Kronik plak tip psoriasiste asitretin-puva ve asitretin-UVB kombine tedavi yöntemlerinin karşılaştırmalı sonuçları
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Dosyalar
Tarih
2002
Kurum Yazarları
Çal, Ali Sait
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
Uludağ Üniversitesi
Özet
Psoriasis, etyopatogenezi tam olarak bilinmeyen, epidermal çoğalma ve olgunlaşmanın normal döngüsündeki defekt sonucu ortaya çıktığı ileri sürülen kronik, inflamatuar bir deri hastalığıdır. Ömür boyu alevlenme ve düzelmelerle seyretmesi ve kesin tedavisi olmamasından dolayı hastaların yaşam kalitesini olumsuz olarak etkilemektedir. Çoğunlukla tek ilaçla hastalık kontrol altına alınabilmekle birlikte uzun süreli kullanıldığında istenmeyen etkileri ve potansiyel kümülatif toksisiteleri nedeniyle önerilmemektedir. Bu nedenle kombinasyon tedavilerini de içine alan çeşitli yöntemler geliştirilmiştir. Çalışmamızda Uludağ Üniversitesi Tıp Fakültesi Dermatoloji Anabilim Dalına başvuran kronik plak tip psoriasis tanısı konulmuş hastalara asitretin-PUVA ve asitretin-dar band UVB olmak üzere iki farklı kombinasyon tedavisi uygulandı. Çalışmaya 47 hasta kabul edilmesine karşın dört hasta değerlendirme dışı bırakıldı ve 43 hasta tedaviyi tamamladı. Asitretin-PUVA tedavisi verilen grupta yaşları 18 ile 64 arasında (ortalama 36.9) değişen, 14'ü erkek 6'sı kadın toplam 20 hasta vardı. Asitretin-UVB tedavisi verilen grupta ise yaşları 16 ile 68 arasında (ortalama 38.8) değişen, 12'si erkek 11'i kadın toplam 23 hasta vardı. Hastaların klinik değerlendirmesinde "Psoriasis Alan ve Şiddet Skoru" kullanıldı. Tedavi sonrası değerlendirmede asitretin-PUVA grubunda %84 ve asitretin-UVB grubunda ise %86 oranında saptanan gerileme, her iki grupta anlamlı istatistiksel farklılık olmadığını ortaya çıkarmıştır. İlk gruptaki hastaların dokuzunda, ikinci grupta ise 11 hastada "tam ya da çok iyi derecede düzelme" saptandı. Sonuçta; her iki kombinasyon tedavisi arasında klinik olarak anlamlı bir farklılık olmamasına rağmen, asitretin-UVB tedavisi göreceli daha az yan etki ve potansiyel riskleri nedeniyle daha güvenilir bir kombinasyon tedavisi olarak değerlendirildi.
Psoriasis is a chronic and inflammatory disease of the skin with unknown etiopathogenesis but postulated to be due to a defect in the normal cycle of epidermal proliferation and differentiation. Since this lifelong disease has a course with remissions and exacerbations and no curative therapy, life quality of the patients are negatively affected. Although the disease is often controlled with monotherapy, this is not advised because of the adverse effects and potential cumulative toxicity of the long-term use of these drugs. For this reason various combination therapy regimens are proposed. In our study, two different combination therapies as acitretine-PUVA and acitretine-narrow band UVB were applied to the patients who were admitted to the Uludağ University Medical Faculty, Dermatology Department and diagnosed as chronic plaque type psoriasis. Although 47 patients were admitted to the study at the beginning, 4 patients were excluded and 43 patients completed the study. Acitretine-PUVA therapy group included a total of 20 patients, 14 men and 6 women. aged between 18 and 64 (mean, 36.9 years). Acitretine-UVB therapy group included a total of 23 patients, 12 men and 11 women, aged between 16 and 68 (mean, 38.8 years). "Psoriasis Area and Severity Score" was used for the clinical assesment of the patients. At the end of the therapy there was 84% of regression in PASI scores of acitretine-PUVA group and 86% regression in PASI scores of acitretine-UVB group implying that there is no statistically significant difference between both groups. "Complete or nearly complete improvement" was observed in nine of the patients in the first group and eleven of the patients in the second. In conclusion, though there is no significant difference in the efficacy of both combination therapies, we evaluate the combination of acitretine and UVB as a safer therapy regimen with relatively less adverse effects and potential risks.
Psoriasis is a chronic and inflammatory disease of the skin with unknown etiopathogenesis but postulated to be due to a defect in the normal cycle of epidermal proliferation and differentiation. Since this lifelong disease has a course with remissions and exacerbations and no curative therapy, life quality of the patients are negatively affected. Although the disease is often controlled with monotherapy, this is not advised because of the adverse effects and potential cumulative toxicity of the long-term use of these drugs. For this reason various combination therapy regimens are proposed. In our study, two different combination therapies as acitretine-PUVA and acitretine-narrow band UVB were applied to the patients who were admitted to the Uludağ University Medical Faculty, Dermatology Department and diagnosed as chronic plaque type psoriasis. Although 47 patients were admitted to the study at the beginning, 4 patients were excluded and 43 patients completed the study. Acitretine-PUVA therapy group included a total of 20 patients, 14 men and 6 women. aged between 18 and 64 (mean, 36.9 years). Acitretine-UVB therapy group included a total of 23 patients, 12 men and 11 women, aged between 16 and 68 (mean, 38.8 years). "Psoriasis Area and Severity Score" was used for the clinical assesment of the patients. At the end of the therapy there was 84% of regression in PASI scores of acitretine-PUVA group and 86% regression in PASI scores of acitretine-UVB group implying that there is no statistically significant difference between both groups. "Complete or nearly complete improvement" was observed in nine of the patients in the first group and eleven of the patients in the second. In conclusion, though there is no significant difference in the efficacy of both combination therapies, we evaluate the combination of acitretine and UVB as a safer therapy regimen with relatively less adverse effects and potential risks.
Açıklama
Anahtar kelimeler
PUVA, Dar band UVB, Asitretin, Psoriasis, Acitretin, Narrow band UVB
Alıntı
Çal, A. S. (2002). Kronik plak tip psoriasiste asitretin-puva ve asitretin-UVB kombine tedavi yöntemlerinin karşılaştırmalı sonuçları. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.