Kugwiritsa ntchito poizoni wa botulinum mu dermatology ndi 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 Foni yotsutsana +971 503725616 imelo [imelo yalandira Chitetezo] Abstract Poizoni wa botulinum (BoNT) ndi neurotoxin yopangidwa ndi mabakiteriya a Clostridium botulinum.Ili ndi mphamvu komanso chitetezo chodziwika bwino pochiza focal idiopathic hyperhidrosis.BoNT ili ndi ma neurotoxin asanu ndi awiri;komabe, poizoni A ndi B okha ndi omwe amagwiritsidwa ntchito kuchipatala.BoNT yakhala ikugwiritsidwa ntchito posachedwapa pochiza matenda osiyanasiyana apakhungu.Kupewa zipsera, hyperhidrosis, makwinya, timadontho tating'ono ting'onoting'ono, kutayika kwa tsitsi, psoriasis, matenda a Darier, matenda akhungu, thukuta la herpes ndi zochitika za Raynaud ndi zina mwazizindikiro zatsopano za BoNT mu zodzoladzola, makamaka mu dermatology Non cosmetic mbali.Kuti tigwiritse ntchito BoNT moyenera muzochita zamankhwala, tiyenera kumvetsetsa bwino momwe thupi limagwirira ntchito la minofu yofananira.Kufufuza mozama m'mabuku kunachitika kuti asinthe zoyeserera zonse zokhudzana ndi dermatological ndi mayeso azachipatala pazinthu za BoNT kuti apereke chidule cha kagwiritsidwe ntchito ka BoNT mu dermatology.Ndemangayi ikufuna kusanthula ntchito ya poizoni wa botulinum mu dermatology ndi cosmetology.Keywords: poizoni wa botulinum, poizoni wa botulinum, botulinum, dermatology, cosmetology, neurotoxin
Botulinum neurotoxin (BoNT) imapangidwa mwachilengedwe ndi Clostridium botulinum, yomwe ndi bakiteriya yowononga gram-positive, spore-spore.1 Mpaka pano, ma serotypes asanu ndi awiri a BoNT (A mpaka G) apezeka, ndipo mitundu A ndi B yokha ingagwiritsidwe ntchito pochizira.BoNT A (Oculinum) idavomerezedwa ndi US Food and Drug Administration (FDA) mu 1989 pochiza blepharospasm ndi strabismus.Mtengo wamachiritso wa BoNT A udadziwika koyamba.Sizinafike mu Epulo 2002 pomwe FDA idavomereza kugwiritsa ntchito BoNT A pochiza mizere ya glabellar.A FDA adavomereza BoNT A kuti azichiza mzere wakutsogolo ndi mzere wa canthal mu Okutobala 2017 ndi Seputembala 2013, motsatana.Kuyambira pamenepo, ma BoNT angapo adayambitsidwa pamsika.2 Chiyambireni malonda ake, BoNT yakhala ikugwiritsidwa ntchito pochiza kukokana, kukhumudwa, hyperhidrosis, mutu waching'alang'ala, ndi kukalamba kwa khosi, nkhope, ndi mapewa muzachipatala ndi zodzoladzola.3, 4
Clostridium botulinum imatulutsa mapuloteni atatu omwe amaphatikizapo poizoni wa 150 kDa, mapuloteni osakhala ndi poizoni, omwe si a hemagglutinin, ndi mapuloteni osakhala poizoni a hemagglutinin.Mabakiteriya a protease amathyola poizoni mu mankhwala ogwiritsidwa ntchito kawiri ndi 50 kDa "kuwala" ndi unyolo "wolemera" wa 100 kDa.Pambuyo potumizidwa ku presynaptic nerve terminal, unyolo wolemera wa poizoni yogwira ntchito umamangiriza ku synaptic vesicle glycoprotein 2, kulimbikitsa endocytosis ya toxin-glycoprotein complex, ndikutulutsa unyolo wopepuka wa poizoni mu danga la synaptic.Toxin light chain cleavage vesicle-associated membrane protein/synaptoxin (BoNT-B, D, F, G) kapena synaptosome-associated protein 25 (BoNT-A, C, E) kuteteza kutulutsidwa kwa zotumphukira zama motor neuron axon Acetylcholine imayambitsanso kusakhalitsa. denervation mankhwala ndi minofu ziwalo.2 Ku United States, pali mankhwala anayi a BoNT-A omwe amavomerezedwa ndi FDA: incobotulinumtoxinA (Frankfurt, Germany), onabotulinumtoxinA (California, US), prabotulinumtoxinA-xvfs (California, US), ndi abobotulinumtoxinA (Arizona, US) ;ndi mtundu umodzi wa BoNT-B: rimabotulinumtoxinB (California, USA).5 Guida et al.6 idapereka ndemanga pa ntchito ya BoNT m'munda wa dermatology.Komabe, sipanakhalepo ndemanga yaposachedwa pakugwiritsa ntchito BoNT pankhani ya dermatology ndi kukongola.Chifukwa chake, ndemanga iyi ikufuna kusanthula ntchito ya BoNT mu dermatology ndi cosmetology.
Mawu ofunika kwambiri akuphatikizapo poizoni wa botulinum, khungu lamafuta, rosacea, kupukuta kumaso, zipsera, makwinya, tsitsi, psoriasis, matenda a khungu, matenda a Darier, exocrine moles, thukuta la herpes, zochitika za Raynaud, hyperhidrosis Poyankha, dermatology, ndi kukongola, kufufuza nkhani. amachitidwa mu nkhokwe zotsatirazi: Google Scholar, PubMed, MEDLINE, Scopus, ndi Cochrane.Wolembayo amayang'ana makamaka zolemba za ntchito ya BoNT mu dermatology ndi cosmetology.Kufufuza koyambirira kwa mabuku kunavumbulutsa zolemba za 3112.Zolemba zomwe zidasindikizidwa pakati pa Januware 1990 ndi Julayi 2021 zofotokoza za BoNT mu dermatology ndi cosmetology, zolemba zosindikizidwa mu Chingerezi, ndi mapangidwe onse a kafukufuku akuphatikizidwa mukuwunikaku.
Canada idavomereza kugwiritsa ntchito BoNT pochiritsa makwinya amnofu am'deralo ndi makwinya ansidze mchaka cha 2000. US FDA idavomereza kugwiritsa ntchito BoNT pazodzikongoletsera pa Epulo 15, 2002. Zizindikiro za BoNT-A zomwe zagwiritsidwa ntchito posachedwa popanga zodzikongoletsera zimaphatikizapo mizere yokhotakhota pakati pawo. nsidze, mapazi a khwangwala, mizere ya akalulu, mizere yopingasa pamphumi, mizere yopingasa, mikwingwirima yamalingaliro ndi chibwano, mikwingwirima ya platysma, kukwinya pakamwa, ndi mizere yopingasa pakhosi.7 Zizindikiro za mtundu wa botulinum A wovomerezedwa ndi US FDA ndi mizere yochepetsetsa mpaka yowopsya yomwe imagwirizanitsidwa ndi zochitika zowonjezereka za prefrontal ndi / kapena tsinya minofu pakati pa nsidze, ndi mizere yapakati mpaka yoopsa kwambiri ya canthal yokhudzana ndi ntchito yochuluka ya minofu ya orbicularis.Ndipo mzere wopingasa wapamphumi wokhazikika mpaka wovuta kwambiri wokhudzana ndi zochitika za minofu yakutsogolo.8
Sebum imathandizira kupereka mafuta osungunuka a antioxidants pakhungu komanso amakhala ndi antibacterial properties;choncho, imakhala ngati chotchinga khungu.Kuchuluka kwa sebum kumatha kutseka pores, kubala mabakiteriya ndipo kungayambitse kutupa pakhungu (mwachitsanzo, seborrheic dermatitis, ziphuphu zakumaso).M'mbuyomu, chidziwitso chofunikira chokhudza zotsatira za BoNT pa sebum zidawululidwa.9,10 Rose ndi Goldberg10 adayesa mphamvu ndi chitetezo cha BoNT pa anthu 25 omwe ali ndi khungu lamafuta.BoNT (abo-BNT, mlingo wa 30-45 IU) umayikidwa mu mfundo za 10 pamphumi, zomwe zimathandizira kwambiri kukhutira kwa odwala ndi kuchepetsa kupanga sebum.Min et al.adapereka mwachisawawa maphunziro a 42 okhala ndi makwinya pamphumi kuti alandire mayunitsi 10 kapena 20 a BoNT pamasamba asanu osiyana jekeseni.Magulu onse awiriwa adalandira chithandizo cha BoNT, zomwe zidapangitsa kuti sebum ichepe kwambiri pamalo opangira jakisoni komanso kutsika kwa sebum kuzungulira malo ojambulira.Pa sabata la 16, kupanga sebum kwa magulu awiri ochizira kunabwereranso pamlingo wabwinobwino, ndipo pakuwonjezeka kwa jekeseni, kuchiritsa sikunasinthe kwambiri.
Njira yomwe jakisoni wa intradermal wa poizoni wa botulinum amatsogolera kuchepetsa kutulutsa kwa sebum sikumveka bwino, chifukwa zotsatira za dongosolo lamanjenje ndi acetylcholine paziwopsezo za sebaceous sizinafotokozedwe bwino.Zotsatira za neuromodulatory za BoNT nthawi zambiri zimalunjika muscarinic receptors mu erector pili muscle ndi sebaceous glands.Mu vivo, nicotinic acetylcholine receptor 7 (nAchR7) imasonyezedwa m'matumbo a sebaceous aumunthu, ndipo chizindikiro cha acetylcholine chimawonjezera kaphatikizidwe ka lipid m'njira yodalira mlingo mu vitro.11 Kafukufuku wochulukirapo akufunika kuti adziwe yemwe ali wofunikira kwambiri komanso njira yabwino kwambiri yoperekera jakisoni ndi mlingo (Chithunzi 1A ndi B).
Chithunzi 1 Chithunzi chapamwamba (A) cha wodwala yemwe ali ndi khungu lodziwika bwino lamafuta, pomwe pamtengo wina, chithunzi chapansi (B) cha wodwala yemweyo pambuyo pa mankhwala awiri a BoNT chikuwonetsa kusintha kwakukulu.(Tekinoloje: mayunitsi a 100, 2.5 ml ya intradermal BoNT-A inalowetsedwa kamodzi pamphumi. Mankhwala awiri ofanana adachitidwa masiku a 30 mosiyana. Kuyankha kwachipatala kwabwino kunatenga miyezi 6).
Rosacea ndi matenda otupa pakhungu omwe amadziwika ndi kuphulika kwa nkhope, telangiectasia, papules, pustules, ndi erythema.Mankhwala a pakamwa, laser therapy, ndi mankhwala apakhungu amagwiritsidwa ntchito pochiza nkhope, ngakhale sizothandiza nthawi zonse.Chizindikiro china chosasangalatsa cha kutha kwa msambo ndicho kutentha kwa nkhope.Kafukufuku wambiri wasonyeza kuti BoNT ingathandize kuchiza kutentha kwa menopausal ndi rosacea.12-14 Zotsatira za BoNT pa Dermatological Quality of Life Index (DLQI) ya odwala omwe ali ndi vuto la nkhope adzafufuzidwa mu kafukufuku wamtsogolo.15 BoNT idabayidwa patsaya kamodzi, mpaka mlingo wokwanira wa mayunitsi 30, zomwe zidapangitsa kutsika kwakukulu kwa DLQI pakatha miyezi iwiri.Malinga ndi Odo et al., BoNT idachepetsa kwambiri kuchuluka kwa kutentha kwa msambo pa tsiku la 60.12 Zotsatira za abo-BoNT zidaphunziridwanso mwa odwala 15 omwe ali ndi rosacea.Patatha miyezi itatu, 15-45 IU ya BoNT idabayidwa kumaso, zomwe zidapangitsa kusintha kwakukulu kwa erythema.13 M’kafukufuku, zolakwa sizimatchulidwa kaŵirikaŵiri.
Kuchulukirachulukira kwa BoNT ndi chimodzi mwazifukwa zomwe zingalepheretse kutulutsa kwa acetylcholine kuchokera ku zotumphukira za autonomic neurons zapakhungu vasodilation system.16,17 Ndizodziwika bwino kuti oyimira pakati otupa monga calcitonin gene-related peptide (CGRP) ndi substance P (SP) amaletsedwanso ndi BoNT.18 Ngati kutupa kwapakhungu kwacheperako ndikuwongolera, erythema imatha kutha.Kuti muwunikire gawo la BoNT mu rosacea, maphunziro ochulukirapo, oyendetsedwa, osinthika amafunikira.Ma jakisoni a BoNT otsuka kumaso ali ndi maubwino owonjezera chifukwa amatha kuchepetsa kupsinjika kwa zopondereza kumaso, potero kuwongolera mizere yabwino ndi makwinya.
Anthu ambiri tsopano akuzindikira kufunika kopewa mwachangu zipsera pochiza zipsera za pambuyo pa opaleshoni.Kuvutana komwe kumachitika m'mphepete mwa bala panthawi yochira ndi chinthu chofunikira kwambiri pozindikira mawonekedwe omaliza a chilonda cha opaleshoniyo.19,20 BoNT imalepheretsa kutulutsidwa kwa acetylcholine neurotransmitter, pafupifupi kuchotseratu kupsinjika kwa minofu pabala lamachiritso kuchokera ku mitsempha yotumphukira.Mphamvu zochepetsera kupsinjika za BoNT, komanso kuletsa kwake mwachindunji kwa fibroblast ndi mawu a TGF-1, zikuwonetsa kuti zitha kugwiritsidwa ntchito kupewa zipsera za opaleshoni.21-23 Mphamvu yotsutsa-kutupa ya BoNT ndi zotsatira zake pakhungu la vasculature zimatha kuchepetsa gawo la machiritso otupa (kuyambira masiku 2 mpaka 5), ​​zomwe zingathandize kupewa kupanga zipsera.
M'maphunziro osiyanasiyana, BoNT ingagwiritsidwe ntchito kupewa zipsera.24-27 Mu RCT, chitetezo ndi mphamvu ya jekeseni wa BoNT oyambirira pambuyo pa opaleshoni mwa odwala 15 omwe ali ndi zipsera za thyroidectomy anayesedwa.24 Zipsera zatsopano (mkati mwa masiku 10 a thyroidectomy) anapatsidwa BoNT (20-65 IU) kapena 0.9% saline wamba (control) kamodzi.Theka la mankhwala a BoNT adawonetsa chiwopsezo chabwinoko komanso kukhutitsidwa kwa odwala kuposa chithandizo chanthawi zonse cha saline.Gassner et al.25 adafufuza ngati jekeseni wa BoNT kunkhope pambuyo pa kuphulika kwa mphumi ndi kudulidwa kungathe kuchiza zipsera za nkhope.Poyerekeza ndi jakisoni wa placebo (saline wamba), BoNT (15-45 IU) adabayidwa pachilonda cha postoperative pambuyo pa kutsekedwa kwa bala mkati mwa maola 24 kuti apititse patsogolo zodzoladzola komanso kuchira kwa bala.
Makwinya amphamvu komanso osasunthika amapangidwa ndi minofu yochulukirapo, kuwonongeka kopepuka komanso ukalamba, ndipo odwala amakhulupirira kuti amawapangitsa kuti aziwoneka otopa kapena okwiya.Imatha kuchiza makwinya amaso ndikupatsa anthu mawonekedwe omasuka komanso otsitsimula.A FDA pakadali pano ali ndi chilolezo chokhacho cha BoNT kuti ichite mzere wa periorbital ndi interbrow.BoNT imagwiritsidwa ntchito pochiza masseter hypertrophy, kumwetulira kwa gingival, gulu la platysma, mango, mango, kukhumudwa kwa chibwano, mzere wopingasa pamphumi, kumwetulira kokhotakhota, mzere wopindika, mzere wopingasa wa mphuno ndi nsidze.Zotsatira zachipatala zimatha pafupifupi miyezi itatu.28,29 (Chithunzi 2A ndi B).
Chithunzi 2 Chithunzi chapamwamba (A) chisanachitike jekeseni wa Botox pamlandu umasonyeza kuti mzere wopingasa pamphumi ndi mzere wa glabellar umapangitsa kuti mutuwo ukhale wokwiya.Kumbali ina, chithunzi chapansi cha mlandu womwewo (B) pambuyo pa nyama ziwiri Pambuyo pa jekeseni wa poizoni, mizere iyi imachotsedwa bwino.(Tekinoloje: mayunitsi a 36, ​​0.9 mL ya intradermal BoNT-A inayikidwa pamphumi pa nthawi. Malo opangira jekeseni analembedwa ndi pensulo ya khungu musanayambe chithandizo. Mankhwala awiri ofanana adachitidwa, masiku a 30 mosiyana).
BoNT imatha kukulitsa chidaliro cha wodwalayo komanso momwe amamuganizira akagwiritsidwa ntchito pochepetsa kayimbidwe.Kusintha kwa mphambu ya FACE-Q kudawonedwa pambuyo pochiza mizere yolimba mpaka yolimba ya glabellar.Ngakhale pambuyo pa masiku 120, pamene zotsatira zachipatala za BoNT ziyenera kuchepa, odwala adanena za kusintha kwa thanzi labwino komanso kukongola kwa nkhope.
Mosiyana ndi kubwezanso kwa BoNT pakatha miyezi itatu iliyonse kuti mupeze yankho labwino kwambiri lazachipatala komanso lamalingaliro, sing'angayo ayenera kukambirana ndi wodwalayo pakafunika kuyambiranso.30,31 Kuonjezera apo, BoNT yagwiritsidwa ntchito bwino pofuna kupewa ndi kuchiza migraine mu ubongo, kupititsa patsogolo moyo ndi thanzi la odwala32 (Chithunzi 3A ndi B).
Chithunzi 3 Chithunzi chapamwamba (A) cha phunziroli chikuwonetsa kuti mizere ya periorbital lateral imapereka kumverera kwa ukalamba ndi kutopa.Kumbali ina, chithunzi chotsika (B) cha vuto lomwelo chimachotsa mizere iyi ndikuyikweza pambuyo pa jekeseni wa Botox Zinsinsi zam'mbali zikuwonekera bwino.Titakhala pansi nthawi ino, mutuwu ukuwonetsanso thanzi labwino lamalingaliro.(Tekinoloje: mayunitsi 16, 0.4 ml intradermal BoNT-A imabayidwa kamodzi, kamodzi m'mbali iliyonse ya periorbital. Kamodzi kokha komwe kunatha ndi kuyankhidwa kwakukulu kwa miyezi inayi.)
Alopecia areata, androgenetic alopecia, alopecia mutu ndi radiation-induced alopecia zathandizidwa ndi BoNT-A.Ngakhale kuti njira yeniyeni yomwe BoNT imathandiza kuti tsitsi libwererenso ndi yosatsimikizika, zimaganiziridwa kuti mwa kumasula minofu kuti muchepetse kuthamanga kwa microvascular, kungathe kupititsa patsogolo mpweya wabwino wa tsitsi.M'maphunziro a 1-12, 30-150 U imayikidwa kutsogolo kwa lobe, periauricular, temporal ndi occipital minofu (Chithunzi 4A ndi B).
Chithunzi 4 Theka lakumanzere (A) la chithunzi chachipatala likuwonetsa mtundu wa 6 wamwamuna wa dazi la bambo wazaka 34 malinga ndi gulu la Norwood-Hamilton.Mosiyana ndi izi, wodwala yemweyo adawonetsa kutsika kwa mtundu wa 3V pambuyo pa jakisoni wa 12 wa botulinum (B).(Tekinoloje: mayunitsi a 100, 2.5 mL ya intradermal BoNT-A idabayidwa kumtunda wamutu kamodzi. Chithandizo chonse cha 12 chopatulidwa ndi masiku a 15 chinapangitsa kuyankha kovomerezeka kwachipatala, kwa miyezi 4).
Ngakhale kuti kafukufuku wambiri amasonyeza kusintha kwachipatala mu kachulukidwe ka tsitsi kapena kukula ndi kukhutitsidwa kwa odwala, ma RCTs ena amafunikira kuti adziwe zotsatira zenizeni za BoNT pakukula kwa tsitsi.33-35 Komano, majekeseni angapo a BoNT a makwinya pamphumi atsimikiziridwa kuti akugwirizana ndi kuchitika kwa tsitsi lakutsogolo.36
Kafukufuku wambiri wasonyeza kuti dongosolo lamanjenje limathandizira pa psoriasis.Kuchuluka kwa ulusi wa mitsempha pakhungu la psoriasis ndikwambiri, ndipo milingo ya CGRP ndi SP yochokera ku minyewa yamanjenje imakhala yayikulu.Choncho, umboni wachipatala wosonyeza kukhululukidwa kwa psoriasis pambuyo pa kutayika kwa malo ogona ukuwonjezeka, ndipo kuwonongeka kwa dongosolo la mitsempha kapena ntchito ya mitsempha kumathandizira lingaliro ili.37 BoNT-A imachepetsa kutulutsidwa kwa neurogenic CGRP ndi SP, komwe kumatha kufotokozera momwe matendawa akuwonera.38 Mu mbewa zazikulu za KC-Tie2, jakisoni wa intradermal wa BoNT-A amatha kuchepetsa kwambiri ma lymphocyte akhungu poyerekeza ndi placebo Infiltrate ndikuwongolera kwambiri acanthosis.37 Komabe, pali malipoti ochepa azachipatala omwe adasindikizidwa ndi kafukufuku wowunika, ndipo palibe amodzi omwe amayendetsedwa ndi placebo.Pakati pa odwala 15 omwe ali ndi psoriasis yosiyana, Zanchi et al.38 adanena kuti ayankha bwino pa chithandizo cha BoNT-A;komabe, zotsatira za kudziyesa kwa odwala ndi kuyesa kujambula kujambula ndi kuyesa kwa erythema kunagwiritsidwa ntchito.Chifukwa chake, Chroni et al39 adawonetsa zodetsa nkhawa zosiyanasiyana za kafukufukuyu, kuphatikiza kusowa kwa ziwonetsero zowonetsera kuwongolera (monga ma PA scores).Wolembayo adalingalira kuti BoNT-A imakhala ndi zotsatira zabwino zochepetsera thukuta la m'deralo, monga matenda a Hailey-Hailey, kumene zotsatira za BoNT-A zimakhala chifukwa cha kuchepa kwa thukuta.40-42 Kukhoza kwa BoNT-A kuteteza hyperalgesia Komabe, kutulutsidwa kwa neuropeptides kumabweretsa kupweteka kochepa komanso kuyabwa kwa odwala.43
Off-label, BoNT yagwiritsidwa ntchito pochiza matenda osiyanasiyana akhungu, monga matenda akhungu a IgA, matenda a Weber-Cockayne ndi matenda a Hailey-Hailey.Majekeseni a BoNT-A, oral tacrolimus, yttrium aluminium garnet ablation laser, ndi BoNT-A yomwe ili ndi erbium akhala akugwiritsidwa ntchito pochiza matenda a Hailey-Hailey m'malo a subbeast, axillary, inguinal ndi intergluteal cleft.Pambuyo pa chithandizo, zizindikiro zachipatala zakhala zikuyenda bwino, ndipo kuchuluka kwa mlingo ndi 25 mpaka 200 U 3 mpaka 6 miyezi iliyonse.42,44 Pankhani yomwe inanenedwa, mayi wina wazaka zapakati yemwe ali ndi dera la epidermolysis bullosa anabayidwa 50 U pamphuno pa phazi lake, ndipo 100 U anabayidwa mwa wodwala ndi mzere wa IgA bullosa Phazi la wodwala wamng'ono yemwe ali ndi matenda a khungu.45,46
Mu 2007, Kontochristopoulos et al47 adathandizira bwino dera la submammary la wodwala wazaka 59, pogwiritsa ntchito BoNT-A ngati chithandizo chothandizira matenda a Darier kwa nthawi yoyamba.Pankhani ina mu 2008, mwana wamng'ono yemwe ali ndi vuto lalikulu la anogenital anali wopindulitsa kuchepetsa thukuta pa malo ophwanyidwa.48 Matenda ake omwe adakumana nawo adathandizidwa ndi 10 mg acitretin ndi maantibayotiki ndi mankhwala oletsa tizilombo toyambitsa matenda patsiku, koma moyo wake unali wochepa ndipo kusapeza kwake kunapitilira.Patatha milungu itatu jekeseni wa poizoni wa botulinum, zizindikiro zake ndi zotupa zachipatala zinasintha kwambiri.
Eccrine nevus ndi khungu lachilendo hamartoma lomwe limadziwika ndi kuchuluka kwa ma eccrine glands koma palibe chitukuko cha mitsempha ya magazi.Chifukwa cha mawonekedwe omaliza, eccrine nevus ndi yosiyana ndi matenda ena monga angiomatous eccrine hamartoma.49 Tizilombo tating'onoting'ono totuluka thukuta timachulukirachulukira m'mikono, ndi zovuta zapakhungu zochepa, koma pali madera omwe ali ndi hyperhidrosis.50 Opaleshoni yochotsa kapena mankhwala apakhungu ndi mankhwala omwe amadziwika kwambiri, kutengera kukula kwa kuphimba ndi mtundu wa hyperhidrosis.Honeyman et al51 adalemba mwana wazaka 12 yemwe ali ndi thukuta laling'ono lobadwa padzanja lakumanja lomwe silinagwirizane ndi antiperspirants.Chifukwa cha kukula kwa chotupacho ndi malo ake a anatomical, opaleshoni ya opaleshoni sinaphatikizidwe.Hyperhidrosis imapangitsa kuti kuchita nawo zinthu zamagulu ndi aluntha kukhala kovuta.Ofufuzawo adasankha kubaya 5 U ya BoNT-A pakadutsa 0.5-1 masentimita.Olembawo sanatchule nthawi yoyamba yoyankha chithandizo cha BoNT-A, koma adanena kuti patapita chaka, adawona kuti chiwerengero cha thukuta chinachepetsedwa kwambiri kamodzi pamwezi, ndipo moyo wa wodwalayo umakhala wabwino.Lera et al49 ankachitira odwala omwe ali ndi moyo wochepa komanso chiwerengero cha HDSS cha 3 pamphuno ndi thukuta laling'ono la naevi (HDSS) (loopsa).BoNT-A (100 IU) idapangidwanso mu 2.5 mL wosabala saline solution yokhala ndi 0.9% sodium chloride ndikubayidwa m'malo oyesera ayodini.Pambuyo pa maola 48, wodwalayo adawona kuchepa kwa thukuta, ndi zotsatira zabwino mu sabata lachitatu.Zotsatira za HDDS zimatsikira ku 1. Chifukwa cha kubwereza kwa thukuta, chithandizo cha BoNT-A chinabwerezedwa miyezi isanu ndi inayi pambuyo pake.Pochiza exocrine hemangioma hamartoma, jekeseni wa BoNT-A ndiwothandiza.52 Ngakhale kuti matendawa ndi osowa, nkosavuta kuona kufunika kwa anthuwa kukhala ndi njira zopezera chithandizo.
Hidradenitis suppurativa (HS) ndi matenda aakulu apakhungu omwe amadziwika ndi ululu, zipsera, mphuno, fistula, zotupa zotupa, ndipo zimawonekera m'matenda a apocrine am'thupi kumapeto.53 The pathophysiology ya matendawa sichidziwika bwino, ndipo malingaliro ovomerezeka kale okhudza chitukuko cha HS tsopano akutsutsidwa.Kutsekedwa kwa tsitsi la tsitsi ndilofunika kwambiri kwa zizindikiro za HS, ngakhale kuti njira yomwe imayambitsa kutsekeka sikudziwika bwino.Chifukwa cha kutupa kotsatira komanso kuphatikiza kobadwa nako komanso kusinthika kwa chitetezo chamthupi, HS imatha kuwonongeka pakhungu.54 Kafukufuku wopangidwa ndi Feito-Rodriguez et al.55 adanenanso kuti BoNT-A idachiza bwino matenda a prepubertal HS mwa atsikana azaka zisanu ndi chimodzi.Lipoti la mlandu wa Shi et al.56 linawona kuti BoNT-A inachiritsidwa bwino mu gawo la -3 HS la mkazi wazaka 41.Kafukufuku waposachedwapa wa Grimstad et al.57 adayesa ngati jekeseni wa intradermal wa BoNT-B ndi wothandiza kwa HS mwa odwala 20.DLQI ya gulu la BoNT-B idakwera kuchokera pakatikati pa 17 poyambira mpaka 8 pa miyezi 3, pomwe DLQI ya gulu la placebo idatsika kuchoka pa 13.5 mpaka 11.
Notalgia paresthetica (NP) ndi minyewa yosalekeza yomwe imakhudza gawo la interscapular, makamaka T2-T6 dermatome, yokhala ndi kuyabwa chakumtunda ndi zizindikiro zapakhungu zokhudzana ndi kugundana ndi kukanda.BoNT-A ikhoza kuthandizira kuchiza kuyabwa kwanuko poletsa kutuluka kwa chinthu P, mkhalapakati wopweteka ndi kuyabwa.58 Lipoti la mlandu wa Weinfeld59 lidawunikiranso mphamvu ya BoNT-A pamilandu iwiri.Onse awiri adathandizidwa bwino ndi BoNT-A.Kafukufuku wopangidwa ndi Perez-Perez et al.58 adawonetsa mphamvu ya BoNT-A mwa odwala 5 omwe adapezeka ndi NP.Pambuyo jekeseni wa intradermal wa BoNT, zotsatira zingapo zidawonedwa.Palibe kuyabwa kwa munthu komwe kunatsitsimutsidwa.Mayesero opangidwa mwachisawawa (RCT) a Maari et al60 adayesa mphamvu ndi chitetezo cha BoNT-A kwa odwala omwe ali ndi NP ku Canadian Dermatology Research Clinic kuyambira July 2010 mpaka November 2011. Phunziroli linalephera kutsimikizira zotsatira zopindulitsa za BoNT-A.Intradermal jakisoni pa mlingo wa 200 U kuchepetsa kuyabwa odwala NP.
Pompholyx, yomwe imatchedwanso hyperhidrosis eczema, ndi matenda obwerezabwereza a vesicular bullous omwe amakhudza zikhatho ndi mapazi.Ngakhale kuti pathophysiology ya chikhalidwe ichi sichidziwika bwino, tsopano imatengedwa ngati chizindikiro cha atopic dermatitis.61 Ntchito yonyowa, kutuluka thukuta, ndi kutsekeka ndizomwe zimatsogolera.62 Kuvala magolovesi kapena nsapato kungayambitse kupweteka, kuyaka, kuyabwa, ndi kusapeza bwino kwa odwala;matenda a bakiteriya ambiri.Swartling et al61 adapeza kuti odwala omwe ali ndi palm hyperhidrosis amathandizidwa ndi BoNT-A amawongolera chikanga chamanja.Mu 2002, adafalitsa zotsatira za kafukufuku wokhudza odwala khumi omwe ali ndi dermatitis ya m'manja ya vesicular;dzanja limodzi lidalandira jekeseni wa BoNT-A, ndipo dzanja lina lidakhala ngati chiwongolero pakutsata.Chithandizocho chinali ndi zotsatira zabwino kapena zabwino kwambiri mwa odwala 7 mwa 10 aliwonse.Mwa odwala 6, Wollina ndi Karamfilov63 adagwiritsa ntchito topical corticosteroids pamanja onse ndikubaya 100 U ya BoNT-A intracutaneously pamanja omwe akhudzidwa kwambiri.Pochiza dzanja la mankhwala ophatikizika, olembawo adapeza kuti kuyabwa ndi matuza kudachepa mwachangu.Adanenanso kuti mphamvu ya BoNT-A ndi impetigo chifukwa chosatulutsa thukuta komanso kuletsa kwa SP.
Finger vasospasm, yomwe imadziwikanso kuti Raynaud's syndrome, ndi yovuta kuchiza ndipo nthawi zambiri imagonjetsedwa ndi mankhwala oyamba monga bosentan, iloprost, phosphodiesterase inhibitors, nitrates, ndi calcium channel blockers Agent.Opaleshoni yokhudzana ndi kuchira ndi kutseka, monga sympathectomy, ndizovuta.The Raynaud's phenomenon yokhudzana ndi primary ndi sclerosis yathandizidwa bwino ndi jekeseni wa BoNT.Ofufuza a 64,65 adanena kuti odwala 13 adamva kupweteka kwachangu, ndipo zilonda zam'mimba zimachiritsidwa mkati mwa masiku 60 atalandira 50-100 U ya BoNT.Majekeseni anaperekedwa kwa odwala 19 omwe ali ndi zochitika za Raynaud.66 Pambuyo pa masabata asanu ndi limodzi, kutentha kwa chala cha nsonga zothandizidwa ndi BoNT kunakula kwambiri poyerekeza ndi jekeseni wa saline wamba, kusonyeza kuti BoNT ndi yopindulitsa pochiza vasospasm yokhudzana ndi zochitika za Raynaud.67 Pakali pano, pali njira iliyonse yovomerezeka ya jakisoni yomwe imagwiritsidwa ntchito;malinga ndi kafukufuku wina, jekeseni mu zala, m'manja, kapena mafupa a distal metacarpal sanabweretse zotsatira zosiyana kwambiri zachipatala, ngakhale kuti zimakhala zothandiza pochiza vasospasm yokhudzana ndi zochitika za Raynaud.68
50-100 U ya BoNT-A pa armpit, yoyendetsedwa ndi intradermally mu kapangidwe ka gridi, itha kugwiritsidwa ntchito pochiza primary axillary hyperhidrosis.Zotsatira zachipatala zimawonekera mkati mwa sabata ndipo zimatha kwa miyezi 3 mpaka 10.Odwala ambiri amakhutira ndi chithandizo chawo.Odwala ayenera kudziwitsidwa kuti mpaka 5% ya milandu idzakhala ndi thukuta lamakono.69,70 BoNT imathanso kuchiza palm ndi plantar hyperhidrosis (Chithunzi 5A ndi B).
Chithunzi 5 Chithunzi chachipatala chapamwamba (A) chikuwonetsa wophunzira wachinyamata wa ku koleji yemwe ali ndi matenda a palm hyperhidrosis omwe ali ndi nkhawa ndi matendawa ndipo samayankha mankhwala.Odwala omwewo omwe adalandira chithandizo cha poizoni wa botulinum adawonetsa kutha kwa hyperhidrosis (B).(Teknoloji: Pambuyo potsimikiziridwa ndi kuyesa kwa ayodini wowuma; mayunitsi a 100, 2.5 mL intradermal BoNT-A anabayidwa kamodzi pa dzanja. Maphunziro awiri ofanana a masiku a 15 omwe adasiyana adapanga kuyankha kwakukulu kwa miyezi 6).
Chala chilichonse chili ndi ma jakisoni a 2-3, ndipo jakisoni ayenera kukonzedwa mu gridi ndi mtunda wa 1 cm.BoNT-A ikhoza kuperekedwa ku dzanja lililonse la mayunitsi 75-100 ndi phazi lililonse la magawo 100-200.Zotsatira zachipatala zimatha kutenga sabata kuti ziwonekere, ndipo zimatha miyezi itatu kapena isanu ndi umodzi.Asanayambe chithandizo, odwala ayenera kudziwitsidwa za zotsatira za jekeseni wa BoNT m'manja ndi mapazi.Pambuyo pa jekeseni wa kanjedza, wodwalayo anganene kufooka.Kumbali inayi, jakisoni wa plantar angapangitse kuyenda kukhala kovuta, makamaka ngati minyewa ya minyewa ikuchitika musanalandire chithandizo cha BoNT.71,72 Mwatsoka, 20% ya odwala hyperhidrosis plantar samayankha chithandizo atalandira jekeseni wa BoNT.72
M'maphunziro aposachedwa, BoNT yagwiritsidwa ntchito pochiza hyperhidrosis m'njira yatsopano.Nthawi ina, wodwala wamwamuna yemwe ali ndi zilonda zam'mimba adalandira jakisoni wa 100 U wa BoNT-A mu gluteal cleft miyezi 6-8 iliyonse kuti achepetse kutulutsa thukuta komanso kutsagana ndi maceration;umphumphu wa khungu unasungidwa Kwa zaka zopitirira ziwiri, sipanakhalepo kuwonongeka kwachipatala kwa kuvulala kokakamiza.73 Kafukufuku wina adagwiritsa ntchito 2250 U wa BoNT-B kuti abayidwe mu occipital scalp, parietal scalp, pamphumi pamphumi ndi pamphumi, komanso madera a perioral ndi peri-diso mumzere chitsanzo kuchiza postmenopausal craniofacial hyperhidrosis.DLQI ya odwala omwe amalandila BoNT-B idakwera ndi 91% mkati mwa milungu itatu atalandira chithandizo, pomwe moyo wa odwala omwe amalandila placebo unatsika ndi 18%.74 jakisoni wa BoNT ndiwothandiza pochiza malovu ndi matenda a Frey.Otolaryngologists nthawi zambiri amachita chithandizo chifukwa cha malo a anatomical a jekeseni.75,76
Thukuta lachikuda likhoza kukhala vuto losokoneza kwa wodwalayo.Ngakhale kuti matendawa ndi osowa kwambiri;kukhudzidwa kwa nkhope ndi m’khwapa kungawonjezere vuto la wodwalayo.Malipoti ambiri amilandu ndi zofalitsa zikuwonetsa kuti BoNT-A imagwira ntchito atabayidwa m'masiku 7 okha.77-79
Fungo losasangalatsa kuchokera ku armpit hyperhidrosis ndi fungo la thupi likhoza kukhala lochititsa manyazi kapena lonyansa.Izi zitha kukhala ndi zotsatira zoyipa pamalingaliro a wodwalayo komanso chidaliro.Posachedwapa, Wu et al.inanena kuti pambuyo jekeseni wa intradermal wa BoNT-A, kununkha m'khwapa kunali pafupifupi kutheratu.80 Mu phunziro lina loyembekezeredwa lamakono;Achinyamata 62 omwe ali ndi matenda a dermatological a fungo la m'khwapa loyamba adalembedwa.82.25% ya odwala adawona kuti kununkhako kudachepa kwambiri BoNT-A itabayidwa m'dera la axillary.81
Meh amadziwika ndi zilonda zamtundu umodzi kapena zingapo za benign cystic mwa amayi azaka zapakati, makamaka omwe ali pakatikati pa nkhope, ndi matenda aakulu komanso kusinthasintha kwa nyengo.Meh nthawi zambiri imawoneka padzuwa ndipo imalumikizidwa ndi hyperhidrosis.Ofufuza ambiri awona zotsatira zachilendo pazochitikazi pambuyo pobaya BoNT-A.82 mozungulira chilondacho.
Post-herpetic neuralgia (PHN) ndiye vuto la minyewa lofala kwambiri la matenda a herpes zoster, omwe amapezeka kwambiri mwa anthu azaka zopitilira 60.BoNT-A imapanga mwachindunji zotsatira zolepheretsa minyewa yam'deralo ndikuwongolera microglia-astrocytic-neuronal crosstalk.Kafukufuku wambiri adawona kuti atalandira chithandizo cha BoNT-A, odwala omwe ululu wawo umachepetsedwa ndi 30% mpaka 50% amachepetsa kwambiri kugona komanso moyo wabwino.83
Chronic simple lichen imafotokozedwa ngati pruritus yochulukirapo popanda chifukwa chodziwikiratu.Zimenezi zingafooketse kwambiri wodwalayo.Kuwunika kwa dermatological kumawonetsa zotupa za erythema, kuchuluka kwa khungu komanso kutuluka kwa epidermal exfoliation.Kafukufuku waposachedwa kwambiri wochokera ku Egypt akuwonetsa kuti BoNT-A imatha kuchiza ndere simplex, hypertrophic lichen planus, lichen planus, burns, reverse psoriasis, komanso kusakhazikika kwa postherpetic neuralgia Pruritus.84
Keloids ndi zipsera zachilendo zomwe zimachitika pambuyo povulala.Keloids ndi okhudzana ndi majini, ndipo mankhwala ambiri ayesedwa, koma zotsatira zake zimakhala zochepa.Komabe, palibe aliyense wa iwo amene wachiritsidwa kotheratu.Ngakhale intralesional corticosteroids akadali njira yayikulu yothandizira, jekeseni wa intralesional wa BoNT-A wakhala njira yabwino kwambiri masiku ano.BoNT-A imatha kuchepetsa kuchuluka kwa TGF-β1 ndi CTGF, ndipo pamapeto pake kufooketsa kusiyanitsa kwa ma fibroblasts.Kafukufuku wambiri watsimikizira kupambana kwa BoNT-A pochiza keloids.Ndipotu, mndandanda wa odwala awiri a keloid adanenanso kuti 100% anayankha, ndipo odwalawo anali okhutira kwambiri ndi kugwiritsa ntchito jekeseni wa intralesional BoNT-A.85
Congenital wandiweyani onychomycosis ndi osowa majini matenda limodzi ndi plantar hyperkeratosis, msomali hypertrophy ndi hyperhidrosis.Ofufuza ochepa atsimikiza kuti jekeseni wa BoNT-A sangangowonjezera hyperhidrosis, komanso kuchepetsa ululu ndi kusamva bwino.86,87
Keratosis yopangidwa ndi madzi ndi matenda osadziwika bwino.Wodwala akakumana ndi madzi, timiyala tating'ono toyera pamiyendo ndi m'manja ndi kuyabwa kumachitika.Malipoti angapo amilandu m'mabuku akuwonetsa chithandizo chopambana komanso kusintha pambuyo pa chithandizo cha BoNT-A, ngakhale milandu yosamva.88
Kutuluka magazi, edema, erythema ndi ululu pamalo opangira jakisoni zitha kukhala zotsatira zoyipa za BoNT.89 Zotsatira zoyipazi zitha kupewedwa pogwiritsa ntchito singano yopyapyala komanso kusungunula BoNT ndi saline.Majekeseni a BoNT angayambitse mutu;komabe, nthawi zambiri amatha pambuyo pa masabata 2-4.Ma analgesics a systemic angagwiritsidwe ntchito kuthana ndi izi.90,91 Mseru, malaise, zizindikiro ngati chimfine ndi ptosis ndi zina zolembedwa.89 Ptosis ndiye gawo la zotsatira zogwiritsira ntchito BoNT kuchiza nsidze.Zimayambitsidwa ndi kufalikira kwa BoNT komweko.Kufalikira uku kumatha kwa milungu ingapo, koma kumatha kuthetsedwa ndi madontho a maso a alpha-adrenergic agonist.BoNT ikabayidwa m'chikope chakumunsi, imatha kuyambitsa ectropion chifukwa cha kufalikira komweko.Kuphatikiza apo, odwala omwe amalandira jakisoni wa BoNT kuti achiritse mapazi a khwangwala kapena akalulu (periorbital) amatha kukhala ndi strabismus chifukwa cha jakisoni wa BoNT mosadziwa komanso kufalikira kwa BoNT komweko.89,92 Komabe, pamene ziwalo za poizoni zimatha pang'onopang'ono, zotsatira zonsezi zidzatha pang'onopang'ono.93,94
Chiwopsezo cha zovuta kuchokera ku jakisoni wodzikongoletsera wa BoNT ndi wochepa.Ecchymosis ndi purpura ndizo zotsatira zofala kwambiri ndipo zimatha kuchepetsedwa pogwiritsa ntchito makatani ozizira pamalo ojambulira jekeseni wa BoNT asanabadwe komanso pambuyo pake.90,91 BoNT iyenera kubayidwa mu mlingo wochepa, osachepera 1 masentimita kuchokera m'mphepete mwa fupa la orbital pansi, lapamwamba kapena lakumbuyo, ndi mlingo woyenera.Wodwala sayenera kugwiritsa ntchito jekeseni mkati mwa maola 2-3 atalandira chithandizo, ndikukhala kapena kuyimirira mkati mwa maola 3-4 atalandira chithandizo.95
BoNT-A m'mapangidwe atsopano osiyanasiyana akuyesedwa pano kuti athetse mizere ya glabellar ndi mizere yamaso.DaxibotulinumtoxinA wapamutu komanso wobaya adawunikidwa, koma mawonekedwe apamutu awonetsedwa kuti alibe mphamvu.Jakisoni wa DAXI walowa mu mayeso a FDA's phase III, kutsimikizira kuti mphamvu ndi zotsatira zachipatala pochiza mizere ya glabellar zitha kukhala zazitali masabata asanu kuposa onabotulinumtoxinA.96 LetibotulinumtoxinA tsopano ili pamsika ku Asia ndipo yavomerezedwa ndi FDA pochiza makwinya a periorbital.97 Poyerekeza ndi incobotulinumtoxinA, LetibotulinumtoxinA imakhala ndi mapuloteni ambiri a neurotoxic pa voliyumu ya unit, koma kuchuluka kwa neurotoxin yosagwira ntchito ndipamwamba, zomwe zimawonjezera chiopsezo cha chitetezo cha mthupi.98
Kuphatikiza pa kupangidwa kwatsopano kwa BoNT-A, BoNT-E yamadzimadzi ikuwerengedwa chifukwa imati imayamba mwachangu komanso imakhala ndi nthawi yayifupi ya zotsatira zachipatala (masiku 14-30).EB-001 yapezeka kuti ndi yotetezeka komanso yothandiza kuchepetsa maonekedwe a mizere yopindika ndikuwongolera maonekedwe a zipsera pamphumi pambuyo pa Mohs microsurgery.99 Akatswiri a Dermatologists atha kuloledwa kugwiritsa ntchito mabukuwa.Kuphatikiza pazokongoletsa zamakono, makampani opanga mankhwala akufunafuna BoNT-A yokonzekera chithandizo chamankhwala chapakhungu.
BoNT ndi jekeseni wosinthika kwambiri womwe ungagwiritsidwe ntchito pochiza matenda osiyanasiyana a khungu, kuphatikizapo hidradenitis suppurativa, psoriasis, bullous skin disease, zipsera zachilendo, kutayika tsitsi, hyperhidrosis, ndi keloids.Muzodzoladzola zodzikongoletsera, BoNT imakhulupirira kuti ndiyotetezeka komanso yothandiza pochepetsa makwinya kumaso, makamaka gawo limodzi mwa magawo atatu a makwinya amaso.BoNT A imadziwika kuti imagwiritsidwa ntchito pochepetsa makwinya m'munda wa zodzoladzola.Ngakhale BoNT nthawi zambiri imakhala yotetezeka, ndikofunikira nthawi zonse kumvetsetsa malo ojambulira chifukwa poizoni amatha kufalikira ndikuwononga madera omwe sayenera kuthandizidwa.Madokotala akuyenera kudziwa zovuta zomwe zimachitika m'malo enaake pobaya BoNT kumapazi, m'manja, kapena m'khosi.Madokotala a Dermatologists ayenera kudziwa bwino za kugwiritsa ntchito BoNT pa label ndi off-label kuti apatse odwala chithandizo choyenera komanso kuchepetsa kudwala.Mphamvu yachipatala ya BoNT m'malo opanda zilembo komanso zovuta zilizonse zachitetezo chanthawi yayitali ziyenera kuwunikiridwa kudzera m'mayesero azachipatala opangidwa bwino.
Kugawana deta sikugwira ntchito m'nkhaniyi chifukwa palibe ma data omwe adapangidwa kapena kufufuzidwa panthawi ya kafukufukuyu.
Kuwunika kwa odwala kumachitika motsatira mfundo za Declaration of Helsinki.Wolembayo amatsimikizira kuti wapeza mafomu onse ovomerezeka a odwala omwe wodwalayo amavomereza kuti aphatikizepo zithunzi ndi zina zachipatala m'magazini.Odwala amamvetsetsa kuti mayina awo ndi zilembo zoyamba sizidziwika, ndipo amayesa kubisa zomwe ali.
Dr. Piyu Parth Naik adangothandizira polemba zolembazo.Wolembayo wapereka chithandizo chachikulu pamalingaliro ndi mapangidwe, kupeza deta ndi kutanthauzira deta;adatenga nawo gawo polemba zolemba kapena zomwe zidasinthidwa mozama kwambiri;adagwirizana kuti apereke ku magazini yamakono;potsiriza adavomereza kuti Baibulolo lifalitsidwe;ndipo adagwirizana ndi ntchito Yoyang'anira mbali zonse.