşturabileceği sonucuna vardık.
Tacrolimus (FK 506) is an immunosuppressant formerly used to prevent tissue rejection in organ transplantation. It is found to be effective both topically and systemically in treatment of many inflammatory skin diseases, recently. The efficacy of topical tacrolimus in chronic plaque psoriasis is evaluated compared with conventional topical treatments and placebo, in a randomized double-blind fashion, in this study. Twentyfour patients with chronic plaque psoriasis included to the study. In 22 (16 women, 6 men) of who completed the study, % 0.1 tacrolimus ointment, % 0.1 mometasone furoate ointment, % 0.005 calcipotriol ointment and placebo were applied every 2-3 days under occlusion in Finn-chambers during 19 days on selected 27 plaques. The efficacy of treatment was assessed through the total clinical score measured by sum of erythema, induration and scaling, at the beginning, in the middle and at the end of the treatment; epidermal thickness measured by superficial doppler ultrasound at the beginning and end of treatment. In addition, total histological score and epidermal thickness were measured in biopsy specimens from the microplaques of 9 patients. The change in total clinical score and ultrasound epidermal thickness for tacrolimus at the end of treatment was statistically significant when compared with placebo (p<0,001). Mometasone furate and calcipotriol showed similar efficacy compared to placebo (p<0,001). The percentage decrease in total score was 62 for tacrolimus, 31 for placebo, 59 calcipotriol and 73 for mometasone furoate. The comparison of changes in total histological score and epidermal thickness according to placebo at the end of the treatment in 9 patients showed that mometasone furoate was the most effective, followed by tacrolimus and calcipotriol. We concluded that topical tacrolimus especially when applied under occlusion can be an alternative to topical corticosteroids.
Tacrolimus (FK 506) is an immunosuppressant formerly used to prevent tissue rejection in organ transplantation. It is found to be effective both topically and systemically in treatment of many inflammatory skin diseases, recently. The efficacy of topical tacrolimus in chronic plaque psoriasis is evaluated compared with conventional topical treatments and placebo, in a randomized double-blind fashion, in this study. Twentyfour patients with chronic plaque psoriasis included to the study. In 22 (16 women, 6 men) of who completed the study, % 0.1 tacrolimus ointment, % 0.1 mometasone furoate ointment, % 0.005 calcipotriol ointment and placebo were applied every 2-3 days under occlusion in Finn-chambers during 19 days on selected 27 plaques. The efficacy of treatment was assessed through the total clinical score measured by sum of erythema, induration and scaling, at the beginning, in the middle and at the end of the treatment; epidermal thickness measured by superficial doppler ultrasound at the beginning and end of treatment. In addition, total histological score and epidermal thickness were measured in biopsy specimens from the microplaques of 9 patients. The change in total clinical score and ultrasound epidermal thickness for tacrolimus at the end of treatment was statistically significant when compared with placebo (p<0,001). Mometasone furate and calcipotriol showed similar efficacy compared to placebo (p<0,001). The percentage decrease in total score was 62 for tacrolimus, 31 for placebo, 59 calcipotriol and 73 for mometasone furoate. The comparison of changes in total histological score and epidermal thickness according to placebo at the end of the treatment in 9 patients showed that mometasone furoate was the most effective, followed by tacrolimus and calcipotriol. We concluded that topical tacrolimus especially when applied under occlusion can be an alternative to topical corticosteroids.
Description
Keywords
Kronik plak tipi psoriasis, Topikal takrolimus, Chronic plaque psoriasis, Topical tacrolimus
Citation
Kaçar, S. D. (2006). Kronik plak tipi psoriasiste topikal % 0.1 takrolimus merhemin etkinliği. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.