Morfea (lokalize skleroderma) hastalarında tedaviye yanıt: Retrospektif çalışma
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Date
2013
Authors
Günay, Işıl Tilki
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Morfea dermis ve subkutan dokunun klinik olarak belirgin, skar benzeri sklerozu ile sonlanan enflamatuar bir hastalığıdır. Tedavisinde topikal ve sistemik tedaviler, fototerapi; özellikle ultraviyole A1 (UVA1) tedavisi uygulanmaktadır. Morfealı hastalarda ultrasonografi hastalığın seyri ve tedaviye yanıtın değerlendirilmesinde ucuz, noninvaziv ve uygulaması kolay bir yöntem olması nedeniyle pek çok invaziv yönteme üstünlük sağlamaktadır. Bu çalışmada; morfea tedavisinde UVA1 fototerapisi uygulanan hastaların tedavi öncesi ve sonrasında yapılan ultrasonografi sonuçları retrospektif olarak değerlendirildi. Morfealı 13 hastaya UVA1+kolşisin, 10 hastaya yalnızca UVA1 fototerapisi uygulanmıştı. UVA1 haftada 2 gün 10J/cm2 , kolşisin 1.5 mg/gün olarak 6 ay süre ile uygulanmıştı. Hastalara tedavi başlangıcında, tedavinin 2. ve 6. ayında aynı morfeik alanlara deri ultrasonografisi yapılmıştı. UVA-1 ile, UVA1 + kolşisin birlikte kullanılan hastaların tedavi öncesi, tedavinin 2. ve 6. aylarındaki ultrasonografi sonuçları değerlendirildiğinde iki grup arasında deri kalınlığındaki azalmada istatistiksel olarak anlamlı fark yoktu (p>0.05). Hastaların tedavi öncesi deri ultrasonografi sonuçları ile, tedavinin 2. ve 6. aylarındaki ultrasonografi sonuçları karşılaştırıldığında her iki grupta da deri kalınlığındaki istatistiksel olarak anlamlı azalma olduğu saptandı (p<0.05). Çalışmamızdaki düşük doz UVA1 fototerapisi sonrasındaki deri ultrasonografi sonuçları değerlendirildiğinde orta ve yüksek dozlarda UVA1 verilen hastalarda deri kalınlığındaki azalmanın daha fazla olduğunu görüldü. Morfeada tedaviye orta dozda başlanılıp, hastanın tolere edebileceği yüksek dozlara çıkılmasının daha uygun olacağı kanısına varıldı. Gelişen teknoloji ile birlikte invaziv yöntemlere göre avantajları nedeniyle dermatolojik ultrasonografi daha yaygın kullanılabilecektir.
Morphea (Localized scleroderma; LS) is an clinically noticeable inflamatuar disease of dermis and subcutaneous tissue and leads to scar like sclerosis. As well as in the treatment of topical and systemic therapy, phototherapy; especially ultraviolet A1 (UVA1) treatment is applied. In patients with morphea ultrasonography is of many advantages compared with many invasive methods due to cheap, non invazive methods in the evaluation of the course of disease and reponse to therapy. In this study; the results of ultrasonography done before and after therapy to patients to whom UVA1 phototherapy is applied in the treatment of morphea were evaluated retrospectively. UVA1+colchicine was applied to 13 patient with morphea and only UVA1 was applied to 10 patients. UVA1 was applied 10 J/cm2 two days in a week and colchicine was applied 1.5 mg/day for six months. Skin ultrasonograpy was done to the same morpheic areas in the beginning of treatment, treatment 2. and 6. months. Before the treatment of patients to whom UVA1 and UVA1+colchicine were used when ultrasonography results in the 2. and 6.months of treatment were evaluated, no statisticaly significant difference was present in the reduction in skin thickness between two groups (p>0.05). In order to compare the results of two treatments when the results of skin ultrasonography before treatment and those of the 2. and 6. months of treatment were compared, it was determined that statisticaly significant decrease was present in skin thickness in both groups (p<0.05). In our study when skin ultrasound results of patients with morphea were evaluated, after low dosage UVA1 phototherapy, it was seen that there were more decreases in skin thickness of patients to whom moderate and high dosage UVA1 was administered. We are of the opinion that, moderate dosage therapy should be administered in morphea and then high dosage should be administered if the patients can tolerate. Dermatologic ultrasonography can be commonly used due to its advantages over in invasive methods together with developing technology.
Morphea (Localized scleroderma; LS) is an clinically noticeable inflamatuar disease of dermis and subcutaneous tissue and leads to scar like sclerosis. As well as in the treatment of topical and systemic therapy, phototherapy; especially ultraviolet A1 (UVA1) treatment is applied. In patients with morphea ultrasonography is of many advantages compared with many invasive methods due to cheap, non invazive methods in the evaluation of the course of disease and reponse to therapy. In this study; the results of ultrasonography done before and after therapy to patients to whom UVA1 phototherapy is applied in the treatment of morphea were evaluated retrospectively. UVA1+colchicine was applied to 13 patient with morphea and only UVA1 was applied to 10 patients. UVA1 was applied 10 J/cm2 two days in a week and colchicine was applied 1.5 mg/day for six months. Skin ultrasonograpy was done to the same morpheic areas in the beginning of treatment, treatment 2. and 6. months. Before the treatment of patients to whom UVA1 and UVA1+colchicine were used when ultrasonography results in the 2. and 6.months of treatment were evaluated, no statisticaly significant difference was present in the reduction in skin thickness between two groups (p>0.05). In order to compare the results of two treatments when the results of skin ultrasonography before treatment and those of the 2. and 6. months of treatment were compared, it was determined that statisticaly significant decrease was present in skin thickness in both groups (p<0.05). In our study when skin ultrasound results of patients with morphea were evaluated, after low dosage UVA1 phototherapy, it was seen that there were more decreases in skin thickness of patients to whom moderate and high dosage UVA1 was administered. We are of the opinion that, moderate dosage therapy should be administered in morphea and then high dosage should be administered if the patients can tolerate. Dermatologic ultrasonography can be commonly used due to its advantages over in invasive methods together with developing technology.
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Keywords
Morfea, Fototerapi, Deri ultrasonografisi, Morphea, Phototherapy, Skin ultrasonography
Citation
Günay, I. T. (2013). Morfea (lokalize skleroderma) hastalarında tedaviye yanıt: Retrospektif çalışma. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.