Kushandiswa kwe botulinum toxin mune dermatology uye cosmetology

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Piyu Parth Naik Dermatology, Saudi German Hospitals and Clinics, Dubai, United Arab Emirates Communications: Piyu Parth Naik Dermatology, Saudi German Hospitals and Clinics, Burj Al Arab, Dubai, United Arab Emirates Opposite phone +971 503725616 email [email received Protection] Abstract : Botulinum toxin (BoNT) inonzi neurotoxin inogadzirwa neClostridium botulinum bacteria.Iyo ine inonyanyozivikanwa inoshanda uye chengetedzo mukurapa kwefocal idiopathic hyperhidrosis.BoNT ine nomwe neurotoxins dzakasiyana;zvisinei, chepfu A uye B chete ndiyo inoshandiswa pakiriniki.BoNT ichangobva kushandiswa kurapa-isina-label kurapwa kwezvirwere zvakasiyana-siyana zveganda.Kudzivirirwa kwevanga, hyperhidrosis, wrinkles, madikidiki ekudikitira, kurasikirwa kwebvudzi, psoriasis, chirwere cheDarier, bullous skin disease, sweat herpes uye Raynaud's phenomenon ndezvimwe zvezviratidzo zvitsva zveBoNT mune cosmetics, kunyanya mune dermatology Zvisiri zvekushongedza zvinhu.Kuti tishandise BoNT nemazvo mumakiriniki ekudzidzira, isu tinofanirwa kunyatsonzwisisa inoshanda anatomy yemamhasuru akafananidzwa.Tsvakiridzo yemabhuku yakadzama yakaitwa kuti ivandudze zvese zvedermatological-oriented tests uye miedzo yekiriniki pazvinhu zveBoNT kuitira kuti ipe tarisiro yekushandiswa kweBoNT mune dermatology.Ongororo iyi ine chinangwa chekuongorora basa re botulinum toxin mune dermatology uye cosmetology.Keywords: botulinum toxin, botulinum toxin, botulinum, dermatology, cosmetology, neurotoxin
Botulinum neurotoxin (BoNT) inogadzirwa neClostridium botulinum, inova anaerobic, gram-positive, bhakitiriya rinogadzira spore.1 Parizvino, manomwe eBoNT serotypes (A kusvika G) akawanikwa, uye mhando A neB chete dzinogona kushandiswa pakurapa.BoNT A (Oculinum) yakabvumidzwa neUS Food and Drug Administration (FDA) muna 1989 yekurapa blepharospasm uye strabismus.Kukosha kwekurapa kweBoNT A kwakatemwa kekutanga.Yakanga isiri kusvika Kubvumbi 2002 iyo FDA yakabvumidza kushandiswa kweBoNT A kurapa mitsara yeglabellar.Iyo FDA yakabvumidza BoNT A kurapwa kwemutsara wemberi uye lateral canthal mutsetse muna Gumiguru 2017 naGunyana 2013, zvichiteerana.Kubva ipapo, akati wandei maBoNT magadzirirwo akaunzwa kumusika.2 Kubva payatengeswa, BoNT yakashandiswa kurapa cramps, kushushikana, hyperhidrosis, migraine, uye kuchembera kwemutsipa, kumeso, uye mapfudzi muminda yekurapa uye yekuzora.3,4
Clostridium botulinum inobudisa matatu-mapuroteni complex anosanganisira 150 kDa toxin, isiri-chepfu, isiri-hemagglutinin protein, uye isiri-chepfu hemagglutinin protein.Bacterial proteases inoputsa muchetura muchigadzirwa chakapetwa kaviri chinoshanda chine 50 kDa "chiedza" cheni uye 100 kDa "inorema" chain.Mushure mekutakurwa kuenda kupresynaptic nerve terminal, cheni inorema yechepfu inoshanda inosunga kune synaptic vesicle glycoprotein 2, ichisimudzira endocytosis yetoxin-glycoprotein complex, uye kuburitsa cheni yechiedza chetoxin munzvimbo ye synaptic.Toxin light chain cleavage vesicle-yakabatana membrane protein/synaptoxin (BoNT-B, D, F, G) kana synaptosome-inosanganiswa protein 25 (BoNT-A, C, E) kudzivirira kuburitswa kweperipheral motor neuron axons Acetylcholine zvakare inokonzera kwenguva pfupi. makemikari denervation uye tsandanyama kuoma mitezo.2 MuUnited States, kune gadziriro ina dzeBoNT-A dzinotengeswa dzakabvumidzwa neFDA: incobotulinumtoxinA (Frankfurt, Germany), onabotulinumtoxinA (California, US), prabotulinumtoxinA-xvfs (California, US), uye abobotulinumtoxinA (Arizona, US) ;uye Imwe mhando yeBoNT-B: rimabotulinumtoxinB (California, USA).5 Guida et al.6 akataura nezve basa reBoNT mumunda wedermatology.Nekudaro, hapasati pave neongororo yazvino pamusoro pekushandiswa kweBoNT mumunda wedermatology uye runako.Naizvozvo, ongororo iyi ine chinangwa chekuongorora basa reBoNT mune dermatology uye cosmetology.
Mazwi akakosha anosanganisira botulinum toxin, ganda rine mafuta, rosacea, kupuruzira kumeso, mavanga, makwinya, kurasikirwa nebvudzi, psoriasis, bullous ganda chirwere, chirwere chaDarier, exocrine moles, sweat herpes, Raynaud's phenomenon, hyperhidrosis Mukupindura, dermatology, uye runako, zvinyorwa zvinotsvaga. anoitiswa mune anotevera dhatabhesi: Google Scholar, PubMed, MEDLINE, Scopus, uye Cochrane.Munyori ari kunyanya kutsvaga zvinyorwa nezve basa reBoNT mudermatology uye cosmetology.Kutsvaga kwekutanga mabhuku kwakaratidza 3112 zvinyorwa.Zvinyorwa zvakaburitswa pakati paNdira 1990 naChikunguru 2021 zvinotsanangura BoNT mune dermatology uye cosmetology, zvinyorwa zvakaburitswa muChirungu, uye ese madhizaini ekutsvagisa anosanganisirwa muongororo iyi.
Canada yakabvumira kushandiswa kweBoNT mukurapa kwekunakisa tsandanyama dzemuno nekuwonyana kwetsiye muna 2000. US FDA yakabvumidza kushandiswa kweBoNT nechinangwa chekuzora musi waKubvumbi 15, 2002. Zviratidzo zveBoNT-A nguva pfupi yadarika kushandiswa kwezvizoro zvinosanganisira mitsetse pakati tsiye, tsoka dzegunguwo, mitsetse yetsuro, mitsetse yehuma yakachinjika, mitsetse yakatarisana, kupeta kwendangariro uye kudhonzwa kwechirebvu, mabhandi eplatysma, kufinyamisa muromo, uye mitsetse yehuro yakachinjika.7 Zviratidzo zvemhando ye botulinum A yakagamuchirwa neU.S. FDA iri pakati nepakati kusvika kune mitsetse yakaomeswa yakabatana nekunyanyisa kuita kwe prefrontal uye / kana kufinyamisa tsandanyama pakati petsiye, uye pakati nepakati kusvika kune yakaoma lateral canthal mitsara inobatanidza nekunyanyisa kuita kwe orbicularis muscle.Uye mutsetse wepakati-kusvika-wakakomba wakatwasuka wehuma unobatanidzwa nekunyanyisa kumberi kwemhasuru chiitiko.8
Sebum inobatsira kupa mafuta-soluble antioxidants kune ganda repamusoro uye ane antibacterial properties;saka, inoshanda sechivharo cheganda.Sebum yakawandisa inogona kuvhara pores, kubereka mabhakitiriya uye inogona kukonzera kuzvimba kweganda (semuenzaniso, seborrheic dermatitis, mburwa).Pakutanga, ruzivo rwakakosha nezvemhedzisiro yeBoNT pane sebum yakaburitswa.9,10 Rose neGoldberg10 yakaedza kushanda uye kuchengetedzeka kweBoNT pavanhu makumi maviri nevashanu vane ganda rine mafuta.BoNT (abo-BNT, chiyero che 30-45 IU) inoiswa muzvikamu gumi zvehuma, izvo zvinonyanya kuvandudza kugutsikana kwevarwere uye kuderedza sebum kugadzirwa.Min et al.zvisina kurongeka 42 zvidzidzo zvine huma huma kuti vagamuchire gumi kana makumi maviri mayunitsi eBoNT panzvimbo shanu dzakasiyana dzejekiseni.Mapoka ese ari maviri akawana kurapwa kweBoNT, izvo zvakakonzera kudzikiswa kwakanyanya kwesebum panzvimbo yejekiseni uye sebum gradient yakatenderedza nzvimbo yejekiseni.Pavhiki regumi nematanhatu, kugadzirwa kwesebum kwemapoka maviri ekurapa kwakadzokera kune zvakajairika, uye nekuwedzera kwejekiseni, kurapa hakuna kunyatso kuvandudza.
Iyo nzira iyo intradermal jekiseni ye botulinum toxin inotungamirira mukuderedzwa sebum secretion haina kunyatsonzwisiswa, nokuti migumisiro yenheyo system uye acetylcholine pane sebaceous glands haina kunyatsotsanangurwa.Iyo neuromodulatory mhedzisiro yeBoNT inonyanya kunanga yemuno muscarinic receptors mune erector pili tsandanyama uye sebaceous glands.Mu vivo, nicotinic acetylcholine receptor 7 (nAchR7) inoratidzwa muhutu hwesebaceous glands, uye chiratidzo cheacetylcholine chinowedzera lipid synthesis mune imwe nzira-inotsamira mu vitro.11 Imwe tsvagiridzo inodiwa kuti uone kuti ndiani anonyanya kukosha mukwikwidzi uye nzira yakanakisa yejekiseni uye dosi (Mufananidzo 1A naB).
Mufananidzo 1 Mufananidzo wepamusoro (A) wemurwere ane ganda rine mafuta ari pachena, nepo kune rimwe danda, mufananidzo wepazasi (B) wemurwere mumwechete mushure mekurapwa kweBoNT kaviri unoratidza kuvandudzwa kwakakosha.(Technology: 100 units, 2.5 ml ye-intradermal BoNT-A yakajairwa kamwe chete muhuma. Mishonga miviri yakafanana yakaitwa mazuva 30 akasiyana. Mhinduro yakanaka yekliniki yakagara kwemwedzi ye6).
Rosacea chirwere cheganda chinotapukira chinoratidzwa nekutsvaira kumeso, telangiectasia, papules, pustules, uye erythema.Mishonga yemuromo, laser therapy, uye mishonga yepamusoro inowanzoshandiswa kurapa kumeso, kunyange zvazvo isiri nguva dzose inoshanda.Chimwe chiratidzo chisingafadzi chekuguma kuenda kumwedzi kugeza kumeso.Ongororo dzinoverengeka dzakaratidza kuti BoNT inogona kubatsira kurapa menopausal hot flashes uye rosacea.12-14 Mhedzisiro yeBoNT paDermatological Quality yeHupenyu Index (DLQI) yevarwere vane kugezesa kumeso ichaongororwa muongororo yeramangwana.15 BoNT yakabayiwa padama kamwe chete, kusvika pahuwandu hwemayunitsi makumi matatu, zvichikonzera kuderera kukuru kweDLQI mumwedzi miviri.Sekureva kwaOdo et al., BoNT yakaderedza zvakanyanya avhareji yenhamba yekupisa kwemenopausal pazuva re60.12 Mhedzisiro yeabo-BoNT yakadzidziswa zvakare muvarwere gumi nevashanu vane rosacea.Mwedzi mitatu gare gare, 15-45 IU yeBoNT yakabayirwa kumeso, izvo zvakaguma nekuvandudzwa kwenhamba mu erythema.13 Mukutsvakurudza, maitiro akaipa haawanzotaurwa.
Kuwedzera kwekutsvaira kweBoNT ndicho chimwe chezvikonzero zvinogoneka zvekudzivirira kwayo kwakasimba kwekuburitswa kweacetylcholine kubva kuperipheral autonomic neurons yeganda vasodilation system.16,17 Zvinonyatso zivikanwa kuti vapoteri vezvekuzvimba senge calcitonin gene-inoenderana peptide (CGRP) uye chinhu P (SP) zvakare inorambidzwa neBoNT.18 Kana kuzvimba kweganda renzvimbo kwakadzikira uye kwakadzorwa, erythema inogona kupera.Kuti uongorore basa reBoNT murosacea, zvidzidzo zvakakura, zvakadzorwa, zvisina kurongwa zvinodiwa.Majekiseni eBoNT ekugezesa kumeso ane mamwe mabhenefiti nekuti anogona kuderedza kuomarara kwechiso, nekudaro achinatsiridza mitsetse yakanaka nemakwinya.
Vanhu vazhinji vava kuona kukosha kwekushingaira kudzivisa mavanga mukurapa mavanga epashure.Kushushikana kunobata kumucheto kweronda panguva yekupora ndicho chinhu chinokosha pakuona kuonekwa kwekupedzisira kwevanga rekuvhiya.19,20 BoNT inodzivirira kuburitswa kweacetylcholine neurotransmitter, inenge ichibvisa zvachose kushushikana kwetsandanyama paronda rekupora kubva patsinga yeperipheral.Iyo yeBoNT inobvisa kushushikana, pamwe nekudzivirirwa kwayo kwakananga kwefibroblast uye TGF-1 kutaura, inoratidza kuti inogona kushandiswa kudzivirira mavanga ekuvhiya.21-23 Iyo inorwisa-kuzvimba mhedzisiro yeBoNT uye mhedzisiro yayo paganda vasculature inogona kuderedza nhanho yekuzvimba maronda ekupora (kubva pamazuva maviri kusvika mashanu), izvo zvinogona kubatsira kudzivirira mavanga.
Muzvidzidzo zvakasiyana, BoNT inogona kushandiswa kudzivirira mavanga.24-27 Mune RCT, kuchengetedzwa uye kubudirira kwekutanga kwemashure ekuvhiyiwa BoNT jekiseni muvarwere ve15 vane mavanga kubva ku thyroidectomy vakaongororwa.24 Mavanga matsva (mukati memazuva gumi ethyroidectomy) akapiwa BoNT (20-65 IU) kana 0.9% yakajairika saline (control) kamwe chete.Hafu yekurapa kweBoNT yakaratidza zvirinani zvirinani mavanga uye kugutsikana kwemurwere pane yakajairika saline kurapwa.Gassner et al.25 vakaongorora kana jekiseni reBoNT kumeso mushure mekubvaruka pahuma uye kubviswazve kunogona kuporesa mavanga ekumeso.Kuenzaniswa neplacebo (yakajairika saline) jekiseni, BoNT (15-45 IU) yakaiswa mukati mevanga repashure mushure mekuvharwa kwemaronda mukati meawa makumi maviri nemana kuti iwedzere kunaka kwekuzora uye kuporesa maronda.
Dynamic uye static wrinkles inoumbwa neakawandisa tsandanyama tishu, kukuvara kwakareruka uye kuchembera, uye varwere vanotenda kuti vanoita kuti vataridzike vakaneta kana kutsamwa.Inogona kurapa kuunyana kwechiso uye kupa vanhu chitarisiko chakasununguka uye chinozorodza.Iyo FDA parizvino ine mvumo yakasarudzika yeBoNT kurapa periorbital uye interbrow mutsara.BoNT inoshandiswa kurapa masseter hypertrophy, kunyemwerera kwegingival, platysma bhendi, mandibular margin, chirebvu depression, yakachinjika yehuma mutsetse, curved kunyemwerera, perioral line, horizontal nasal line uye tsiye dziri kurembera.Chirwere chekiriniki chinotora kwemwedzi inenge mitatu.28,29 (Mufananidzo 2A uye B).
Mufananidzo 2 Mufananidzo wepamusoro (A) pamberi pejekiseni reBotox rekesi rinoratidza kuti mutsara wehuma wakatwasuka uye mutsara weglabellar unoita kuti musoro utaridzike wakatsamwa.Kune rumwe rutivi, mufananidzo wezasi wenyaya imwechete (B) mushure menyama miviri Mushure mejojo ​​yehupfu, mitsetse iyi inobviswa zvakanaka.(Technology: 36 units, 0.9 mL ye-intradermal BoNT-A yakaiswa muhuma panguva imwe chete. Nzvimbo yejekiseni yakanyorwa nepenzura yeganda isati yarapwa. Mishonga miviri yakafanana yakaitwa, mazuva makumi matatu akasiyana).
BoNT inogona kukwidziridza manzwiro emurwere uye kunoonekwa kusatya kana ikashandiswa nekuderedza mutinhimira.Kuvandudzwa kwechikamu cheFACE-Q kwakaonekwa mushure mekurapa kwepakati kusvika kune yakaoma glabellar mitsara.Kunyangwe mushure memazuva zana nemakumi maviri, apo makiriniki ekurapa kweBoNT aifanira kunge adzikira, varwere vakataura kuvandudzwa kwehutano hwepfungwa uye nekunatsiridza kutaridzika kwechiso.
Kusiyana nekudzoserwazve otomatiki kweBoNT mwedzi mitatu yega yega kuti uwane mhinduro yakanaka yekiriniki neyepfungwa, murapi anofanira kukurukura nemurwere kana kudzoka kuchidikanwa.30,31 Uyezve, BoNT yakashandiswa zvakabudirira kudzivirira nekurapa migraine mutsinga, kuvandudza mararamiro ehupenyu uye hutano hwevarwere32 (Mufananidzo 3A uye B).
Mufananidzo 3 Mufananidzo wepamusoro (A) wenyaya unoratidza kuti mitsetse yeperiorbital lateral inopa kunzwa kwekuchembera uye kupera simba.Kune rumwe rutivi, mufananidzo wezasi (B) wenyaya imwe chete inobvisa mitsara iyi uye inoisimudza mushure mejekiseni reBotox Maziso eparutivi anooneka zvakajeka.Mushure mekugara pasi panguva ino, dingindira iri rinoratidzawo hupfumi hwehutano hwepfungwa.(Tekinoroji: 16 units, 0.4 ml intradermal BoNT-A inobaiwa kamwe chete, kamwe munzvimbo yega yega yeperiorbital. Kamwe chete yakaguma nemhinduro yakakosha inotora mwedzi 4.)
Alopecia areata, androgenetic alopecia, alopecia yemusoro uye radiation-induced alopecia zvakarapwa neBoNT-A.Kunyangwe iyo chaiyo iyo nzira iyo BoNT inobatsira bvudzi kudzoreredza haina chokwadi, inofungidzirwa kuti nekuzorodza tsandanyama kuderedza microvascular pressure, inogona kuvandudza iyo oksijeni kugovera kune bvudzi follicles.Mune 1-12 makosi, 30-150 U inobaiwa mu frontal lobe, periauricular, temporal uye occipital tsandanyama (Mufananidzo 4A uye B).
Mufananidzo 4 Ruboshwe hafu (A) yemufananidzo wekiriniki inoratidza mhando 6 yemurume mhanza yemurume ane makore makumi matatu nemana maererano neyakagamuchirwa Norwood-Hamilton.Kusiyana neizvi, murwere mumwecheteyo akaratidza kuderedzwa kusvika pakunyora 3V mushure me12 botulinum jekiseni (B).(Tekinoroji: 100 units, 2.5 mL ye intradermal BoNT-A yakaiswa munzvimbo yepamusoro yemusoro kamwechete. Zvose zve12 mishonga yakafanana yakaparadzaniswa nemazuva 15 yakaguma nemhinduro yekliniki inogamuchirwa, inogara mwedzi 4).
Kunyangwe zvidzidzo zvakawanda zvichiratidza kuvandudzwa kwekiriniki mukuwanda kwebvudzi kana kukura uye kugutsikana kwakanyanya kwemurwere, mamwe maRCT anodiwa kuti aone maitiro chaiwo eBoNT pakukura kwebvudzi.33-35 Kune rumwe rutivi, majekiseni akawanda eBoNT emakwinya ehuma akasimbiswa kuti ane chekuita nekuitika kwekurasikirwa kwebvudzi remberi.36
Ongororo dzinoverengeka dzakaratidza kuti sisitimu yetsinga inoita basa mu psoriasis.Iko kusungirirwa kwetsinga dzetsinga paganda re psoriasis kwakakwira, uye mazinga eCGRP neSP anobva kune sensory nerves akakwira.Naizvozvo, humbowo hwekiriniki hunoratidza kuregererwa kwe psoriasis mushure mekurasikirwa kwemukati kuri kuwedzera, uye kukuvara kwehurongwa hwetsinga kana basa retsinga rinotsigira iyi fungidziro.37 BoNT-A inoderedza neurogenic CGRP uye SP kusunungurwa, iyo inogona kutsanangura subjective kliniki yekucherechedza kwechirwere.38 Muvakuru KC-Tie2 mbeva, intradermal jekiseni reBoNT-A rinogona kuderedza zvakanyanya lymphocyte yeganda kana ichienzaniswa ne placebo Infiltrate uye inovandudza acanthosis zvakanyanya.37 Zvakadaro, kune mishumo yekiriniki shoma yakaburitswa uye zvidzidzo zvekutarisa, uye hapana kana imwe yadzo inodzorwa ne placebo.Pakati pevarwere ve15 vane inverse psoriasis, Zanchi et al.38 vakarondedzera mhinduro yakanaka kune BoNT-A kurapwa;zvisinei, migumisiro yekuzviongorora kwemurwere uye infiltration photography assessment uye erythema assessment yakashandiswa.Nokudaro, Chroni et al39 vakaratidza kushushikana kwakasiyana-siyana pamusoro pekudzidza, kusanganisira kushayikwa kwehuwandu hwezviratidzo zvekufungidzira kuvandudzwa (zvakadai sePA scores).Munyori akafungidzira kuti BoNT-A ine mhedzisiro yakanaka mukudzikisa dikita remunharaunda mumapete, senge chirwere cheHailey-Hailey, uko mhedzisiro yeBoNT-A inokonzerwa nekudzikira kwekudikitira.40-42 Kukwanisa kweBoNT-A kudzivirira hyperalgesia Zvisinei, kusunungurwa kwemauropeptides kunotungamirira kumarwadzo mashoma uye kuchenesa kune varwere.43
Off-label, BoNT yakashandiswa kurapa zvirwere zvakasiyana-siyana zveganda, senge linear IgA bullous skin disease, Weber-Cockayne chirwere uye Hailey-Hailey chirwere.Majekiseni eBoNT-A, oral tacrolimus, yttrium aluminium garnet ablation laser, uye BoNT-A ine erbium yakashandiswa kurapa chirwere cheHailey-Hailey muzasi-zamu, axillary, inguinal uye intergluteal cleft nzvimbo.Mushure mekurapwa, zviratidzo zvekiriniki zvave nani, uye huwandu hwedosi ndeye 25 kusvika 200 U mwedzi mitatu kusvika ku6.42,44 Muchiitiko chakataurwa, mukadzi wepakati-kati ane epidermolysis bullosa akaiswa 50 U per armpit mutsoka yake, uye 100 U akaiswa mumurwere ane linear IgA bullosa Foot yemurwere wechidiki ane chirwere cheganda.45,46
Muna 2007, Kontochristopoulos et al47 vakanyatsobata nzvimbo yepasi pemurwere ane makore makumi mashanu nemapfumbamwe, vachishandisa BoNT-A semushonga wekurapa chirwere cheDarier kekutanga.Mune imwe nyaya muna 2008, mwana mudiki ane zvakanyanya anogenital kubatanidzwa kwaibatsira mukuderedza dikita panzvimbo yakabvongodzwa.48 Chirwere chake chakabatanidzwa chakarapwa ne10 mg acitretin nemishonga inorwisa mabhakitiriya nemishonga inorwisa fungal pazuva, asi mararamiro ake akanga akaderera uye kusagadzikana kwake kwakaramba kuchienderera mberi.Vhiki nhatu mushure mekubayiwa muchetura we botulinum, zviratidzo zvake nemaronda ekiriniki zvakavandudzwa zvakanyanya.
Eccrine nevus ishoma ganda hamartoma rinoratidzwa nekuwedzera kwenhamba ye eccrine glands asi hapana tsinga yeropa kukura.Nekuda kwechimiro chekupedzisira, eccrine nevus yakasiyana nezvimwe zvirwere zvakaita seangiomatous eccrine hamartoma.49 Madikidiki ekudikitira anonyanya kuzara pamaoko, ane mashoma matambudziko eganda, asi kune nzvimbo dzenzvimbo dze hyperhidrosis.50 Kuvhiya kubviswa kana mushonga wepamusoro ndiwo marapirwo anonyanya kufarirwa, zvichienderana nehukuru hwekuvhara uye chimiro che hyperhidrosis.Honeyman et al51 vakanyora mwana ane makore gumi nemaviri ekuzvarwa ane dikita diki nevi paruoko rwekurudyi iro raisashingirira kune topical antiperspirants.Nekuda kwehukuru hwebundu uye nzvimbo yaro yeanatomical, kuvhiya kubviswa kwakabviswa.Hyperhidrosis inoita kuti kutora chikamu mune zvemagariro uye zvehungwaru zviome.Vatsvagiri vakasarudza kubaya 5 U yeBoNT-A pa 0.5-1 cm nguva.Vanyori havana kutsanangura apo mhinduro yekutanga yekurapa kweBoNT-A yakaitika, asi vakataura kuti mushure megore, vakaona kuti nhamba yekutsvaira yakaderedzwa kusvika kamwe chete pamwedzi, uye hupenyu hwemurwere hunovandudzwa.Lera et al49 vakarapa murwere ane hupenyu hwakaderera uye HDSS chibodzwa che3 paruoko nedikidiki dikita naevi (HDSS) (yakanyanya).BoNT-A (100 IU) yakagadziridzwa zvakare mu 2.5 mL sterile saline solution ine 0.9% sodium chloride uye yakabaiwa munzvimbo yekuteedza iodine.Mushure memaawa makumi mana nemasere, murwere akaona kuderera kudikitira, nemhedzisiro yakanaka muvhiki yechitatu.Nhamba yeHDDS inodonha kusvika ku 1. Nekuda kwekudzokororazve kwekudikitira, kurapwa kweBoNT-A kwakadzokororwa mwedzi mipfumbamwe gare gare.Mukurapa kwe exocrine hemangioma hamartoma, BoNT-A jekiseni therapy inobatsira.52 Kunyange zvazvo chirwere ichi chisingawanike, zviri nyore kuona kukosha kwazvakaita kuti vanhu ava vawane nzira dzekurapa dzinoshanda.
Hidradenitis suppurativa (HS) chirwere chisingaperi cheganda chinoratidzwa nemarwadzo, mavanga, sinuses, fistulas, zviputi zvinopisa, uye zvinoonekwa mumatanho ekupedzisira emuviri apocrine.53 The pathophysiology yechirwere haina kujeka, uye fungidziro dzakambogamuchirwa pamusoro pekuvandudzwa kweHS dziri kupikiswa.Kuvharirwa kwebvudzi rebvudzi kunokosha kune zviratidzo zveHS, kunyange zvazvo nzira iyo inokonzera kuvhara haina kujeka.Nekuda kwekuzvimba kunotevera uye musanganiswa wekuzvarwa uye adaptive immune dysfunction, HS inogona kukura kukuvara kweganda.54 Chidzidzo chakaitwa naFeito-Rodriguez et al.55 chakashuma kuti BoNT-A yakabudirira kubata prepubertal HS muvasikana vane makore matanhatu.Nyaya yenyaya yeShi et al.56 yakacherechedza kuti BoNT-A yakabudirira kurapwa mu -3 HS danho remukadzi ane makore 41.Ongororo ichangoburwa yakaitwa naGrimstad et al.57 yakaongorora kana jekiseni remukati meganda reBoNT-B rinoshanda kune HS muvarwere ve20.Iyo DLQI yeboka reBoNT-B yakawedzera kubva pakati pegumi nenomwe pakutanga kusvika pa8 pamwedzi mitatu, nepo DLQI yeboka replacebo yakadzikira kubva pa13,5 kuenda pa11.
Notalgia paresthetica (NP) is a persistent sensory neuropathy inokanganisa nzvimbo ye interscapular, kunyanya T2-T6 dermatome, ine kumusoro kwemusana kukwenya uye zviratidzo zveganda zvine chekuita nekukwenya nekukwenya.BoNT-A inogona kubatsira kurapa kukwenya kwenzvimbo nekuvhara kuburitswa kwechinhu P, marwadzo uye murevereri wekukwenya.58 Weinfeld's case report59 yakaongorora kushanda kweBoNT-A mumakesi maviri.Vese vari vaviri vakarapwa zvakanaka neBoNT-A.Chidzidzo chakaitwa naPerez-Perez et al.58 vakaongorora kushanda kweBoNT-A muvarwere ve5 vakaonekwa kuti vane NP.Mushure meintradermal jekiseni reBoNT, maitiro akawanda akaonekwa.Hapana kukwenya kwemunhu kwakadzikira zvachose.The randomized controlled trial (RCT) yeMaari et al60 yakaongorora kushanda uye kuchengeteka kweBoNT-A kune varwere vane NP paCanada Dermatology Research Clinic kubva munaJuly 2010 kusvika munaNovember 2011. Chidzidzo chacho chakakundikana kusimbisa migumisiro inobatsira yeBoNT-A.Intradermal jekiseni pachiyero chinosvika ku200 U kuderedza kutemwa muvarwere vane NP.
Pompholyx, inonziwo hyperhidrosis eczema, chirwere chinowanzoitika che vesicular bullous chinokanganisa zvanza nezvigadziko zvetsoka.Kunyange zvazvo pathophysiology yechiitiko ichi isingazivikanwi, ikozvino inoonekwa sechiratidzo cheatopic dermatitis.61 Basa rakanyorova, kudikitira, uye kuvharidzira ndizvo zvinonyanya kukonzeresa zvinhu.62 Kupfeka magirovhosi kana shangu kunogona kukonzera marwadzo, kupisa, kukwenya, uye kusagadzikana muvarwere;mabhakitiriya zvirwere zvakajairika.Swartling et al61 vakawana kuti varwere vane palm hyperhidrosis vairapwa neBoNT-A yakagadziridzwa ruoko eczema.Muna 2002, vakaburitsa zvakabuda muongororo yaisanganisira varwere gumi vane bilateral vesicular hand dermatitis;rumwe ruoko rwakagamuchira BoNT-A jekiseni, uye rumwe ruoko rwakashanda sekutonga panguva yekutevera.Kurapa kwacho kwaive nemhedzisiro yakanaka kana yakanaka muvarwere vanomwe kubva kune gumi.Pavarwere vatanhatu, Wollina naKaramfilov63 vakashandisa topical corticosteroids pamaoko ese uye vakabaya 100 U yeBoNT-A intracutaneously pamaoko akanyanya kubatwa zvakanyanya.Mukurapa kweruoko rwemusanganiswa kurapa, vanyori vakaona kuti itching uye blisters yakaderera nekukurumidza.Ivo vakati kushanda kweBoNT-A kune impetigo nekuda kweiyo isiri-perspirant mhedzisiro uye inhibition yeSP.
Finger vasospasm, inozivikanwawo seRaynaud's syndrome, inonetsa kurapa uye kazhinji inoshingirira kumishonga yekutanga senge bosentan, iloprost, phosphodiesterase inhibitors, nitrate, uye calcium channel blockers Agent.Maitiro ekuvhiya anosanganisira kupora uye kuvhara, senge sympathectomy, inopindira.Iyo Raynaud's phenomenon ine chekuita neprimary uye sclerosis yakabudirira kurapwa nejekiseni reBoNT.64,65 Vatsvakurudzi vakacherechedza kuti varwere ve13 vakawana kukurumidza kurwadziwa, uye zvironda zvisingaperi zvakapora mukati memazuva makumi matanhatu mushure mekugamuchira 50-100 U yeBoNT.Majekiseni akapiwa kuvarwere ve19 vane chiitiko chaRaynaud.66 Mushure memavhiki matanhatu, tembiricha yemunwe yeminwe yakabatwa neBoNT yakawedzera zvakanyanya kana ichienzaniswa nejekiseni resaline yakajairwa, zvichiratidza kuti BoNT inobatsira pakurapa Raynaud's phenomenon-related vasospasm.67 Parizvino, pane nzira dzakamira dzejekiseni dzinoshandiswa;maererano nekumwe kuongorora, majekiseni muminwe, wrists, kana distal metacarpal mapfupa haana kutungamirira kumigumisiro yakasiyana-siyana yekliniki, kunyange zvazvo inoshanda mukurapa Raynaud's phenomenon-related vasospasm.68
50-100 U yeBoNT-A pahapwa, inopihwa intradermally mune grid-yakafanana dhizaini, inogona kushandiswa kurapa primary axillary hyperhidrosis.Mhedzisiro yekiriniki inoonekwa mukati mevhiki uye inogara kwemwedzi mitatu kusvika gumi.Varwere vazhinji vanogutsikana nekurapwa kwavo.Varwere vanofanirwa kuziviswa kuti anosvika 5% ematambudziko achasangana nekudikitira kwemazuva ano.69,70 BoNT inogona zvakare kurapa palm uye plantar hyperhidrosis (Mufananidzo 5A uye B).
Mufananidzo 5 Mufananidzo wekiriniki wepamusoro-soro (A) unoratidza mudzidzi wechidiki wepakoreji ane diffuse palm hyperhidrosis ari kunetseka nezvechirwere ichi uye haapindure kumushonga.Varwere vakafanana vakagamuchira botulinum toxin kurapwa vakaratidza kugadziriswa kwakakwana kwe hyperhidrosis (B).(Tekinoroji: Mushure mekusimbiswa ne starch iodine test; 100 units, 2.5 mL intradermal BoNT-A yakabayiwa kamwe chete paruoko. Kosi mbiri dzakafanana dzemazuva gumi nemashanu dzakaparadzana dzakaburitsa mhinduro yakakosha inotora mwedzi mitanhatu).
Chigunwe chega chega chine 2-3 jekiseni nzvimbo, uye majekiseni anofanira kurongeka mugidhi nechinhambwe che 1 cm.BoNT-A inogona kupihwa kuruoko rumwe norumwe muchikamu che75-100 mayunitsi uye kutsoka imwe neimwe muchikamu che100-200 mayunitsi.Mhedzisiro yekiriniki inogona kutora kusvika kusvondo kuti ibude pachena, uye inogona kugara kwemwedzi mitatu kusvika mitanhatu.Vasati vatanga kurapwa, varwere vanofanira kuziviswa nezvezvinogona kuitika zveBoNT jekiseni mumaoko netsoka.Mushure mejekiseni yemichindwe, murwere anogona kutaura kushaya simba.Kune rimwe divi, majekiseni eplantar anogona kuita kuti kufamba kuve kwakaoma, kunyanya kana zvivharo zvetsinga zvichiitwa pamberi peBoNT kurapwa.71,72 Nehurombo, 20% yevarwere veplantar hyperhidrosis havapindure kurapwa mushure mekugamuchira majekiseni eBoNT.72
Muzvidzidzo zvenguva pfupi yapfuura, BoNT yakashandiswa kurapa hyperhidrosis nenzira itsva.Mune imwe nyaya, murwere wechirume ane chironda chekumanikidza akagamuchira 100 U yeBoNT-A majekiseni mu gluteal cleft mwedzi yese ye6-8 kuderedza kuburitsa dikita uye kuperekedza maceration maronda;kutendeseka kweganda kwakachengetedzwa Kwemakore anopfuura maviri, hakuna kumbove nekuderera kwekliniki yekukuvara kwekumanikidza.73 Imwe ongororo yakashandisa 2250 U yeBoNT-B kubayiwa jekiseni mu occipital scalp, parietal scalp, huma scalp nehuma, pamwe ne perioral uye peri-ziso nzvimbo mu strip pateni kurapa postmenopausal craniofacial hyperhidrosis.Iyo DLQI yevarwere vanogamuchira BoNT-B yakavandudzwa ne91% mukati memavhiki matatu mushure mekurapwa, nepo hupenyu hwevarwere vanowana placebo hwakadzikira ne18%.74 BoNT jekiseni rinoshanda mukurapa salivation uye Frey syndrome.Otolaryngologists vanowanzoita kurapwa nekuda kwenzvimbo yeatomical yejojo.75,76
Dikita reruvara rinogona kunge riri mamiriro ezvinhu anoshungurudza murwere.Kunyange zvazvo chirwere ichi chisingawanzoitiki;kubatanidzwa kwechiso nehapwa kunogona kuwedzera dambudziko remurwere.Mazhinji nyaya mishumo uye zvinyorwa zvinoratidza kuti BoNT-A inoshanda mushure mekubaiwa mukati memazuva manomwe chete.77-79
Iko kunhuhwirira kusingafadzi kubva kune armpit hyperhidrosis uye kunhuhwirira kwemuviri kunogona kunyadzisa kana kusemesa.Izvi zvinogona kutokanganisa nzvimbo yepfungwa yemurwere uye chivimbo.Munguva pfupi yapfuura, Wu et al.yakashuma kuti mushure mejekiseni remukati meganda reBoNT-A, kunhuwa muhapwa kwakapotsa kwapera.80 Mune imwe yemazuva ano inotarisirwa kudzidza;62 vechidiki vane dermatological diagnostic yekunhuhwirira kwekutanga underarm vakanyoreswa.82.25% yevarwere vakanzwa kuti kunhuwa kwacho kwakadzikira zvakanyanya mushure mekunge BoNT-A yabayiwa munzvimbo yeaxillary.81
Meh anozivikanwa neasina kana akawanda benign cystic maronda muvakadzi vezera repakati, anonyanya kuwanikwa munzvimbo yepakati pechiso, ane chirwere chakareba chechirwere uye kushanduka kwemwaka.Meh inowanzoonekwa mumamiriro ezuva uye inosanganiswa ne hyperhidrosis.Vatsvakurudzi vakawanda vakaona migumisiro isina kujairika munyaya idzi mushure mekubaya jekiseni reBoNT-A.82 rakatenderedza chironda.
Post-herpetic neuralgia (PHN) ndiyo inowanzozivikanwa neurological complication yeherpes zoster infection, iyo inowanzoitika muvanhu vanopfuura makore makumi matanhatu.BoNT-A inogadzira zvakananga pan-inhibitory mhedzisiro pane emuno nerve endings uye inogadzirisa microglia-astrocytic-neuronal crosstalk.Ongororo dzakawanda dzakaona kuti mushure mekugamuchira kurapwa kweBoNT-A, varwere vane marwadzo akaderedzwa neinenge 30% kusvika 50% vakanyanya kudzikisa zvibodzwa zvekurara uye hupenyu hwehupenyu.83
Chronic simple lichen inotsanangurwa seyakanyanya focal pruritus pasina chikonzero chiri pachena.Izvi zvinogona kukanganisa murwere zvakanyanya.Kliniki yedermatological kuongororwa yakaratidza erythema plaques ari ega, akawedzera mavanga eganda uye epidermal exfoliation.Ongororo ichangobva kuitika kubva kuEgypt inoratidza kuti BoNT-A inogona kurapa zvakachengeteka uye zvinobudirira chisingaperi lichen simplex, hypertrophic lichen planus, lichen planus, kutsva, reverse psoriasis, uye kusagadzikana kwenzvimbo kwepost-herpetic neuralgia Pruritus.84
Keloids mavanga asina kujairika anoitika mushure mekukuvara.Keloids inoenderana nemajini, uye marapiro mazhinji akaedzwa, asi mhedzisiro yacho ishoma.Zvisinei, hapana nomumwe wavo anoporeswa zvakakwana.Kunyangwe intralesional corticosteroids ichiri nzira huru yekurapa, intralesional jekiseni reBoNT-A rave imwe nzira yakanakisa mumazuva achangopfuura.BoNT-A inogona kuderedza mazinga eTGF-β1 uye CTGF, uye pakupedzisira kuderedza kusiyanisa kwe fibroblasts.Zvidzidzo zvakati wandei zvakaratidza kubudirira kweBoNT-A mukurapa keloids.Kutaura zvazviri, nyaya dzakatevedzana dzevarwere vaviri vekeloid dzakatotaurira 100% mhinduro, uye varwere vakagutsikana zvikuru nekushandiswa kwejekiseni ye-intralesional BoNT-A.85
Congenital gobvu onychomycosis chirwere chisingawanzo genetika chinoperekedzwa neplantar hyperkeratosis, chipikiri hypertrophy uye hyperhidrosis.Vashoma vaongorori vakagumisa kuti jekiseni reBoNT-A haringogone kuvandudza hyperhidrosis, asiwo kuderedza marwadzo uye kusagadzikana.86,87
Mvura-keratosis chirwere chisingawanzoitiki.Kana murwere asangana nemvura, hurungudo chena dzakakora pamakumbo nepazvanza zvemaoko uye kukwenya kunogona kuitika.Nyaya dzinoverengeka dzenyaya mumabhuku dzinoratidza kurapa kwakabudirira uye kuvandudzwa mushure mekurapa kweBoNT-A, kunyangwe muzviitiko zvinopokana.88
Kubuda ropa, edema, erythema uye kurwadziwa panzvimbo yejekiseni zvese zvinogona kunge zviri mhedzisiro yeBoNT.89 Izvi zvinokonzeresa zvinogona kudzivirirwa nekushandisa tsono yakatetepa uye kudiluta BoNT nesaline.Majekiseni eBoNT anogona kukonzera kutemwa nemusoro;zvisinei, ivo vanowanzonyangarika mushure memavhiki e2-4.Systemic analgesics inogona kushandiswa kugadzirisa iyi side effect.90,91 Nausea, malaise, zviratidzo zvefuruwenza uye ptosis mamwe mimwe mhedzisiro yakanyorwa.89 Ptosis ndiyo mativi mhedzisiro nzvimbo yekushandisa BoNT kurapa tsiye.Inokonzerwa nekupararira kweBoNT yemunharaunda.Kupararira uku kunogona kugara kwemavhiki akati wandei, asi kunogona kugadziriswa nemadonhwe emeso ealpha-adrenergic agonist.Kana BoNT ikabaiwa muzasi meziso, inogona kukonzera ectropion nekuda kwekupararira kwenzvimbo.Pamusoro pezvo, varwere vanopihwa majekiseni eBoNT ekurapa tsoka dzegunguwo kana tsuro maitiro (periorbital) vanogona kuita strabismus nekuda kwekusaziva jekiseni reBoNT uye kupararira kweBoNT yemuno.89,92 Zvakadaro, sezvo kuoma mitezo kwechepfu kunopera zvishoma nezvishoma, zvese izvi zvinokonzeresa zvichapera zvishoma nezvishoma.93,94
Ngozi yematambudziko kubva kune cosmetic majekiseni eBoNT yakaderera.Ecchymosis uye purpura ndiwo mhedzisiro inowanzoitika uye inogona kudzikiswa nekuisa inotonhora yekumanikidza kunzvimbo yejekiseni isati yasvika uye mushure mejekiseni reBoNT.90,91 BoNT inofanira kubaiwa mudosi yakaderera, ingangoita 1 cm kubva kumucheto kwebhonzo re orbital rakaderera, repamusoro kana reparutivi, rine muyero wakakodzera.Murwere haafaniri kushandura nzvimbo yejekiseni mukati meawa 2-3 mushure mekurapwa, uye kugara kana kumira mukati maawa 3-4 mushure mekurapa.95
BoNT-A mune akasiyana siyana magadzirirwo ari kuedzwa kurapa glabellar mitsara uye mitsara yeziso.Iyo topical uye injectable daxibotulinumtoxinA yakaongororwa, asi maumbirwo emusoro akaonekwa kuti haashande.Jekiseni reDAXI rapinda muyedzo yeFDA's phase III, zvichiratidza kuti kushanda nesimba uye mhedzisiro yekiriniki mukurapwa kwemitsara yeglabellar inogona kusvika kumasvondo mashanu kureba kupfuura onabotulinumtoxinA.96 LetibotulinumtoxinA yave pamusika muAsia uye yakabvumidzwa neFDA kuti irapwe periorbital wrinkles.97 Kuenzaniswa ne incobotulinumtoxinA, LetibotulinumtoxinA ine huwandu hwepamusoro hweprotein yeurotoxic pavhoriyamu yeyuniti, asi huwandu hweisingaite neurotoxin hwakakwirawo, izvo zvinowedzera njodzi yekupindura kwemuviri.98
Pamusoro peiyo itsva BoNT-A kuumbwa, yemvura BoNT-E iri kudzidzwa nekuti inonzi ine kukurumidza kutanga kwekuita uye nguva pfupi yemhedzisiro yekiriniki (14-30 mazuva).EB-001 yakawanikwa yakachengeteka uye inobudirira mukuderedza kutaridzika kwemitsara yakafukidzirwa uye kuvandudza kuonekwa kwemavanga ehuma mushure meMohs microsurgery.99 Dematologists vanogona kubvumidzwa kushandisa mabhuku aya.Pamusoro pezvinangwa zvazvino zvekunakisa, makambani emishonga ari kutsvaga BoNT-A gadziriro dze-off-label kurapwa kwehutano hwezvirwere zveganda.
BoNT mushonga unopindwa nejekiseni unogona kushandiswa kurapa zvirwere zvakasiyana-siyana zveganda, zvinosanganisira hidradenitis suppurativa, psoriasis, bullous skin disease, mavanga asina kujairika, kurasikirwa nebvudzi, hyperhidrosis, uye keloids.Mukushandisa zvizorwa, BoNT inotendwa kuve yakachengeteka uye inoshanda mukudzikisa kuunyana kwechiso, kunyanya chetatu chepamusoro chekuwonyana kwechiso.BoNT A inozivikanwa nekushandiswa kwayo mukuderedza makunakuna mumunda wezvizoro.Kunyangwe hazvo BoNT ichiwanzo chengeteka, zvinogara zvakakosha kuti unzwisise nzvimbo yejekiseni nekuti chepfu inogona kupararira nekukanganisa nzvimbo dzisingafanirwe kurapwa.Varapi vanofanirwa kuziva nezvezvinonetsa munzvimbo chaidzo pakubaya BoNT mutsoka, maoko, kana muhuro.Madermatologists anofanirwa kujairana ne-on-label uye off-label mashandisirwo eBoNT kuitira kuti vape varwere kurapwa kwakakodzera uye kuderedza kurwara kwakabatana.Kushanda kwekiriniki kweBoNT mu-off-label marongero uye chero zvingangove zvenguva refu nyaya dzekuchengetedza dzinofanirwa kuongororwa kuburikidza neyakagadzirwa nemakiriniki miedzo.
Kugovana data hakushande kuchinyorwa ichi nekuti hapana seti yedata yakagadzirwa kana kuongororwa panguva ino yekutsvagisa.
Kuongororwa kwevarwere kunoitwa maererano nemitemo yeDeclaration yeHelsinki.Munyori anosimbisa kuti akawana mafomu ese akakodzera emvumo yemurwere umo murwere anobvuma kuisa mifananidzo uye mamwe ruzivo rwekiriniki mujenari.Varwere vanonzwisisa kuti mazita avo nemainitials haazoziviswa pachena, uye vanoedza kuvanza zvitupa zvavo.
Dr. Piyu Parth Naik vakangobatsira pakunyorwa kwechinyorwa ichi.Munyori akaita zvipo zvakakosha mune pfungwa uye dhizaini, kutora data uye kududzira data;akatora chikamu mukunyora zvinyorwa kana kunyatsogadziridzwa zvakakosha zveruzivo;vakabvuma kuendesa kujenari razvino;pakupedzisira yakabvumira kuti shanduro yacho ibudiswe;uye vakabvumirana nebasa Responsible for all aspects.